Editor’s note: The VA asked if U.S. Medicine could help disseminate important information on its response to the COVID-19 pandemic. Here is a discussion from some of the agency’s top leaders.
By Carolyn Clancy, MD, Teresa Boyd, DO, and Scotte Hartronft, MD
We believe two of the most important lessons that our nation has learned about COVID-19 are the need to protect our most vulnerable citizens, especially those who live in nursing homes, and the need to quickly and effectively respond to evolving situations.
As the first news reports surfaced from a nursing home in Kirkland, WA, in late February, it became apparent this new coronavirus could rapidly spread in nursing facilities. The Department of Veterans Affairs (VA) proactively issued guidance to its Veteran Community Living Centers (CLCs) (nursing homes) in early March, advising the adoption of strict infection control practices and daily screening protocols.
As our response to the pandemic continued to evolve, physician-researchers at the VA Greater Los Angeles Healthcare System discovered the benefit of universal testing and daily screening for all staff and residents in their community living center, whether they showed symptoms of COVID-19 or not.
Their vigilance and intuition paid off. They found 14 of 19 residents who tested positive for COVID-19 showed no symptoms of infection. Half of the eight staff members who tested positive were also asymptomatic.
Their findings had major implications for managing disease surveillance in VA CLCs. The researchers concluded that universal and repeated lab-based testing for the virus was an effective strategy that can curb the spread of COVID-19.
VA CLCs are hybrid nursing facilities; they provide a home for older veterans who need assistance with daily tasks as well as skilled nursing care. VA operates more than 100 such facilities across the United States.
The revised testing protocols at the VA Greater Los Angeles CLC were built on earlier VA guidance to limit the introduction and spread of COVID-19. The results: CLCs were closed to unnecessary visitors; Veteran transfers between different facilities were limited and staff were restricted to one nursing unit — all to cut down on disease transmission. We also made sure that staff had appropriate access to personal protective equipment (PPE), per guidance from the national Centers for Disease Control and Prevention. .
To make up for the lack of in-person visits by family and providers, we engaged our robust system of telehealth appointments and video visits. Under President Donald Trump, VA has significantly expanded its use of telehealth applications, and that has served our patients well during the outbreak. As of mid-May, we have provided 22,810 daily telehealth video visits — a 900% increase in scheduled virtual visits during a two-and-a-half-month period. This enabled us to continue to see patients while limiting foot traffic in our facilities, reducing disease transmission as well as PPE usage.
At VA we recognize that our efforts to protect veterans in our care from exposure to COVID-19 are a continuous process, but we’re confident we are equal to the task.
We are fortunate to have the opportunity to work with and talk to the heroes in the battle against COVID-19 every day. They are the staff members who clean our facilities, the social workers who make sure veterans have the support they need, and the physicians and nurses who work tirelessly to care for their patients, at great risk to themselves.
Our veterans are also heroes, fighting once again, but this time against a deadly disease. We know they are made of stern stuff. We are reminded of a quote by Ralph Waldo Emerson, “What lies behind you and what lies in front of you, pales in comparison to what lies inside of you.”
We at VA are committed to honoring our duty to the nation’s veterans, through continued vigilance, dedication and selfless service. We will be fighting for our veterans, every step of the way, because they earned it fighting for us.
Carolyn Clancy, MD is the Assistant Under Secretary for Health for Discovery, Education and Affiliate Networks for the Veterans Health Administration. Teresa Boyd, DO is the Assistant Under Secretary for Health for Clinical Services for the Veterans Health Administration. Scotte Hartronft, MD is the Executive Director, Office of Geriatrics & Extended Care for the Veterans Health Administration.