Not all COVID hospital patients in the Richmond region were actually infected with COVID during the Omicron wave.Richmond Local News

Since the outbreak of the Omicron wave in December, more than 14,000 Virginia residents have been hospitalized with COVID-19. However, not all of them were actually infected with the virus and were hospitalized for another reason, obscuring the definition of COVID hospitalization.

At Virginia Commonwealth University Health, all patients are tested for COVID-19, regardless of the illness they were taken to the hospital. The other two major hospital systems, BonSecours and HCA, only test patients who are symptomatic or undergoing serious treatment.

It may explain why VCU saw a higher rate of COVID patients during the Omicron wave. In mid-January, one in three adult inpatients with VCU was infected with COVID. In HCA-owned hospitals Chippenham and Johnston Willis, only one in five patients was infected with the virus.

This suggests that the more tests a hospital performs, the more COVID infections will be found. This means that more patients will need additional resources, regardless of the level of infection.

Disparities indicate that hospitalization is a potentially flawed metric and inflates the severity of community illness, said Dr. Wesshepard, a professor of lung and critical care VCU. ..

“For these important indicators, we need to refine the way we track this kind of data a bit,” he said.

The number of COVID patients who actually needed COVID treatment during the Omicron wave at a hospital in the Richmond area is unknown. A spokesperson for the three systems refused to share the number or stated that there was no data.

However, studies in other states show the number of patients who do not need treatment. It can be expensive. In mid-January, the Massachusetts Public Health Service reported that half of COVID patients came to the hospital for another reason and happened to test positive. In early January, 43% of New York inpatients were hospitalized for infections other than coronavirus. It is unknown how many of these patients developed symptoms after admission.

Omicrons are already less reliable in the number of COVID cases because they are more infectious and less severe than previous variants. Experts believe that many people infected with the virus were tested at home for asymptomatic and did not report results, resulting in four to five times as many cases reported.

“All of these are the most important indicators we’ve used,” says Shepherd. “If you’re 50% off hospitalization, it’s important to know.”

Hospitals have different approaches to testing

It is unclear what percentage of COVID patients in the Richmond region needed treatment for COVID, but the percentage of the entire patient population who had COVID may provide hints.

In mid-January, 32% of adult inpatients with VCU were COVID-19 positive. VCU tests all patients as a way to prevent infection from asymptomatic patients.

“We wipe everyone who comes to the door, and as a result, we see people with minimal or no symptoms wipe positives,” Shepherd said.

At HCA-owned Chippenham and Johnston Willis Hospitals, 22% of patients were infected with COVID. At HCA’s Henrico Doctors, 20% were infected with the virus. According to a spokesperson for the health system, HCA examines patients who are symptomatic and undergoing high-risk treatment. Other patients can be tested at the doctor’s discretion.

However, not all data support the conclusion that more tests are always the reason for more cases. Bon Secours has not tested all patients for COVID, a spokeswoman said. However, at one of the hospitals, Memorial Regional, the proportion of COVID patients was about the same as VCU, at 31%. And St. Mary’s was not too late at 27%. One of the reasons for the relatively high proportion of Memorial Regional COVID patients is the number of patients. The hospital treats areas with low vaccination, such as King William and King & Queen County. St. Mary’s receives transfers from other hospitals, as does Chippenham.

Misidentifying hospitalization with COVID has several implications. Vaccinated patients who test positive appear to have a serious breakthrough infection, even if the patient’s case is actually mild or asymptomatic.

If the patient requires a ventilator, the ventilator statistics requiring COVID will also be discarded. For example, one of Shepherd’s patients arrived at the hospital due to drug overdose and was subsequently tested positive. She needed a ventilator and a stay in the intensive care unit. In her records, she is counted as a COVID patient in need of mechanical ventilation and care in the ICU.

But if the hospital doesn’t test all patients, it’s unclear who can spread COVID and who doesn’t.

It’s unforgettable, Shepherd said, there are still many patients with COVID in the hospital. At the peak of Omicron, Virginia had more hospitalizations than any previous wave. And people who are already hospitalized may be more susceptible to COVID if they are infected with COVID.

COVID remains unpredictable

It’s important to remember that COVID does something unpredictable to the human body, said Dr. Melissa Belay, director of the health districts of Richmond and Henrico. Doctors are still learning about the complications. COVID is more than just a respiratory virus, it can affect the heart, vascular system, and human taste and smell.

Diseases that may appear unrelated to COVID can be affected by the virus, she said. Also, the addition of COVID can exacerbate existing medical conditions. It is important to plot that relevance. Therefore, she believes that all COVID patients need to be counted that way. They may not be the majority of patients, but they are sufficient to take into account how hospitalizations are counted.

“I agree that at some point some people have just been infected with COVID and may not have a substantial impact on the outcome, but that has artificially inflated our hospitalizations. I don’t know if I can say that. “

According to Viray, death certificates often include the COVID by doctors, even if there is no direct line between the virus and death. The Council of State and Territory Epidemiologists has set guidelines on how healthcare professionals should make this decision.

“It’s important for us to be able to count them,” Viray said. “There are enough blurry areas between these lines, so it’s important to include them because we’re thinking about the overall impact of COVID-19.”

Still, the number of deaths in the United States over the last two years is unmistakable. This week, the country has surpassed one million mortality. This is an indicator that exceeds the expected number of deaths based on past trends. Steven Woolf, VCU’s demographic health expert, said 80% to 85% of these deaths were directly caused by the virus and the rest were related to the pandemic-induced confusion. In 2020, life expectancy in the United States fell by nearly two years to 76.9.

Dr. Noel Bissell, Director of Health at New River, it is important to note the total number of COVID patients. Because those patients need more resources. At VCU, each patient who tests positive is isolated and his or her treatment team uses personal protective equipment, regardless of the severity of the patient’s illness.

According to Shepherd, a better way to count COVID hospitalizations is to target patients who receive the steroid dexamethasone, which is the first-line treatment given to patients at the onset of COVID infection. In this way, Massachusetts determined which of the COVID patients needed and did not need treatment for the virus.

As the pandemic transitions to endemic, the variants become more contagious, less severe, and complicate the current approach to counting hospitalizations with COVID, Shepherd said.

“The advance of COVID is probably quite flawed,” he added.