City responds to surge in COVID-19, testing shortages

City responds to surge in COVID-19, testing shortages
People lined up down the sidewalk and around the corner in front of Charles Houston Recreation Center to receive COVID-19 tests on Dec. 16. (Photo/Denise Dunbar)

By Cody Mello-Klein |

COVID-19 case numbers continue to rise and tests remain difficult to come by, as Alexandria, much like the rest of the country, grapples with the spread of the Omicron variant. Amid the most recent surge, the Alexandria Health Department provided some guidance to residents during Tuesday night’s City Council legislative meeting.

Dr. David Rose, director of AHD, emphasized that case numbers in Alexandria, Virginia and the U.S. right now are higher than ever before.

“Previously in the pandemic we only had a handful of days over 120 cases per day. Now we’re seeing anywhere from roughly 400 to 600 cases daily,” Rose said. “… Although most infections are resulting in mild illness, the sheer number of cases makes us concerned about staffing shortages for essential services and pressure on our area hospital surface capacity.”

The city’s current positivity rate is about 30%. In summer 2021, it sat at about 3%.

The sheer number of cases has overwhelmed AHD, meaning that staff are no longer able to investigate or conduct contact tracing on every case themselves. Instead, AHD is exploring ways to use text messaging to reach those affected by COVID-19 and pivot to an approach that empowers residents to self-report their test results to the health department.

“Previously we were calling every person who had a positive test, and sometimes we would try to call them three or four times to get ahold of them, but with the number of cases [now] that’s just not physically possible,” Natalie Talis, population health manager for AHD, told the Times. “We don’t have enough staff, we don’t have enough resources to do that. Now, we really are at this point where we have to triage and talk to people who are at higher risk of severe illness.”

With projected models for the current surge predicting that cases will start to decrease by the end of the month, Rose said there are still three primary ways to mitigate transmission. Residents should continue to practice transmission prevention – i.e. wearing a well-fitting mask, distancing and avoiding large in-person gatherings – and AHD must continue its focus on testing and increasing vaccination and booster rates.

Currently, 81% of eligible residents have received at least one dose of a COVID-19 vaccine and about 30% have received a booster, according to AHD. In addition, nearly 51% of children ages 5 to 11 in the city have received at least one dose of the vaccine.

Testing availability remains a pressing concern for communities nationwide, and Alexandria is no different. Alexandria has the second highest testing rate in Northern Virginia, after Arlington, and there is not enough supply to keep up with skyrocketing demand for rapid at-home tests.

“Many people have been driving around to various pharmacies in our community to find them, and unfortunately they are usually out of stock,” Talis said. “It is hard to keep them on the shelves and that is due to national and international supply chain concerns as well as that growing demand.”

The availability of at home tests is not the only challenge when it comes to testing. In lieu of at-home tests, residents logically turn to testing at urgent care centers, the city’s Curative kiosks, primary care offices and other sources. In turn, testing appointments fill up at these locations, overwhelming employees who are already hard pressed due to staffing limitations.

“It’s really tough because we know our residents are trying to do the right thing,” Talis said. “They’re trying to get tested to prevent the spread, so we as a health department are working with the city to see what other options are available so that way we can continue working on expanding access to testing.”

Alexandria library branches have partnered with the health department to hand out free test kits. Although all branches are currently out of stock, shipments do come in regularly, Talis noted. Talis also encouraged residents to check with their own primary care providers, since private doctors will only provide tests to their patients.

“You have a less competitive pool of people that you would be looking for tests with. I think that first checking to see if your doctor’s office offers tests is a great place to start,” Talis said.

AHD is looking to increase its communication around testing and will be adding more information to its website about when it is best to receive a rapid test as opposed to a PCR test, in addition to information about the latest isolation and quarantine guidelines. The department will also be launching a new online portal that will go live next week and will allow residents to report positive test results they have received from at-home rapid tests.

Dr. Rina Bansal, president of Inova Alexandria Hospital, was also on hand during the meeting on Tuesday and spoke to the hospital’s capacity levels as it responds to the recent surge. According to Alexandria’s COVID-19 webpage, one in 20 Alexandria residents who test positive require hospitalization.

According to Bansal, the acuity of the Omicron variant is lower but due to the sheer number of cases in the community, the hospital is still dealing with higher rates of patients than in previous months. The patients most severely impacted by COVID-19 are still unvaccinated, Bansal said.

“Our critical care teams are busy, but, again, we’re nowhere close to where we were with the first pandemic in terms of the acuity of illness in the numbers we were seeing previously,” Bansal said.

Talis attributed this to Alexandria’s high vaccination rate, which “has really made a difference in terms of the severity of illness that we’re seeing.”

Bansal said the hospital is still within its current capacity limits, but that Gov. Ralph Northam’s recent public health emergency declaration will help Inova respond should hospitalizations rise even higher.

“It’s key from an in-patient perspective because it will allow us to increase our licensed bed capacity beyond our current license. It will allow us to work in staffing ratios that may not be what we actually do right now,” Bansal said.

Inova is advising that patients should refrain from coming into the hospital just to get tested or if they have mild symptoms that are not enough to require hospital care.

Both Rose and Talis said the recent surge has prompted the health department to change its approach to the pandemic. Rose cautioned the community that more surges are likely in the future and that both residents and public health professionals may have to start thinking of COVID-19 as an endemic disease, “much like we see the flu come around.”

According to Talis, after 22 months of the pandemic officials are trying to balance the benefits of public health guidance with the risk tolerance of the community in order to mitigate COVID-19. For the most part, that means sticking with common sense precautions, such as mask wearing, while adapting it to the current situation.

“Personally, I think the time has passed for the ‘Keep going, we just have to tough this out. We have to make it through.’ I don’t think that we can keep doing that. It’s been too long,” Talis said. “I think we have to be really practical about the level of tolerance and the level of risk that people can take and implement those measures in more of a harm reduction strategy versus an abstinence strategy. That’s more the model we’re taking.”