Loudoun doctors concerned patients are delaying treatment during COVID-19 crisis

Dr. Ather Anis, a cardiologist at Inova Loudoun Hospital, wearing protective gear while at work. 

As Inova Loudoun continues to see hospitalization numbers rise with COVID-19 patients, doctors at the Lansdowne-based hospital say they are ready and prepared to deal with a possible surge.

On April 27, there were 27 patients hospitalized with COVID-19 at Inova Loudoun, a number that had doubled from 13 patients on April 13. System-wide, Inova had 332 patients currently hospitalized.

In preparation, Inova increased its bed capacity and opened a new $300 million North Tower on April 13, two weeks ahead of schedule.

At the request of Inova Loudoun's chief medical officer, Dr. Ather Anis, a cardiologist who is affiliated with the hospital, said he has recently changed his schedule so he is available to work nights at the hospital.

“We are seeing a number of patients who are critically ill. They are very sick. There is definitely a rise in hospitalizations here,” Anis said.

Anis said providers have been treating people of all ages, gender and ethnicity with COVID-19 in Loudoun County.

“This is a time for us to act and help. The under-served community is getting hit hard – it is true all over the U.S. and here too. It is important to educate everyone to use protective gear and wash hands,” he said.

Loudoun County's confirmed COVID-19 cases were reported to be 727 on Wednesday, a 252-case jump from one week earlier. 14 people had died as a result of the virus as of April 29.

Anis said he is grateful to the community for coming together, staying inside and supporting health care workers.

“Not going out counts. Every bit adds up to take care of our family, friends and neighbors and get through this, that time is now. It's real. I remember vividly in March when I saw the first ICU patient who was really sick. It's not the time to relax, everyone needs to wear masks,” he said.

Dr. Edward Puccio, Emergency Department chair and medical director, says increased testing is the best way for moving forward and for identifying the root cause of other issues.

“If we know a patient is COVID positive we may intervene differently. We now have access to a rapid Abbott test which can provide a positive result in five minutes, ” he said.

Inova continues to test patients based on symptoms and risk of contracting COVID-19.

Health care officials encourage people to continue social distancing and to be protected with wearing a mask.

“As the numbers continue to increase what we are doing may be our new normal. We just don't know when will we see the curve start to flatten,” Puccio said.

Inova Loudoun Patient

Inova Loudoun Hospital providers are reminding people to seek medical treatment if they're experiencing a severe health problem, even if it's not related to COVID-19.

While the system is prepared it has also been hit hard financially. Inova Health System President and CEO Dr. J Stephen Jones on April 21 announced more than 400 layoffs of staff positions.

"Unfortunately, we have seen immense decline in clinical activity resulting in hundreds of millions of dollars in loss of revenue," Stephens said in a video statement. " … These significant changes and unbelievable challenges will be remembered forever. This is the defining challenge of our lifetime, and we will get through this time and we will see brighter days in the future.”

Inova Loudoun Chief Medical Officer Dr. Christopher Chiantella told the Times-Mirror that while the coronavirus numbers continue to increase, he is more concerned that people are not seeking the necessary care for other illnesses out of fear of contracting the virus. This can cause long-term complications, he said.

Puccio agreed, saying the primary message to the public is that it is safe to come to the ER at any of Inova's Loudoun locations at Cornwall in Leesburg, Lansdowne or Ashburn.

“There is a risk of delaying a visit which is far greater than the fear of contracting COVID-19. We are seeing more perforated appendixes and lacerations that should have been sutured sooner. If a person needs to go to the emergency room, they should feel safe and not delay,” Puccio said.

He said hospital staff is using gloves and masks, noting “it's second nature here.”

“This is part of what we have always done. I want to reassure patients we have been safe from the beginning, and no staff or physicians have contracted COVID-19 or have tested positive. We have been very diligent,” Puccio said.

The doctors say they have observed a rise in other symptoms indicating COVID-19 beyond respiratory issues or fever. They are seeing symptoms similar to a heart attack or stroke, and the virus can also affect blood clotting.

“The symptoms are masquerading as a lot of other things people would not typically think are related to an infectious disease,” Puccio said.

Overall, as the pandemic enters its third month locally, doctors are hoping to raise awareness about community health impacted by other non-COVID-19 illnesses being left untreated.

“The big concern relates to the health of the community in general – we are trying to do better in terms of helping people maintain their health. The concern is that people are staying home when they should be reaching out for medical help. Social isolation is causing an increase in alcohol-related injuries as well,” Chiantella said.

Chiantella said they have had to increase the number of trained medical staff on call to help deal with the rise in hospitalized patients.

He also urged people to start thinking about advanced care planning if they need to unexpectedly be placed on a ventilator.

“It is so important and can be catastrophic,” Chiantella said. “We need to know how much support does someone want. We need to think about those things.”

(30) comments

Acorn

Negativity never works. Helping people during this unpredictable health crisis is better than voicing your assumed conspiracy theory.

More Cowbell

Gee, why would people be unhealthy, is it because we're told to stay at home, all gyms closed, eat more unhealthy, sit around more. Most doctor offices are closed or doing virtual appointments. X-ray/MRIs not being done unless it's life threatening(who decides). And welcome to real world where over 20 million have lost their job and many small business closed for good. I'm sure Loudoun Hospital will easily make back whatever they claimed to lose over these few months.

Progress4LoCo

Such a mystery! It’s almost as if this is about funneling more $$$ through the medical industry.... While we’re at it, let’s keep all public facilities closed because we certainly wouldn’t want to provide access to children of all income levels to athletics, exercise, and play.

amerigirl

The health system is losing money, especially hospitals. Elective surgeries have been canceled and that is where the real money comes from. Have you thought about the healthcare workers that are out there risking their lives to save the people with this virus? According to the nursing union National Nurses United, at least 29 registered nurses have died nationwide, including 3 of their members, and 222 of their members have so far tested positive for COVID-19. That doesn't count the doctors, EMT's, and other hospital workers. Sure go out there and make them risk even more.

amerigirl

And going out in a pandemic will not make you healthier. The slow opening will be starting very soon, keep your pants, and mask, on.

More Cowbell

Health system isn't losing money, congress put in for more money to go to hospitals on top of all extra charges. My last hospital bill was close to $200K, $50K was for medication, $75K for operating room & 75K for room and board.

Have you ever thought about military that does this 24X7, year after year. You take many other essential workers for granted. I've been working 80 hour weeks to keep US citizens safe. There are many people out there working just as hard or harder.

amerigirl

The money that Congress put it probably won’t even be enough to save some hospitals from bankruptcy. What extra charges? Don’t think that all the people that they needed to care for can pay the costs, much of it will be written off. You can’t get blood from a rock. Hospitals that didn’t see hot spots but had to empty their beds incase they were inundated have had a massive decline in revenue. Hospitals big and small, urban and rural, “have experienced an economic decline due to the pandemic … due in large part to the cancelation of non-emergent care and the deferral of other non-urgent treatments and visits,” according to Erika Rogan, a senior associate director for policy at the American Hospital Association. From ABC News A lower volume of patients during the normal course of business makes rural facilities particularly vulnerable in times of crisis. With thinner margins, the pandemic is exacerbating the financial stress that's hobbling even the country's largest hospital systems, experts said. The financial pinch has left other hospital administrators to think creatively and embrace emerging technologies. Dr. Kevin Lewis, the regional president of SSM Health in Oklahoma, said the pandemic adjustments are tantamount to “completely redesigning our business.” There is a gy named Hughes oversees program at the university that tracks rural hospital closures. In 2018, for example, 14 rural hospitals shuttered operations, according to his count – almost exclusively in the Midwest and the South. In 2019, that number was 18.

With 10 closures already in 2020, Hughes said rural hospital closures are on pace for a “big bump up, even if things slow considerably.”

The proposed budget for 2020 totals $718 billion, how do you possibly compare that to hospitals? That bill you got has a negotiated price from insurance companies and they don’t ever pay as much as you are charged. I don’t take essential workers for granted; my husband, both brothers, sister, daughter-in-law, and quite a few other relatives are essential workers. They are doctors, nurses, hospital employees, heating and air, automotive industry, hardware store personal and a few other “essentials”. They go home to care for the elderly, spouses with cancer, heart conditions, hypertension and diabetes. I see all the stress they go through. I am appreciative of all they do.

amerigirl

Who is doing that? Most people with kids wouldn't have time. Not everyone goes to the gym. With money being tight who spend it on snacks? I don't think most doctors offices are closed, dentist probably unless you have an emergency. People still need to have blood drawn or other things you can't do with a virtual appointment. How sure are you that Loudoun Hospital will recoup that money? They just finished a huge improvement project that is probably costing them a fortune. Hospitals have taken a significant loss of revenue as they cut back lucrative elective procedures to free up resources to treat COVID-19 patients. At the same time, they are pouring money into efforts to fight the virus like buying personal protective equipment (PPE) supplies, providing child care for staff and overtime pay, transforming units to COVID-19 wings for treatment and setting up drive-thru testing sites, (ABC News). The hospital needs to treat anyone with an emergency regardless of their ability to pay since they are bound by bound by the Emergency Medical Treatment and Labor Act . The real world, as you state, has many people who have lost their insurance and if they get sick will still need a hospital. How do you think they will get that money back?

springerdad

Dr. Ather Anis is my cardiologist and he is a very good doctor!

Virginia SGP

So let me get this straight. The medical "experts", who don't seem to understand we must develop herd immunity until a vaccine can help in that process, are now upset their bottom line will be affected. They say don't venture out to ANY business but theirs. Grocery stores are not really safe bit the emergency room is?!!! Who are they asking? Funny how a lock down is good for everyone not affected financially but when it hits the bottom line, even medical workers admit it is a scam.

Oh and BTW, did he forget to tell you that infections obtained INSIDE hospitals are one of the leading causes of death for hospitalized patients? Do you trust these doctors?

Drank Sinatra

Please have a look at Sweden to see how the herd immunity idea has worked out.

pual mase

ILockdowns were instituted to flatten the curve so hospitals weren’t overrun and maybe buy time so treatments and vaccines could be developed, which may never happen. By flattening the curve you may be reducing infections in the short term but may extending the time infections find its way way through the population.

They WHO calls Sweden a model for the world for what that’s worth. At least Sweden didn’t destroy its economy.

Jeanne T

Correct!

Jeanne T

And the WHO is now praising Sweden's approach. Sweden has pretty much rejected the "lockdown model". Dr. Mike Ryan, Executive Director of the WHO Health Emergencies Program, said, among other things, "What it has done differently is it has very much relied on its relationship with its citizenry and the ability and willingness of its citizens to implement self-distancing and self-regulate,” said the WHO official. “In that sense, they have implemented public policy through that partnership with the population.” I think if we are to reach a new normal, Sweden represents a model if we wish to get back to a society in which we don’t have lockdowns,” added Ryan."

"ability and willingness of its citizens to implement self-distancing and self-regulate"

Imagine that.

LetSanityPrevail

Pual, your comment is a good one. None of the Drs. on the task force ever said that through isolation the virus would disappear, but that the goal was to slow the explosion of cases so as not to overwhelm the medical infrastructure, or in other words see consistent levels of new cases, hospitalizations (and yes fatalities since there are no therapeutics). Too many on this board also seem to think we are living in a Netflix Hollywood movie where vaccines will be created in one week and magical cures appear in 1 day. Even the drug Dr. Fauci was extolling reduces the amount of time of infection (15-11 days) but does not drastically reduce fatality so lots more work will have to go on. Even a vaccine is iffy in that new strains might not be impacted and it is not yet clear if the vaccine is a live or attenuated vaccine. If live then those who have compromised immune systems will be out of luck. The entire strategy as you said was to stop the exponential growth until treatments and vaccines are available and that still could be months if not years off. So you are spot on...the lockdown was only designed for a short period of time.

amerigirl

Jeanne, how is that praise? There doesn’t seem to be enough trust in the people here self-distancing. Look at the rallies they have had, no masks, shoulder to shoulder. Sweden has been hit hard by the virus and faced a deadlier outbreak than its Nordic neighbors. More than 20,000 cases of COVID-19 have been confirmed in Sweden, and the death toll has climbed to 2,462, according to data compiled by Johns Hopkins University. Norway and Finland, countries about half as populous as Sweden, both have death tallies under 250. It has higher death rates in relation to its population size than anywhere else in Scandinavia. Sweden, with a population of 10 million, remains amongst the top 20 in the world when it comes to the total number of cases, even though it mostly only tests those with severe symptoms. More widespread checks on key workers are just now being introduced. Pretty risky considering that they don’t even know if those that have had it will develop immunity.

LetsBreal

Take a look at the USA body mass index as compared to countries in the rest of the world. That's really the answer for this disease (besides advanced age). If you have a high BMI, it's coming after you. Put down the soda, chips and ice cream.

Jeanne T

And it's the ER doctors around the country, who actually see patients and are operating under reality (Dr. Fauci hasn't seen a patient in 20 years), not the academics operating in theories, who are telling us to open up. Theory and reality are not the same. When we hear about "more cases of COVID-19", we must keep in mind that 96 percent of those who contract the virus recover. Of the four percent who die, 90 percent of those had "comorbidities", i.e., underlying conditions.

Doctors are also reporting they are being pressured to list COVID as the cause of death, even when it isn't. Dying OF COVID is different from dying WITH it. Indeed, my husband has a friend in Oklahoma whose father just died recently of a heart attack. COVID-19 was listed as the cause of death on the death certificate, even though it was not the cause of death. When my husband's friend demanded that the death certificate be changed to reflect the real cause of death the medical examiner said they weren't allowed to change it.

amerigirl

The fact that someone is not a surgeon, especially in Fauci’s field. What surgeries would he be performing? If the death rate is that high, it is unacceptable. Those people who don’t seem to count to so many others could have continued to live, for many of them, health lives with mediation. They are not disposable, people aren’t disposable. It is just the opposite; doctors are saying that there may be up to 10 times as many deaths from covid than are listed. They think that many of the deaths of people who weren’t tested as far back as March were from the virus. Right here in Virginia, a funeral director prepared the remains of three people after health workers cautioned her that they each had tested positive for the coronavirus. But only one of the three had the virus noted on the death certificate. In rural areas, coroners say they don’t have the tests they need to detect the disease. Doctors now believe that some deaths in February and early March, before the coronavirus reached epidemic levels in the United States, were likely misidentified as influenza or only described as pneumonia.

“We definitely think there are deaths that we have not accounted for,” said Jennifer Nuzzo, a senior scholar at the Johns Hopkins University Center for Health Security. Covid forms blood clots, do you think that your husband's friend heart attack could have been caused by that?

Chris McHale

CATFUGHT!!!!

Jeanne T

And no, the friend's father didn't have COVID. But I repeat myself.

amerigirl

Jeanne who in this post said your friend's father did have COVID?

amerigirl

AGP, since they believe there is a vaccine and have already started human testing why would you want to have a higher death rate to have herd immunity? Who said ‘don't venture out” to ANY business? Who said emergency rooms are safe? But if you need one than you need one. Tell me what medical workers say it’s a scam? Hospitals are losing money at a record rate, they are not getting hazard pay, and they are risking their lives and the lives of those they are going home to. I have a lot of family that are in the medical field from nurses to VP of a major DC hospital and that is the complete opposite of what they say. Oh and BTW Sepsis is the leading cause of death in hospitals. The types of healthcare associated infections are from central lines or bloodstream infection surgical site infection, pneumonia, and gastrointestinal infection. The most common pathogens recovered are Enterobacteriaceae, S. aureus, P. so if you need attention from something like a stroke or heart attack take the risk, at least you’ll have a greater survival rate.

I would trust a doctor who has dedicated his life to helping people over your medical advise any day.

Virginia SGP

Are you serious? Can you not read the news?

Daniel G. Murphy heads the ER at St. Barnabas Hospital in The Bronx wrote an op-ed urging an end to the lockdown.

Australian National University infectious diseases physician Peter Collignon also believes the restrictions in NSW and Victoria have gone too far.

University of Melbourne epidemiologist Tony Blakely believes the quickest way for Australians to get back to their old way of living was to adopt option three: flatten the curve by herd immunity.

Scott W. Atlas, MD, the former chief of neuroradiology at Stanford University Medical Center: open most workplaces and small businesses with some prudent large-group precaution.

amerigirl

SGP, that is Murphy’s and Collignon opinions, and no I don’t read the right-wing news. I agree with Dr. Frank Esper from the Cleveland Clinic, and the New England Journal of Medicine, and real health professionals. Not the very few picked up by Fox for their opinions. Maybe you should listen to Fauci, "I think the American public have done a really terrific job of just buckling down and doing those physical separation and adhering to those guidelines," Maybe if you gave examples that were covered by the main stream media, not right wing slanted media, I would listen to you. But I have to believe that a slow and cautious opening is safe for everyone.

DavisB

There is nothing surprising in this comment, SGP - no one in Loudoun should expect that you are incapable of accepting that some people work for the betterment of others and are not focused on their own finances. But this comment and your others reflect on you, not on those in our community like those in this article who care about our neighbors

Virginia SGP

You leech off other people as we'd not worry about others who pick uupup the tab despite being out of work. I:we furloughed ALL the teachers aanaand bureaucrats you would ssissing a d8fferent tune.

DavisB

not sure what you mean, SGP, but I am not a teacher, rather I am a parent who grew sick and tired of bullies here in Loudoun and chose to speak up against them. Your take on this article is all wrong, again.

amerigirl

SGP, you think everyone is leeching off others. You must have a warped sense of humanity to even think that. I have never seen an empathy in your posts. There are people like my husband and I that received money from the govt and donated most of it to charities that have the reach to get it to those in need. We know that people are suffering and at least we have some income right now. Do you think that those people who have been able to pay their way but can't because of the pandemic are leeches?

amerigirl

I guess you know better than the medical experts. It's not just a vaccine, which 8 companies in the US alone have started human trials on. How would herd immunity work if you don't build up an immunity from the virus? There are people that have gotten it twice, where was their immunity? Things can open slowly with restrictions in place to protect people, it is not a all or nothing situation. Most patients that get infections in hospitals from hospitals, about 4%, are surgical site infections, some of which cause death. If you need the surgery then you take that risk.

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