The Department of Veterans Affairs recently required nearly every worker in its health care system to be vaccinated against the coronavirus. Meanwhile, COVID-19 cases in Oregon continue to increase. Chris Pfeiffer is the chief of infectious diseases with the VA Portland Health Care System. He joins us with details on what the system is seeing as the delta variant continues to spread.
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Dave Miller: This is Think Out Loud on OPB. I’m Dave Miller. The Department of Veterans Affairs recently required that basically everybody in its health care system be vaccinated against the coronavirus. Meanwhile, COVID-19 cases in Oregon continued to increase with record numbers of COVID hospitalizations. Chris Pfeiffer is the Chief of Infectious Diseases with the VA Portland Healthcare System. He joins us now to talk about what he’s seeing as the Delta Variant continues to spread. Chris Pfeiffer, if we had talked even a month and a half ago--as in pre-Delta and with close to 70% of Oregonians 18 and over having gotten at least one vaccine dose--what would you have said the situation was at the Portland VA?
Chris Pfeiffer: I’ll say that pre-Delta we were feeling pretty good. We were starting to reopen things and the discussions around town and within our system were around how do we increase face-to-face visits, how do we get back to and stay on normal surgical volumes, how do we increase visitors and things like that. But that’s now obviously completely changed and reversed.
Miller: So what is the situation right now in the Portland Healthcare System for the VA?
Pfeiffer: Looking back through, I think we’re around the same place we were with the surge last fall as far as numbers both in diagnosis of outpatients with COVID-19 and numbers of admitted patients with COVID-19. And so it’s a pretty dramatic increase. And of course, I think in the fall it was more of a 2 to 3 month curve but right now we’re kind of at the early spike of a really sharp curve.
Miller: So it doesn’t sound like you are at this point as bad as some other hospital systems in Oregon and in Central Oregon or in Southwest Oregon, but are you close to running out of staffed hospital beds?
Pfeiffer: Not really. We’re getting a little bit close to running out of ICU beds. Our ICU is on a surge plan right now. But we do have the beds to support it. We do have some hospital beds open although those are very tight as they are kind of around the city and state.
Miller: Does that mean that you potentially have slack to take up patients from the community, not veterans?
Pfeiffer: Yeah that’s a good question. This has come up over the pandemic. The VA has this fourth mission--a kind of humanitarian mission--of taking community patients in and we’ve operationalized that at least once or maybe twice during the pandemic so far. It’s kind of above my paygrade to figure out if we’re going to be able to operationalize that again. I think it will just depend on what the situation here in Portland looks like and what the other hospital systems are dealing with compared to ours on any particular day. But that has not been discussed at least that I know of yet in the last couple days.
Miller: What kinds of restrictions or returns to COVID protocols have you put back into place?
Pfeiffer: Good question. Yesterday we updated our visitor policy basically not allowing visitors into the building and we had loosened that up before. We are ramping back up our drive in testing which we had ramped down before. There just wasn’t the demand for it, now there’s the demand again. I would just say that our kind of surge meetings, incident command type meetings, really had become a weekly meeting and much shorter over the last few months. But those are becoming obviously more intense and we’re trying to make bigger decisions in these meetings and they’re happening more frequently now. So with things around the facility and the healthcare system, we are definitely feeling it.
Miller: So what does that mean for the return to routine care for colonoscopies or managing diabetes or heart disease, both potentially emergent problems but also managing long-term health issues?
Pfeiffer: Right. So for any return care that requires a hospitalization is where that is really being impacted. So colonoscopy, at least right now, I don’t think has been affected because we can handle that in the clinics. But things like semi-elective surgeries are the things we’re really thinking hard about how to limit those if we need to limit those and when to limit those. I’ve heard of other health care systems going through the same process and trying to figure out how, when and how much to limit things. We actually haven’t limited anything specifically yet, to my knowledge.
Miller: Let’s turn to vaccination rates specifically among veterans in Oregon. How much of a sense do you have for those numbers?
Pfeiffer: That’s a great question. We don’t have the best sense of that. We know how many vaccinations we’ve given to veterans, which is about 75,000 doses, veterans and staff actually.
But the database we have doesn’t cross talk automatically with the state databases and of course, we’re vaccinating across Oregon and Washington in our system. So we don’t actually know exactly how many veterans are vaccinated, which we wish we did but that’s the situation.
Miller: Is that something that doctors or nurses do ask about though when patients come in?
Pfeiffer: Yeah, certainly. So I think we can document outside COVID vaccination. It’s just, as you might imagine, a less than thorough way of documentation because we don’t catch everyone and all that. So, my sense is that a lot of veterans are vaccinated and I wouldn’t think that it would be at a rate too much different if not may be higher than the community. But we just don’t have the data to support what I’m saying really.
Miller: Is it also fair to say that because of the average age of the veterans’ population and the potential for underlying conditions that on average VA patients might be more susceptible to COVID than the general population.
Pfeiffer: I think that is a fair statement. And we had a lot of patients that were eligible early on when the vaccine came in mid to late December. And we looked at those lists and we had a lot of higher-risk patients on that list. And I was really proud of our vaccine effort, from day one to try to get those patients vaccinated. So, we think we’ve done a good job vaccinating, especially the highest risk patients that we care for.
Miller: Meanwhile there’s also healthcare staff within the VA System. As I mentioned in my intro last month, the Secretary of Veterans Affairs, Denis McDonough required that healthcare staff in the system get vaccinated and then just a couple days ago he really expanded that mandate to include not just doctors and nurses, but almost everybody who works or in or contracts with a facility. Do you have a sense for how effective that’s going to be?
Pfeiffer: It’s a great summary of the situation. I would think it’s going to be effective at least in Portland. Our current staff vaccination rate is quoted to me as 81%. So that’s where we are seeing right now. I would expect that rate to obviously go up and be northwards of 95%. But we’re still waiting to figure out exactly how some of the details of this are going to roll out through the system and what kind of carrots and sticks there will be for staff that still don’t want to be vaccinated despite the mandate or can’t get vaccinated for some reason despite the mandate.
Miller: Chris Pfeiffer, thanks very much for starting us off today. I appreciate it.
Pfeiffer: Hey, thanks a lot, appreciate your time today.
Miller: Chris Pfeiffer is the Chief of Infectious Diseases with the Portland Healthcare System.