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A year with the virus

A year with the virus

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The word “apocalyptic” actually appeared in a Jan. 1, 2020, headline in this newspaper. It was used to modify the noun “wildfires,” which were scorching millions of acres a world away.

The day’s paper brought news of far-away catastrophes. As Australia burned, thousands were swept up in floods in Indonesia and dozens of zoo animals perished in a Berlin fire.

Locally, the news was rather ho-hum. Roanoke County planned a broadband survey to figure out which areas were unserved or underserved.

Turns out, we’d all discover soon enough how critical broadband is to education, health care, commerce, and even just to see family and friends.

But we didn’t quite know that then. We were blissfully unaware that a different apocalyptic event had already started as a new coronavirus emerged in China. It would soon enough sweep across the globe.

We might not have grasped then that pandemics are local. This is how we came to learn that.

January:People begin to hear about a new mysterious disease, a novel coronavirus, that originated in China and is killing people. They wonder: Is it here? By the end of the month, Carilion Clinic logs so many worried phone calls that its director of infection prevention and control, Dr. Anthony Baffoe-Bonnie, talks with local reporters to quell the hysteria.

Unless you had traveled to China within the past two weeks, you should worry about the flu, not the coronavirus, he says.

About a half-dozen Virginia Tech student had been to Hubei providence over winter break.

The Virginia Department of Health tests three people. None has the virus.

February:The month passes quietly in the Roanoke and New River valleys as the disease spreads to other countries and begins to make an appearance in the U.S. A few more Virginians are tested. Though there are no confirmed cases, test results take a week or more to come back and tensions rise.

March:During the first week of March, the Salem VA Medical Center, LewisGale and Carilion Clinic begin to screen people, asking if they had traveled recently. Friendship installs handwashing stations.

Robert Hawkins, executive director of the Near Southwest Preparedness Alliance, talks about how health care providers drill for pandemics.

Months earlier, alliance members had trained on the possibility of a supply-chain disruption. A concern is raised that a run by consumers on masks, gloves and supplies could cause shortages for health care providers.

On March 7, Virginia has its first case, a U.S. Marine stationed at Fort Belvoir. The next day comes word of a second case, a Fairfax resident who went on a Nile River cruise. A third, fourth, fifth case soon follow — all related to international travel. People pour into emergency rooms with flu symptoms, thinking they have the virus.

Carilion restricts visitors.

On March 13, Gov. Ralph Northam orders all public schools to close. The announcement comes as Roanoke Mayor Sherman Lea and Baffoe-Bonnie host a news conference at city hall to say the St. Patrick’s Day parade and Shamrock Festival are canceled. All city events and libraries are closed for 30 days. The state’s colleges and universities extend spring break and move classes online.

The Virginia Department of Health has reported 30 cases, mostly in Northern Virginia. There are no cases in this region.

“There is lots of rumor going around. And this happens in times of new diseases. It is important to always go to the right source,” Baffoe-Bonnie says. “As far as I know, looking today, there are no cases in the southwestern Virginia area. And our efforts now are to try and do everything we can to keep it that way.

“If there is one thing I want to leave from here: Hand-washing saves lives. It’s very simple. You want to do it frequently,” he adds.

On March 14, Virginia records its first death: a man in his 70s who lived in the Peninsula Health District.

A few days later, Carilion and the Salem VA halt all nonessential surgeries and procedures, and the governor begins regular briefings.

By March 18, Virginia’s cases have risen to 77, but a true picture is stymied by lack of testing supplies. Fewer than 2,000 Virginians have been tested. Tests are rationed, given only to those who have traveled to a known hot spot or have been in close contact with someone known to be infected, who had symptoms and whose doctors have first ruled out flu and other respiratory illnesses.

Test results are also slow to process.

Dr. Norman Oliver, Virginia’s health commissioner, says the state’s lab is processing 65 tests, and commercial labs are also running samples.

People attending the governor’s daily briefings begin to sit farther apart. Messaging begins: Limit the size of gatherings so that people are no closer than 6 feet, wash your hands frequently, stay home, particularly older people. By now two Virginians have died.

March 19, Carilion reports its first positive case, a Botetourt woman in her 80s. The following day, Northam says “social distancing” is helping to “flatten the curve” — two new terms that are quickly adopted into casual conversations.

A third new term, “PPE,” for personal protective equipment — meaning gowns, gloves and especially masks that protect health care workers from infections — enters the lexicon. Virginia places an order for 1 million surgical masks and 500,000 N95 respirators.

On March 23, with 219 known cases in Virginia, Northam orders bowling alleys, theaters, barber shops, gyms and spas to close and restaurants to serve only carryout, curbside and delivery. At midmonth, Virginia has one of the lowest unemployment rates in the country. That rapidly changes, as Northam reports 40,000 Virginians file new unemployment claims.

Carilion opens a testing referral center, but only for patients with doctors’ orders.

“It would be nice to say this would be behind us in two weeks,” Northam says in response to a question about President Donald Trump’s goal to return to business as usual in 19 days. “That’s really not what the data tells us. The data tells us this will be with us for two to three months and perhaps longer. So while our intentions are to get back to normal, we have to be realistic.”

The month ends with Northam issuing a stay-at-home order: All Virginians must remain home until June 10 unless they need — not just want — to go out for food, work, medical care or fresh air.

The directive comes on reports that 1,020 Virginians have tested positive for COVID-19, including six in Roanoke, the first cases in the city. The virus, days earlier, had killed the Botetourt County woman who had been the area’s first confirmed case. She is among 25 Virginians who have died from the disease.

April:

Projection models predict Virginia will see a surge in cases between late April and late May.

“You need to know the truth. No sugarcoating,” Northam says as he delivers yet another sobering message about the pandemic, saying Virginians need to be realistic in their expectations and prepare “for the long haul.”

midmonth, researchers from the Biocomplexity Institute at the University of Virginia release more refined state models that show how social distancing will work. The modelers go on to offer different projections of infection rates that depend on how well people adhere to staying apart.

Carilion announces pay cuts for executives, a reduction in hours for some employees and furloughs for others. LewisGale redeploys what staff it can and offers 70% pay for up to seven weeks for those furloughed by the pandemic.

Health systems across the country take similar actions as a response to the financial toll caused by the COVID-19 pandemic. Carilion sees a sharp decline in revenue as outpatient visits and surgeries are halted, and it has taken on unexpected expenses in purchasing equipment, medications and supplies and readying units for infectious patients.

The Virginia Medical Reserve Corps begins recruiting volunteers to help with the state’s response to COVID-19. The corps is seeking 30,000 medical and nonmedical volunteers to provide support for the expected surge in hospitals and to help in long-term care facilities across Virginia.

Ballad Health announces it will begin to treat seriously ill COVID-19 patients with antibodies from survivors’ plasma.

Testing remains a challenge and is limited still to only people with symptoms, despite evolving evidence that about half of people infected have mild symptoms or none at all and yet can spread it to others.

Virginia Secretary of Health and Human Services Daniel Carey said the goal is to be able to do thousands more tests each day, but supplies and equipment remain limited.

“We are scouring the country looking for equipment to help our institutions increase testing. We haven’t been successful because of a national shortage,” Carey says. “We realize we need to get significantly higher testing to accomplish the missions that the governor has indicated have to be done.”

On April 22, scientists at Virginia Tech announce they have cleared bureaucratic red tape to begin running COVID tests in their Roanoke and Blacksburg labs.

At about that time, three staff members at South Roanoke Nursing Home test positive. All 81 residents and 100 staff members are tested in one of the state’s first point-prevalence studies. The outbreak claims 13 lives.

Outbreaks at 80 long-term care homes in Virginia have by this point caused 939 illnesses and 77 deaths. Virginia health officials claim that state code bars them from naming any of the homes. Oliver, the health commissioner, says homes may tell each other of infections since low-paid staff sometimes hold jobs at several homes.

The federal Centers for Medicare and Medicaid Services says nursing homes must report directly to the Centers for Disease Control and Prevention when a staff member or resident tests positive for COVID-19, and must inform residents and their families. There is no such requirement for assisted living facilities and group homes.

By month’s end, one-third of the infections in the Roanoke Valley so far are in health care workers. An outbreak among construction workers shuts down construction at Cave Spring High School. Local hospitals, which haven’t seen many cases, prepare to resume surgeries and other nonessential procedures.

May:

The state changes the way it reports COVID-19 cases, making it appear that daily testing has tripled overnight. Virginia had been criticized for having among the lowest testing rates when compared to other states.

The new reporting lumps together all types of tests, both those that diagnose active cases with those that check for antibodies to detect past infections.

By counting this way, Virginia can boost the overall number of tests and lower the percentage of positive results. Both are key measures Northam has cited as ways to determine the safety of moving into Phase 1 of reopening Virginia. (The state will within weeks separate the test results following public outcry.)

On May 8, Northam says that the data look encouraging and Virginians can ease back into stores, churches and outdoor cafes, and he allows most of Virginia to enter Phase 1 on May 15.

All of the charts and curves Northam shows during his briefing, and those posted to the Virginia Department of Health’s website, mark statewide trends. There is no easy way to sort through the data to tell what is happening in individual localities. Dr. Molly O’Dell holds weekly news conferences to explain what is happening in the Roanoke City and Alleghany Health Districts and continues to report slow, steady increases in the virus.

The state Health Department says it will do better and provide clearer reports, and has since added pages of data to answer most questions about how the virus is behaving in different parts of Virginia, and its impact on racial, ethnic and age groups.

By the time Virginia begins to reopen, nearly 60% of the deaths from COVID have been among people in long-term care. Northam has assembled a task force on long-term care but rarely talks about this impact during his briefings. His administration refuses to provide names of the facilities that are affected.

The Virginia Hospital and Healthcare Association launches an online dashboard to report on the number of COVID-19 cases in licensed nursing homes and to show the pressing need for masks and gloves to reduce infections.

Carilion, which had switched patient visits to telephones and computers at the start of the shutdown, says it has done about 11,000 video chats and calls.

The state’s mental health agency reports that 14 workers and patients are being treated for COVID-19 at seven of Virginia’s psychiatric hospitals.

On May 26, Northam orders everyone 10 and older to wear a mask if they enter a business, but there is no clear directive for how it will be enforced. The governor will ask the General Assembly to consider a civil penalty for violations when it convenes this summer.

“This is not a criminal matter and our law enforcement, our police, our sheriffs will not have a role in enforcing this,” he says. “I’m not looking for people to get in trouble by not wearing a mask, but I am looking for people to please do the right thing. I am asking people to respect one another.”

Northam says the Virginia Department of Health will investigate businesses it licenses — restaurants, hotels, campgrounds — that defy his executive order.

He also says that the commissioner of labor and industry will write emergency regulations.

June:

At the start of June, Northam moves most of Virginia to Phase 2. Northern Virginia and Richmond, which have experienced the brunt of infections, have just entered Phase 1.

“Phase 2 will include more flexibility for restaurants, gyms, sports, outdoor entertainment venues and gatherings of up to 50 people,” Northam says. “It means restaurants can have indoor seating again, up to 50% of their capacity. It means gyms and fitness centers can have indoor classes and workouts at 30% of their capacity, and pools can open with some restrictions.”

Within two weeks, cases of COVID-19 increase at a fast pace in the Roanoke Valley. At least a dozen outbreaks are reported in businesses, restaurants, long-term care, a day care and a church. Five restaurants, which the health department is barred from naming, have outbreaks.

A disproportionate share of the cases are occurring in the Hispanic population.

On June 10, Virginia’s COVID-19 deaths surpass 1,500. The stay-at-home order expires. People leave for vacations. By June 23, local case counts surge as people return from Myrtle Beach, South Carolina, with the virus and then spread it around.

The state begins to release the names of long-term care facilities that have outbreaks of the virus. There have been 230 outbreaks in long-term care, accounting for about 12% of the state’s 56,793 cases but 62% of the deaths.

July:

On July 1, Northam moves Virginia into Phase 3. The rate of new cases in the Roanoke Valley continues to rise, while falling off elsewhere in Virginia.

By midmonth, the governor is upset that people are partying at the beaches without masks, and on July 28 he cuts off alcohol service at 10 p.m. for restaurants and bars in Hampton Roads.

August:

At the start of August, cases are slowing in Roanoke but deaths are increasing. Roanoke leaders look for ways to reach Hispanic residents, who continue to make up a disproportionate share of cases.

By midmonth, testing again becomes sluggish, with turnaround times stretching to two weeks. The state psychiatric hospitals are dealing with outbreaks and with having more patients than beds. For the first time since 2013, when the General Assembly ordered state hospitals to always have a bed available, Northam limits admissions to allow the hospitals to deal with COVID.

Ballad Health, which has seen a surge of cases, says mask wearing has helped tamp down the spread of the virus in northeastern Tennessee and far southwest Virginia.

By month’s end, college students begin to return to Radford and Blacksburg, and case counts soar in the New River Valley.

September:

The governor leaves decisions about holding in-person classes to local school boards. Each school system develops its own plans, adopting hybrids of online classes and staggered schedules, and they ready for some in-person classes after a summer of reviewing buildings and spacing of teachers and students.

Virginia adds a new online dashboard aimed at making sure local decision-makers, mostly school officials, have information on the spread of the disease in their area.

Southwest Virginia, particularly the rural region west of the New River Valley, continues to show faster spread of the virus than elsewhere in the state. Efforts to control the disease in this hot spot are hampered by a Twitter post shared by President Donald Trump that falsely claims that 94% of Americans who have died from COVID-19 actually died from something else.

Ballad Health officials attempt to stop the harm of misinformation. The health system begins holding weekly Facebook Live briefings to share factual information about the disease.

Virginia begin plans for vaccinating millions once a vaccine is approved, and health officials advise it is not too early to get flu shots. People can get both infections at the same time.

Six residents of Raleigh Court Health and Rehabilitation Center die. The home reports on its website that 50 patients and 28 staff are infected with the virus.

October:

In October, local outbreaks, primarily in long-term care, begin to fill hospitals. The governor and his wife are infected. Northam says his case proves that masks work, as none of his close contact become infected.

Fighting misinformation becomes harder. On a day when the number of COVID-19 patients in Roanoke-area hospitals rises to the highest level yet, the Associated Press releases a poll showing that more people disbelieve what the government and the media tell them about the virus than they did in April.

“I have never experienced this level of mistrust or misinformation,” Dr. Cynthia Morrow, director of the Roanoke City and Alleghany Health Districts, says Oct. 20.

Ballad reports that cases are exceeding its capacity, and UVa modelers say daily case counts, which are at 1,000 a day statewide, will double if behavior does not change.

November:

At the start of the month, health officials warn that the virus is spreading among families, church-goers and friends. Morrow calls for high school sports to halt and asks people with positive test results to reach out to their contacts rather than to wait on the Health Department. Cases are piling up so fast that investigators can’t get to them all.

Northam on Nov. 10 says he plans a marketing campaign rather than restrictions for Southwest Virginia, but within days he changes his mind. He limits public gatherings statewide to no more than 25 people and lowers the mask mandate age to 5. He says images from other states of morgue trucks have moved him to act in Virginia to keep cases from reaching that point here.

Carilion seeks volunteers for an antibody study, and all health officials plead with people not to travel for Thanksgiving and to have their meal only with household members.

December:

Ballad brings in morgue trucks as its cases rise. It halts all nonemergency procedures and opens more COVID units. As infected patients push past 300, it projects the count will rise to 500 by year’s end. Hundreds of its staff members have been on quarantine from exposure. Many are exhausted.

Unlike in the spring, hospitals across Virginia are seeing a rise in COVID patients and have no staff to spare to help other facilities.

Cases now surge across Virginia. Daily case counts soar past the 2,000 mark, then the 3,000 mark, and within days hit 4,000.

Hospitalizations follow, doubling from about 1,000 a day at the beginning of November to 2,400 by mid-December.

Virginia’s health commissioner says there are just too many cases to contact all who have been exposed, and a Roanoke undertaker posts to social media about multiple COVID deaths daily in an attempt to open eyes to what is happening.

Northam institutes a midnight curfew. Everyone must be at home unless they’re working.

midmonth, the first shipments of vaccine arrive in the Roanoke and New River valleys and vaccinations begin in health care workers first at Carilion Clinic and LewisGale, then at the Salem VA. A clinic is held for first responders to get the first of the two-shot series. Health officials talk about an end in sight, but that it is still months away.

In the meantime, they repeatedly stress: Wear a mask, wash your hands, and keep your distance.

In the closing weeks of the year, the state adds a new dashboard to track vaccinations. It also posts more information about outbreaks in long-term care and health care facilities, and offers more data on localities.

Almost 2,400 Virginians spent New Year’s Eve in the hospital with confirmed cases of COVID-19, and the state recorded its 5,000th death.

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