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As covid cases rise — again — doctors in D.C. area are ‘holding their breath’

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A month ago, covid-19 wards at hospitals across the D.C. region were empty and doctors said they were finally able to take a breath, some hopeful that increased vaccinations meant the worst of the pandemic was behind them. Now, the anxiety for many is creeping back.

Physicians in the area say they are closely watching an uptick in recent weeks of the region’s caseload and positivity rate, and bracing for another potential surge of covid-19 patients. While the number of hospitalized covid patients in the Washington area has so far remained relatively low, hospitalizations in other parts of the country have increased dramatically in recent weeks, with figures in Arkansas, Louisiana and Florida nearing their earlier peaks.

Even as doctors in the D.C. area are concerned that another wave driven in part by the highly transmissible delta variant could be coming, they’re hopeful that the D.C. area’s relatively high vaccination rates could keep hospitalizations and deaths down.

But the overwhelming feeling at hospitals in this moment, they said, is of exhaustion.

“People are burned out, weary, tired,” said Eunmee Shim, president of Adventist HealthCare Fort Washington Medical Center. “They never had the time to recover.”

For several weeks in June, there were no covid patients at Shim’s hospital in Prince George’s County, which has seen higher per capita coronavirus case and death rates since the pandemic began than the District or its other suburbs. As of Monday, there were five covid-19 patients at the hospital, which in spring 2020 saw a surge so large that patients had to be treated in overflow medical tents brought in from the state.

The positivity rate among patients at the hospital is about 5 percent, Shim said — much higher than earlier this summer, but still a fraction of the 20 percent that it was at the height of the pandemic last year.

And the urgent-care clinics run by Adventist HealthCare have been busier in recent weeks, she said, which in the past has been followed by increased patient volume at hospitals. This time, she added, it is fewer seniors and more young people — including children too young to be vaccinated — reporting covid symptoms.

“One of the questions we are trying very hard to answer is, as we head into another wave of the pandemic, how resilient are our staff? And how do we support them?” Shim said. “That is the thing we are struggling with on a daily basis. How do you cheer them on?”

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The D.C. region has higher vaccination rates than most of the country. Nationwide, 49 percent of the population was fully vaccinated as of Tuesday. About 54 percent of the population in D.C. has been fully vaccinated; in Montgomery County and Prince George’s County in Maryland, the rates are 71 percent and 54 percent, respectively; the rate is 58 percent in Fairfax County; 52 percent in Alexandria and 56 percent in Arlington, according to city and state data.

The Centers for Disease Control and Prevention has found that vaccines are highly effective in preventing hospitalizations and deaths, with the covid hospitalization rate among fully vaccinated individuals between 0 percent and 0.06 percent and the death rate between 0 percent and 0.01 percent.

But the anxiety that health-care workers feel is also related to what the rising caseload and possible return of some restrictions could mean outside their lives at the hospital, said Hasan Zia, the president and chief operating officer at Sibley Memorial Hospital in Northwest Washington. Concern about whether schools will ultimately be in-person in the fall is a top concern he hears among staff, he said.

There has been no recent uptick in the number of covid patients at Sibley, which has hovered in recent weeks at less than two despite the city’s recent increase in cases, Zia said. That speaks to the power of vaccines, Zia said, noting that in past surges before vaccinations were widely available, hospitalizations consistently went up between two and four weeks after cases did.

Still, he said, “everybody, from front line to leadership, is holding their breath a little bit.”

Glenn Wortmann, chief of infectious diseases at MedStar Washington Hospital Center, said there have been fewer than 10 people hospitalized daily with covid at Washington Hospital Center — a tiny fraction of what the largest private hospital in D.C. was treating at the height of the pandemic. But Wortmann said staff are preparing for things to get worse.

“There was a realism that it wasn’t going to go away. But there was a hope that it would,” he said. “People are putting the armor back on. . . . We have done this before. There is more realism, like, ‘Here we go again.’ ”

In the Hampton Roads region, where vaccination rates are substantially lower than in the D.C. area, Mary Baker, a pulmonary and critical-care physician at the Norfolk-based Sentara Healthcare system, said she and her colleagues are back to strapping on goggles and tight N95 masks all day long.

Although they had downgraded to sometimes wearing looser face coverings earlier this year, the rising case positivity rate in the region — from about 2.8 percent on July 7 to 9.3 percent on July 29 — has prompted a weary sense of deja vu in the area, where caseloads are higher than in Northern Virginia. In Norfolk, only 34 percent of the population is fully vaccinated, according to state data.

“There’s a little dread,” she said. “Everybody’s bracing for a potential wave in the fall or a potential wave of unvaccinated patients who will die of covid. None of us want to go back to those places.”

If there was one good thing to come out of these hospitalizations, she said, it’s that unvaccinated family members of those hospitalized with covid are now rushing to get shots.

“It’s not always malfeasance. They’re waiting longer; they just want to be sure. They’re seeing so many conflicting news reports that they don’t know what to believe,” she said. But “when they have a first-degree relative affected, they go, ‘Oh my god. It’s real now. It’s in my home.’ ”

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At UVA University Hospital in Charlottesville, there is a palpable sense of fatigue among health workers looking after unvaccinated patients, said intensive care unit director Taison Bell.

“They’re just as sick as they were in the beginning,” he said. The difference, this time around, is that “these are preventable admissions.”

Some, finally coming face-to-face with the severity of the disease, have asked Bell or his colleagues for the vaccine. And they have to tell them it’s too late.

Across Maryland’s hospitals, there are 309 people hospitalized with covid this week, said Bob Atlas, president of the Maryland Hospital Association — an increase from figures in June and early July, which were often below 100. (By comparison, there were 447 covid patients across Maryland’s hospitals in April 2020.)

“There has been an uptick in cases,” Atlas said. “The fact that it is an upward trend has people on alert. But it is a manageable set of patients in hospitals right now.”

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At Suburban Hospital in Bethesda, epidemiologist Sonia Qasba, who co-led the hospital’s medical covid response, said that because of its high vaccination rates, the area is “in better shape than most” when it comes to dealing with the delta variant.

Qasba said unvaccinated patients she talks to at the hospital still do not understand the science, or they think: “I’m young, it won’t happen to me.”

“It is unfortunate for them,” she said. “People still don’t recognize how severe this disease can be . . . you can be a young, healthy individual and still be significantly impacted.”

She said she thinks about people who have decided not to get the shots much the same way she does patients who have hypertension or diabetes but do not take the medication they need.

“I can only try to encourage them and give them sound medical advice,” she said. “But it is ultimately up to them to make the best decisions for themselves.”

Covid wards in the D.C. area are almost empty. Doctors credit the coronavirus vaccine.

The pandemic rocked this small hospital in a mostly Black suburb. Now it’s trying to grow.

Breakthrough cases are extremely rare. Here’s what it’s like to be one of them.

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