As August ends, the Department of Veterans Affairs has seen more than 12,000 additional COVID-19 cases and more than 800 deaths among its patients and staff this month. But VA also is touting a relatively low infection rate, fewer coronavirus-related hospitalizations and new clinical trials as it prepares for a possible second surge of the virus this fall.
As of Aug. 31, VA recorded 51,722 cumulative COVID-19 cases among its patients and staff, plus those it has treated as part of its Fourth Mission as America's backup healthcare system in times of crisis, which includes some military personnel, family members and other non-veterans. That total includes about 3,300 active COVID-19 cases and more than 45,000 "convalescent" cases, those who have recovered from the virus or who have passed the 14-day mark since testing positive.
The additional 12,698 cases in August represents an about 33% increase in overall cases in August.
August is the deadliest month of the pandemic for VA, with 825 deaths, according to data from the department. May saw the second-most deaths at VA during the pandemic thus far, with more than 730. VA's mortality rate is about 5.7%, nearly double the 3.1% death rate among Americans overall, according to the Centers for Disease Control and Prevention.
VA also added seven more deaths among staff in August, for a total of 49 employee deaths.
In the final week of August, VA saw 355 deaths from the virus among its patients. From Aug. 27 to Aug. 28 alone, VA added 109 deaths. In August, deaths at the department increased nearly 40%.
VA Press Secretary Christina Noel told Connecting Vets said there is often a "time lag" from when COVID-19 cases first present, and deaths caused by the virus.
"The surge in cases began in late June, through July and into early August," she said. "Deaths are seen in higher numbers weeks into a spike of cases."
But while the department reached several bleak milestones over the month, it's also announced some hopeful developments.
The best measure of how the fast-spreading virus is affecting VA patients is hospitalization rates, Noel said. And at department hospitals, those rates are continuing to fall.
In March, 38% of VA COVID-19 patients were hospitalized. That number continued to drop each month, reaching 16% in August. But that's not unique to VA patients, Noel said. Hospitalization trends are generally dropping at private hospitals nationwide, too.
The number of patients actively sick with the virus is also continuing to fall at VA, reaching about 3,300 on Aug. 31, though it remains significantly higher than the low point VA reached in late May and early June of about 1,250.
The department is also crediting its relatively low infection rate to a slate of efforts including a digital screening at VA hospitals and clinics, increased telehealth, testing and more.
VA has administered more than 588,000 COVID-19 tests nationwide, though that number includes patients, staff and others, and also includes all tests administered -- not just how many individuals have received tests. VA cares for more than 9 million veterans and has hundreds of thousands of employees, according to the department.
Testing at VA is up nearly 900% since March when the department was administering about 631 tests per day. As of Aug. 24, VA was administering 6,300 tests daily.
The employee infection rate, VA officials say, is lower than 1% of its total workforce.
“Testing is a critical piece of VA’s public health response to protect and care for veterans, their families, health care providers and staff during the COVID-19 pandemic,” VA Secretary Robert Wilkie said in a statement Aug. 27. “Our testing policies and procedures have helped to significantly limit the spread of the virus within our medical facilities, while universal COVID-19 testing for patients and staff as well as other safeguards at VA’s community living centers and spinal cord injury units, has minimized the COVID-19 exposure risk for some of our most vulnerable patient populations.”
VA continues to use remdesivir as a possible COVID-19 treatment, Noel said, along with dexmethasone, "when appropriate."
Remdesivir is an investigational antiviral medication shown in one clinical trial to shorten recovery time for some patients, according to the Food and Drug Administration, which issued an emergency use authorization (EUA) for the drug in May. The drug is administered intravenously once a day for up to 10 days in an attempt to decrease the virus' presence in the body over time. Studies have yet to prove the drug's effectiveness as a treatment for the coronavirus and the FDA so far has not approved the drug except as part of the EUA.
Dexamethasone is an anti-inflammatory medication shown in one study to improve survival rates among COVID-19 patients and also received emergency authorization from the FDA.
On Aug. 28, VA announced a new clinical trial for veterans who have contracted COVID-19. The study aims to analyze convalescent plasma for treating seriously ill coronavirus patients. The trial is the first of multiple VA Coronavirus Research and Efficacy Studies (VA CURES).
“This trial will go a long way toward helping in the fight against COVID-19,” Wilkie said in a statement. “VA CURES will provide valuable information that will benefit our veterans who are battling COVID-19, as well as other patients and the medical community in general.”
The trial is expected to include about 700 veterans hospitalized at VA facilities. Study volunteers will randomly receive either convalescent plasma or a saline placebo to "track and assess recovery and effects of the treatment," VA said in its announcement.
The FDA has authorized emergency use of convalescent plasma as an investigative therapy for COVID-19 based on currently available evidence, but evidence from more rigorous, extensive trials is necessary to establish how safe and effective the treatment may be for patients ill from the virus.
VA leaders say they are preparing for a potential second surge of the virus this fall and winter, coupled with an increase in flu cases.
"We are preparing in the event this boomerangs on the country in the fall and in the winter,” Wilkie said in a recent interview. "We are preparing for the eventuality of flu and COVID coming together.”
Veterans Health Administration chief Dr. Richard Stone told Capitol Hill lawmakers in recent months that he's comfortable with VA's preparations so far, "but make no mistake, if we hit a really big second peak like was seen in late 1918, we'll be in the need to really grow even further ... Early on in this we bought a very large number of ventilators ... I think I've got about 2,500 extra ventilators that have come in now and will be distributed across the country."
The flu epidemic of 1918 is the closest medical experts can come to evaluating how the COVID-19 pandemic might play out based on past experiences in the United States, Stone said, adding that 1918 saw a much deadlier second wave in the fall and winter.
"We'll be prayerful that there's not a second wave, but I don't think we can predict it," Stone said.
Veterans can request a COVID-19 test at VA by sending a message to their healthcare provider on My HealtheVet, by scheduling an appointment online or calling their provider. To be tested by VA, veterans must be enrolled in VA healthcare. There is no copay for the test, and results "typically take two to four days," according to the department.