COVID-19 cases and deaths at the Department of Veterans Affairs continue to climb but on Thursday, VA announced a plan to begin resuming normal operations at its hospitals and clinics nationwide.
More than 10,500 veterans and VA staff have tested positive for the virus, more than 800 veterans and 25 VA staff have died. The department so far has tested just more than 115,000, in a healthcare system that serves more than 9 million and has hundreds of thousands of staff.
More than 7,000 of those cases are convalescent, meaning they're in some stage of recovery or it's been more than 14 days since they tested positive. But VA officials also recently warned hospital leaders that recovering patients who needed intensive care treatment to survive the virus could need as many as four weeks of major rehabilitation care.
VA emphasized that its three-phase plan aims to "maximize veterans' safety," the department said in a news release Thursday, adding that VA "never closed its doors" during the pandemic, but did take steps to curb some operations to prevent spreading the virus.
The department said "conditions on the ground" will determine how quickly each of its facilities returns to normal operations and "each phase of the plan is aimed at making sure veterans' safety comes first."
"A central planning solution for resuming regular operations makes no sense here because some areas of the country will take longer to recover, while other areas have seen minimal cases,” VA Secretary Robert Wilkie said in a statement. “That’s why we’re letting local conditions dictate our next steps.”
VA medical facilities will be allowed to begin Phase 1 of the plan once certain conditions are met, including falling numbers of patients with COVID-19 symptoms, fewer people testing positive and increased testing capacity.
Once conditions are met to begin resuming normal activities, VA facilities will continue using some strategies to reduce risk, such as telework where possible. But those hospitals and clinics may also begin to decide how they might resume elective procedures and face-to-face appointments with patients that have been postponed during stay-at-home orders.
Phase 2 of the plan includes resuming those postponed appointments and procedures, depending on conditions on the ground at each hospital or clinic "and subject to safety protocols deemed as necessary by local staff," VA said.
Phase 3 includes visitors being allowed back at VA hospitals, nursing homes and other centers that have been closed since March to protect the most vulnerable veterans. Phase 3 will only after staff is sure of the risks and only if those areas of the country have shown continued improvement. In Phase 3, most VA employees will also return to work.
The Veterans Benefits Administration, national cemeteries and Board of Veteran Appeals will be using the same three-phase plan, the department said.
The announcement of the plan comes one week after VA officials told hospital network leaders to prepare for a "significant surge" of COVID-19 patients who will need major rehabilitation care after being hospitalized.
Experiences at three VA hospital networks so far "and other projections suggest that a significant surge in the demand" for rehabilitation care following patient hospitalization "is on our horizon," the memo read, adding that patients infected with the virus could require longterm care -- up to three or four weeks.
Patients recovering from the virus are facing "several debilitating complications from ICU/intubation such as delirium and encephalopathy; cardiopulmonary limitations; neurological limitations; renal failure and need for dialysis and decreased muscle strength -- and these symptoms have been found to last beyond the expected acute hospitalization stages," the memo said, adding that as many as 30 to 50 percent of all COVID-19 patients in ICUs will need rehab care.