Staff from the Overton Brooks VAMC in Shreveport, LA, applaud Air Force Veteran Robert Colleton, 66, as he leaves the hospital. Brooks spent weeks on a ventilator and in an induced coma with COVID-19. He was one of more than 2,600 COVID-19 patients treated by the VA. Photo from the July 30, 2020, VAntage Point Blog

WASHINGTON — On Jan. 11, 2020, China reported the first known death from a novel coronavirus. Ten days later, the U.S. announced its first confirmed case. By mid-January, VA’s infectious disease and public health experts initiated regular updates about the new virus to department leadership. By the end of the month, VA’s Office of Emergency Management (OEM) and Population Health had begun updating the existing pandemic influenza plan to reflect the specifics of COVID-19.

A year later, the world has changed in significant ways. Hundreds of thousands of Americans have died, millions have perished worldwide. Healthcare systems have shifted many of their visits online. Workers have left offices to telecommute; businesses have closed.

Through all of it, the VA has planned, responded, adjusted, stepped up to meet the needs of communities, struggled to locate sufficient personal protective equipment, rethought access to care for veterans. What’s been learned and how will it affect how the VA proceeds through the duration of the pandemic and into the future beyond it?

In November, the VA issued its COVID-19 Response Report, which summarized its response in the first six months of the pandemic. Webinars and Congressional testimony over the final months of 2020 provided additional insight.

Overall, “the effectiveness and agility of the comprehensive VHA response to a historic crisis of unprecedented scope and scale is the fundamental finding of this report,” said the COVID-19 Response Reporting team of the department’s performance through June 30. That finding remained largely true through the end of the year. The agility was facilitated by a central strategy supported by detailed analytics.

Still, opportunities for better coordination between the VA and other federal agencies to enable smoother interagency identification and response to public health crises remained. The VA also acknowledged early on that a lack of a centralized view to supplies at the facility level hampered proper acquisition and distribution of personal protective equipment and other critical supplies. Critical supply chain challenges also emerged quickly in the pandemic and highlighted some shortcomings in the VHA Plan for Modernization.

Caring for Veterans

At the time of publication, VA had conducted more than 1,150,000 COVID-19 tests and diagnosed nearly 160,000 employees and veterans receiving care through the VA with a SARS-CoV-2 infection. More than 6,700 veterans and 95 employees died of COVID-19 during 2020; 2,651 of those were cared for at VA hospitals.

The VA committed to caring for veterans wherever they were during the pandemic. In fiscal year 2020, veterans attended more than 3.8 million telehealth appointments from their homes, up 1200% from 2019. In August, VA conducted more than 35,000 telehealth visits per day.

Concerns about post-traumatic stress disorder, depression, and other suicide risk factors increasing with the social isolation and anxiety of the pandemic made quickly shifting the Veterans Crisis Line from communal call centers to a telework from home model essential. The Office of the Inspector General found that the Office of Information and Technology efficiently equipped and transitioned 800 VCL employees in six weeks and that expanded work space during the transition period along with face masks, sanitizing wipes, and COVID-19 screening minimized risk prior to full telework initiation.

In December, the VA undertook a joint operation with William Beaumont Army Medical Center (WBAMC) in El Paso, TX, to open a 16-bed mobile intensive care unit on the campus of WBAMC and the El Paso VA Health Care System. “El Paso is very fortunate to have this type of deployable resource to assist during this unprecedented time,” said Jamie Park, El Paso VA associate director. “The arrival of the mobile ICU is the result of proactive, strategic planning. We want to ensure we are able to serve veterans in the midst of any situation or circumstance.”

The mobile ICU also enabled care for all of the base’s eligible beneficiaries as cases surged in El Paso.

Fourth Mission

Perhaps most surprising to Americans outside the VA system, much of VA’s response has focused on performing its “Fourth Mission,” supporting communities in crisis. “Decades ago, we were charged to be the backstop of the nation’s private medical system in times of need, and over the years we have primarily performed that role through local responses to hurricanes and other disasters,” said Richard Stone, MD, VHA executive in charge. “This is the first time in our history that we have mobilized at scale, and I hope that one of the lessons to come out of this pandemic will be the positioning of VA firmly at the center of the nation’s response to future disasters.”

At the end of 2020, more than 2,000 VA employees had completed 75 Fourth Mission assignments or were involved in 25 ongoing efforts to support non-veteran patients and non-VA healthcare systems, according to VA Secretary Robert Wilkie.

The VA cared for 452 non-veterans at VAMCs as part of its humanitarian mission during the year. It provided more than 920,000 pieces of PPE and medical supplies to other healthcare systems and offered its 3D printing capabilities around the country to produce face shields and other essential equipment for healthcare providers. With the U.S. Food and Drug Administration and the National Institutes of Health 3D Print Exchange, the VA facilitated creation of open-source medical products to address supply chain issues.

VA clinicians deployed to other healthcare systems through the Disaster Emergency Medical Personnel System (DEMPS). Personnel traveled to 49 states and territories to support state veterans homes, community nursing homes, and non-VA hospitals.

Two hundred VA employees increased the healthcare capacity of the Indian Health Service and the Navajo Nation. Sixteen nurses supported the Whiteriver Indian Hospital in Whiteriver, Ariz., to help the hard-hit Apache Tribe, who were infected at more than 10 times the rate of other Arizonans.

“We learned so much from each other. We shared a few heartbreaks and sadness as well,” said one Whiteriver emergency department nurse to her temporary VA colleagues. “Thank you for coming to our rescue when we needed it the most. You were truly the best parts of the fight against COVID-19.”