City leaders reflect on six months of COVID-19

City leaders reflect on six months of COVID-19
An illustration of the COVID-19 virus. (Image/Centers for Disease Control and Prevention)

By Missy Schrott |

Mid-September marked six months since the coronavirus pandemic began spreading in Alexandria.

Many consider mid-March the beginning of the pandemic in the country and in the region. The first case of COVID-19 was reported in Alexandria on March 11, and City Council declared a local state of emergency on March 14. Since then, residents have lost loved ones, jobs and quality of life.

While the coronavirus remains an imminent threat, a lot has changed in the city over the course of six months: Some businesses forced to close have reopened, testing has largely become more accessible and health leaders have gathered more information about the virus.

As of Wednesday, a cumulative 3,938 Alexandria residents have tested positive for COVID-19, of which 327 have been hospitalized and 71 have died.

City and healthcare leaders appear cautiously optimistic about the state of Alexandria at this six-month mark.

“Compared to a few months ago, Alexandria’s numbers have somewhat stabilized,” Dr. Stephen Haering, director of the Alexandria Health Department, said in an email.

When asked about the city’s current COVID-19 numbers, both City Manager Mark Jinks and Rina Bansal, president of Inova Alexandria Hospital, said the city is coming down from a slight spike in cases in August.

Alexandria’s seven-day positivity rate, the percentage of positive results out of total tests conducted, has been in the single digits since early June. However, it increased slightly over the summer months: from 5.1% on June 21 to 5.4% on July 21 to 6.2% on Aug. 21. It is currently down to 4%, according to the Virginia Department of Health.

“It appears a second peak that we had in August, we’re coming down from that,” Jinks said. “Our positivity rate is not quite as low as we’d like it to be … but we’re getting there.”

Bansal said it is encouraging that hospitalizations in the city have decreased dramatically. As of Oct. 4, Inova Alexandria had treated 711 COVID-19 patients, Bansal said.

In March, when COVID-19 was spreading rapidly and there were still a lot of unknowns, many were concerned about the hospital having the capacity to treat COVID-19 patients. In fact, Inova Alexandria ended up being one of the busiest hospitals in the state, Bansal said.

“Alexandria Hospital was the first hospital in the Northern Virginia region to be impacted by COVID-19, in terms of the number of patients who were coming in and who were admitted to the ICU,” Bansal said. “I believe we ended up being the second busiest hospital in the state of Virginia.”

However, according to Bansal, at no point during the pandemic thus far has the hospital reached capacity, run out of ventilators or run out of critical care rooms. If the hospital were to reach its capacity of 303 beds, it would be able to turn to other hospitals in the Inova system for help, Bansal said.

Another concern for healthcare providers at the beginning of the pandemic was resources, specifically personal protective equipment. Bansal said Inova has acquired enough PPE that it will be prepared if there is a “second wave” of the virus in coming months.

While PPE supply and capacity don’t pose a concern, a new challenge for Inova has emerged in the last six months: staffing.

“I do think that the pandemic has forced people to reconsider their career choices,” Bansal said. “We’ve definitely had some turnover, especially amongst our nursing staff, where they’re choosing not to stay in healthcare or not to say in an acute care setting. So we have seen some turnover of staff, and we are working on recruitment again.”

One way the hospital is combatting staffing challenges is by employing “team nursing,” a model that allows for expanded capability to care for critical care patients, Bansal said.

Inova also allowed providers in the community, such as nurse practitioners, to pick up shifts and help the hospital with staffing.

We did reach out to the other team members in the community to come in and help and were able to do that successfully,” Bansal said. “Some of these people weren’t otherwise employed during that time so it was a good opportunity for them to continue to contribute to healthcare while getting paid.”

AHD has also experienced a change in its staffing since the beginning of the pandemic.

“There has been both influx and efflux of support throughout,” Haering said in an email. “Newly hired staff have been contact tracers and case investigators with funding through [the] CARES act. AHD has also received significant support from the City of Alexandria and Alexandria City Public Schools.”

In addition, hundreds of volunteers have been helping AHD with contact tracing, case investigation, community outreach, administrative support and staffing the COVID-19 hotline, according to Haering.

Another facet of the pandemic that has shifted over the last six months is testing. In the early days of the virus’ spread, limited test kits nationwide meant only those with symptoms of COVID-19 and a doctor’s order could be tested. While Inova was able to test patients meeting that criteria, some primary care physicians in the city couldn’t secure test kits at all.

Gradually, test kit suppliers and the labs that run samples caught up to the demand for more testing.

In April, Inova opened four respiratory illness clinics in the region where patients who met criteria could be tested. In May, Neighborhood Health began offering COVID-19 testing by appointment to those with or without symptoms, largely due to the disproportionate impact of COVID-19 on the Arlandria community.

Since mid-July, AHD, the city and Neighborhood Health have been hosting weekly free testing events to reach the city’s most underserved members, according to Haering. About 80 to 100 people have been tested per event.

Now, those who wish to be tested for COVID-19 antigens or antibodies have numerous options, including the Inova clinics, city-hosted testing events, Neighborhood Health, urgent care facilities, private medical practices and lab facilities. The City of Alexandria continues to advocate that residents first contact their primary care doctor if they wish to be tested.

“Now that [testing] is more widely available, we encourage anyone with symptoms or who has been exposed to someone with COVID-19 to get tested,” Haering said in an email. “We have been working with private healthcare providers to support the expansion of their testing capacity.”

Inova has also expanded its testing to presurgical patients and pregnant women going to the hospital for deliveries.

“[Testing] extended beyond people who are symptomatic, but it is still being done within the criteria, meaning that either you have symptoms, exposure or a procedure that requires presurgical testing,” Bansal said.

Looking to the future, a recurring sentiment among city leaders is that battling COVID-19 will be a marathon, not a sprint.

As such, Jinks said complacency is one of the city’s greatest concerns. The city has noticed an uptick of residents who – encouraged by the decreasing number of hospitalizations and fatalities in the region – are no longer taking social distancing and mask requirements as seriously as they should be, Jinks said.

To combat this, the city implemented a mask ordinance on Oct. 1 with stricter requirements than the state. The ordinance requires that face coverings be worn in all indoor locations, other than a personal residence or vehicle, and all outdoor locations where physical distancing cannot be achieved.

There are several exceptions to the ordinance, and there is no fine for noncompliance. However, the city will have ambassadors enforcing the rules and distributing masks to those who disobey, Jinks said. In addition, AHD is doing spot checks and responding to complaints of noncompliance at indoor businesses.

Overall, the message from city leaders to Alexandrians is to continue following federal, state and local guidance.

“I would suspect we are, at best, halfway through [the pandemic,]” Jinks said. “We’ve probably got another six months. It depends on the national vaccine, it depends on how that rolls out, how long it takes … to become effective, so we’ve got a lot of work left to do.”