Secretary of Veterans Affairs Robert Wilkie and President Trump in March. (Jabin Botsford/The Washington Post)

The Department of Veterans Affairs has sidestepped questions about its response to the coronavirus, veteran service organizations and congressional committees have said, even as the number of deaths at VA hospitals attributed to covid-19 eclipsed 500 on Friday.

Veterans advocates say that in particular, VA has not provided a complete picture concerning the continued use of hydroxychloroquine, an antimalarial drug touted by President Trump that a study showed had no benefit in treating coronavirus patients and was linked to higher rates of death among veterans.

“Veterans need access to as much information as possible. And we need VA to provide that information,” said Chanin Nuntavong, the executive director for government and veteran affairs at the American Legion, a leading veteran service organization.

VA oversees the country’s largest integrated health system with more than 1,200 medical facilities, from sprawling hospitals to strip-mall clinics. Around 9.5 million veterans are enrolled in VA health care — about half of all U.S. veterans.

The agency has acknowledged shortages of personal protective equipment but said that has not impacted patient care. VA spokeswoman Christina Noel also said the agency, following FDA guidelines, permits the use of hydroxychloroquine only “after ensuring veterans and caretakers are aware of potential risks.”

Here are some key issues veterans advocates say VA officials have not addressed.

Use of hydroxychloroquine

Much of recent criticism launched at VA has centered on its use of hydroxychloroquine, a fixture in Trump’s briefings and on Fox News as a treatment until a study by VA and academic researchers said it was linked to a higher rate of deaths of veterans who received it.

The results of the study, which included physicians at VA’s Columbia, S.C., hospital, were not part of a randomized, placebo-controlled clinical trial and have not been peer-reviewed or published in academic journals. But they provided researchers with potential new insights into the drug.

Veterans of Foreign Wars said it is “very disturbed” VA is still administering the drug for covid-19 treatment.

“We request the immediate halt of this drug for our veterans until further information on its true impact is determined,” said William Schmitz, the national commander of the veteran service organization.

VA Secretary Robert Wilkie, in an appearance on MSNBC last week, said the study involved a small number of veterans, “sadly those of whom were in the last stages of life.” VA questioned the drug’s efficacy in combating coronavirus infection, but Noel said the agency routinely dispenses it to treat lupus and rheumatoid arthritis.

Wilkie said there were signs the drug “has been working on middle-aged and younger veterans,” an assertion Noel conceded was based on anecdotal accounts.

Jeremy Butler, the chief executive of Iraq and Afghanistan Veterans of America, described the tests as experiments on veterans, a description Noel has rejected.

“The question is how long they continue the experiment and what results they’re using to drive the decision to continue or not,” Butler said.

Wilkie led a call Wednesday with veterans groups, Butler said, adding that the chief health executive at VA, Richard A. Stone, was also on the call but did not address the issue.

Sen. Jon Tester (D-Mont.), the ranking Democrat on the Senate Veterans’ Affairs Committee, sent the agency 11 questions “regarding the efficacy of hydroxychloroquine for covid-19 treatment” but has not received a response, the committee said Thursday.

Reaching high-risk veterans

VA’s efforts to reach veterans with preexisting medical conditions to tell them about increased risk of infection have been inconsistent, advocates said. That is a particular concern, they said, for a group that is older than the general population and including service members who were exposed to toxins in war and at home.

Black Americans, a group with higher rates of diabetes, heart disease and lung disease, appear to be dying of covid-19 infections at disproportional rates. More than 2 million black Americans are veterans, according to 2016 VA data, more than half of whom are older than 65.

But in their daily information release, VA has not provided race breakdowns of infections or deaths among its patients, and in recent weeks stopped publishing age demographics of deceased veterans.

VA officials also have not warned Vietnam veterans of additional risks they may face after exposure to defoliants such Agent Orange, said Rick Weidman, executive director for policy and government affairs at Vietnam Veterans of America.

“We’re the ones with targets on our backs,” Weidman said, listing common ailments among Vietnam veterans, including diabetes, hypertension, ischemic heart disease and lung problems, that have been linked to Agent Orange exposure. “All of those things make us a high risk group.”

In a similar vein, Butler said VA has not explicitly warned veterans of the wars in Iraq and Afghanistan who may have inhaled toxic fumes from burn pits — in which plastic, body parts, bloody uniforms and other items were soaked in jet fuel and set ablaze — about how the virus may affect them.

VA maintains a voluntary registry of veterans who may have been exposed to burn pits, and sent an email to registry members after a Daily Beast story noted the agency had not told them to take any extra precautions. The message had general information and did not link toxic exposure to elevated covid-19 infection risk.

It is unclear how widespread the emails were. Three veterans in Butler’s office are on the registry, but only one received it, he said.

The agency did not return a request for comment regarding racial demographics of deceased veterans or wartime toxic exposure and coronavirus risk. Its hazard information page has said concerned veterans can consider joining the registry and advises them to wash their hands and socially distance.

Mental health and other issues

VA has made strides in providing mental health care during the pandemic, advocates said, such as the distribution of thousands of Facebook Portal devices to help connect veterans with telehealth services and reduce isolation.

And VA’s focus on telehealth has positioned the agency well as its physicians cope with remote appointments, Butler said. Wilkie reported on last week’s call that VA handled 154,000 remote mental health appointments in March, Butler said, three times the usual amount.

On other issues, VA has been less clear.

Another VA capability, its obligation to back up civilian and military hospitals in times of crisis, dubbed the “fourth mission,” treated 135 non-veteran patients, Bloomberg reported April 16.

VA did not provide updated statistics, and it is unclear to veterans groups, Butler said, if that number met the need requested by health officials at other agencies.

If it didn’t, he said, “it’s a good thing to know, because much of this is planning for the next big thing.”

Weidman was more blunt in his assessment.

“VA was totally unprepared for the fourth mission,” he said.