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U.Va. Health leaders reflect on one year of COVID-19

Leaders and doctors cite overall success while acknowledging a few roadblocks, such as testing limitations during summer 2020

<p>At first, communities — both locally and elsewhere in Virginia — were overwhelmed with COVID-19 patients and had trouble keeping up with testing needs.</p>

At first, communities — both locally and elsewhere in Virginia — were overwhelmed with COVID-19 patients and had trouble keeping up with testing needs.

Nearly 13 months ago, COVID-19 first hit the University as students were asked not to return from spring break March 11, 2020 and the first University community tested positive March 16. Since then, U.Va. Health has taken several actions in a continuous and evolving response to the pandemic. Now, U.Va. Health administrators and physicians involved in ramping up COVID-19 testing and response reflect on the pandemic and the lessons learned from one year of tumultuous operations.

Dr. Craig Kent, executive vice president for Health Affairs at U.Va. and chief executive officer at U.Va. Health, was a new arrival to the University on Feb. 1, 2020, just weeks before the health administration began to realize the threat that COVID-19 posed. 

“It's an odd time to show up to lead a health system, you know, three weeks before an international pandemic begins,” Kent said.

According to Kent, U.Va. Health was aware of the virus in December, but it was not until February and March when officials began to realize the scope of the threat COVID-19 posed. 

After that, U.Va. Health moved quickly to keep up with the pandemic’s trajectory by bringing together 15 to 17 representatives from the School of Medicine, School of Nursing and Medical Center to coordinate a response.

“In some ways, it was a crisis management team,” Kent said. “Some of us would learn what was happening around the country, some of us were experts in virus, some of us were experts in operation.”

At first, communities — both locally and elsewhere in Virginia — were overwhelmed with COVID-19 patients and had trouble keeping up with testing needs, according to Dr. Amy Mathers, associate professor of medicine and pathology.

“I went into a nursing home and 95 percent of the occupants ... tested positive, and that’s terrifying,” Mathers said. “I was not licensed to practice in that facility ... [but] there were people that needed attention.” 

Nursing home residents were hit the hardest by COVID-19 due to the age of residents, close proximity within living spaces and heightened rates of mortality among the elderly — Virginia was no exception. Within weeks of the first confirmed case in Virginia, dozens of residents died after COVID-19 spread through a nursing home facility in Richmond — the highest known death toll at a U.S. long-term care facility at the time, The New York Times reported.

The University began providing a CDC-approved COVID-19 test when the pandemic first broke out. Dr. Melinda Poulter, director of clinical microbiology at the School of Medicine, explained that U.Va. Health worked to bring in the CDC test first since the physicians saw data supporting its good performance. However, the University had to purchase the specific reagents — chemical mixtures used to determine if a testing sample matches COVID-19’s genome sequence — separately, which caused some issues.

“The hard part was actually getting the test components,” Poulter said in an email to The Cavalier Daily. “They aren’t sold as a ‘kit.’ You have to get everything separately from multiple different companies then build the ‘kit’ yourself.”

Additionally, even when the University Health System did receive tests from public health departments, there were often only enough tests for the sickest or highest risk patients, which is what inspired Mathers and Poulter to create the University’s own test.

Despite high demand for reagents and swabs across the country, University sales representatives were able to secure the needed supplies for the tests, Poulter said, and soon after, the University created its first functioning COVID-19 test. 

“I think this was a big step toward managing COVID in our state and did much to help out our fellow hospital systems until they could get instruments, reagents and supplies to start their own testing programs,” Poulter said.

These new tests only took 24 hours to turnaround test results. By mid-March, U.Va. Health was testing at a volume of 100 tests per day and was offering 50 tests per day to six hospitals in Virginia and North Carolina for their doctors to use on patients that met clinical testing guidelines. This partnership continued to expand, according to Kent.

“At one point, we were sharing our tests with almost 30-some hospitals around the state, and  that was really exciting,” Kent said.

U.Va. Health also worked to test the surrounding Charlottesville community and continues to do so, Mathers said.

“The community testing events that U.Va. hosts in collaboration with the health department are just critical,” Mathers said. “People here [are] figuring out how to meet the community where they are [by having the] Mount Zion Baptist Church [host] the testing event, and we're just a guest that brings the test.” 

Kent added that health system volunteers helped test indigent parts of the community five to six days per week throughout the fall. Each community site would administer between 75 and 115 tests during each two-hour outing.

Poulter said that U.Va. Health also created and validated several different tests that helped keep up with demand, including a high-throughput one that could test 94 samples at once. However, Kent acknowledged that over the summer, there were testing shortages. 

“There was a period of time — April, May, June — where there weren't enough tests for everybody we wanted to test,” Kent said. “We had to set priorities.”

During this time, community testing remained a priority, as did testing of healthcare providers. However, asymptomatic individuals could not be tested in large numbers. Kent said that the addition of saliva testing helped overcome the shortage.

“When saliva testing became available in large numbers, I think that was, in some ways, almost transformational because we could test large numbers of people on a daily basis,” Kent said. “Since that's been available, I think we've had no trouble with testing.”

When saliva tests were first announced Sept. 5, the seven-day testing average at the University was only 174 people. Now — eight months since the test’s creation — the University’s seven-day testing verage is 1,891 people.

Another beneficial move by U.Va. Health at the start of the pandemic was opening a new 84-bed tower in April, five months earlier than planned. According to Kent, these new beds were perfect for the influx of COVID-19 patients as they were all negative pressure rooms — which are constructed to prevent particles from escaping when the door is opened — and separated from non-COVID-19 patients.

“We've moved all of our COVID patients into this new 84-bed tower … a different place than where a non-COVID patient is so there isn't any cross contamination,” Kent said. 

Kent also said that recent data shows U.Va. Health ranks in the top decile of other American academic medical centers in terms of COVID-19 patient mortality, praising the frontline physicians who take care of the patients. According to Dr. Mitchell Rosner, chair of the Department of Medicine, U.Va. Health has cared for over 1,300 patients and its overall mortality index — the observed mortality divided by the expected mortality — is less than one.

Since March, hospital workers have felt the pressure associated with caring for patients amid a surging pandemic. In April 2020, some employees were furloughed due to an $85 million deficit resulting from the decline of clinical care and related services. In November, hospital workers announced their unionization, citing “top-down approaches to management, inadequate staffing and subpar wages.” Anthropology graduate student Ida Hoequist said that many of these issues pre-dated COVID-19 but were exacerbated by the pandemic. 

Less than two months later, U.Va. Health mandated that healthcare workers in inpatient units take an additional 12-hour shift every three weeks in response to a surge in cases from holiday gatherings.

Looking forward, Mathers and Kent both emphasize the importance of continuing to vaccinate the community and urge everyone to get the vaccine when they are able to. With continued vaccinations, they said COVID-19 cases will decrease, nearing light at the end of the tunnel. 

“I'm pretty hopeful that with the widespread … and successful rollout of vaccinations to the larger population, in the coming months, is just going to be critical,” Mathers said.

So far, U.Va. Health has opened a vaccination center in Seminole Square in collaboration with the Virginia Department of Health, and it is now capable of vaccinating 2,500 to 3,000 people a day, according to Kent.  All Virginians aged 16 and older are currently eligible for the vaccine.

However, a roadblock in the face of continued vaccination efforts has been groups within the community who are hesitant to receive the vaccine. 

“There's different sects of people who have different reasons they don't want to be vaccinated,” Kent said. “The idea is to try to approach each of those different groups with different arguments as to why they should be vaccinated.” 

Kent stressed the need to dispel misinformation and educate hesitant communities on the safety and efficacy of the vaccine. U.Va. Health has already begun making efforts to reach out to multiple groups in the surrounding Charlottesville area.

“A number of people from U.Va. Health have reached out to the Latinx community, some to the Black community, some to our rural community,” Kent said. 

He added that U.Va. Health is soon partnering with VDH to formally launch a public relations campaign to encourage getting vaccinated.

Overall, Kent, Mathers and Poulter expressed their pride in U.Va. Health’s continued and past efforts regarding the pandemic.

“I think we've done a superb job of keeping our community safe and in patients that were unfortunate and contracted COVID,” Kent said. “We've kept them as safe as possible and I'm really proud of that.” 

Poulter also applauded the many volunteers who have come together to help U.Va. Health in its response to the pandemic. For example, a 600-member vaccination volunteer team was critical in administering vaccinations during the spike in cases over the holiday season. 

“What we have accomplished between the University and the Health System has taken a village of incredibly committed people who are willing to give endlessly of their time and talents, and they have done it all as volunteers,” Poulter said. “These people inspire me to work harder and give more.”