I have been a medical professional, having completed an internal medicine and pulmonary fellowship, and was one of the first hospitalists in Hampton Roads until 2004. Since then, I have been the medical director for long-term care, or LTC, facilities and a hospice organization, practicing medicine to ensure the well-being of our aging population. Unfortunately, this population is the most vulnerable for having fatal outcomes from the coronavirus.

Statistics at several nursing homes with COVID-19 outbreaks have had very different results based on protective measures put in place. Some facilities have had almost half of the resi- dents and staff contract the virus, with death rates of 30 percent to 40 percent. Sadly, news articles are popping up daily, highlighting that 40 percent of the cases are from LTC facilities.

Leadership and decision making regarding medical issues are not predominately from medical professionals, but rather from administra- tors, lawyers and corporate or political leaders who worry too much about current regulations, lawsuits, bottom lines and appearances, and not enough about the well-being of the patients and the medical providers. Regrettably, our medical system requires balancing financial, legal and political risks with the health of patients and long-term residents. Tragically, during times of crisis, this mindset results in responses that are too little, too slow and too antiquated to be effective, resulting in lives lost.

With the onslaught of this indiscriminate, unforgiving and devastating viral disease, we do not have the luxury of time for a graduated response with ineffective actions. Now is the time for medical providers to speak up and take a more active role in making decisions based on understanding how this virus is transmitted and how it kills once an infection occurs. The decisions being made daily by administrators must be focused on stopping the spread, preventing the infection and a clear separation of those who have it and who have potentially been exposed to the virus. Decisions should be informed primarily by medical, disease and crisis management professionals and should be open to innovative, “out-of-the-box” ideas, such as the use of cloth masks for everyone in public places.

The data from Canterbury Rehabilitation & Healthcare Center in Henrico County showed that 50 percent were asymptomatic positive out of 105 residents, showing some will never know they were infected but will still be carriers of the disease and an unwitting vector to infect others. This is why we all need to be vigilant and protect each other by wearing masks and learning about infection control in public. Innovative thinking doesn’t have to be costly or dangerous. We do not yet know the overall fatality rate of this virus, but if it is one of your loved ones, the effect is the same as if it is 100 percent.

Sometimes innovation not informed by medical professionals can have unintended consequences. A perfect example is supporting local restaurants. With the development of drive-thru meal pickup, we still have risk of transmitting this virus. Medical personnel on one side of town are conducting drive-thru testing in full hazmat suits. Why aren’t drive-thru, take-out personnel required to wear a face mask, face shield and goggles? Let’s prevent drive-thru infections.

Most importantly, due to the daily increase of COVID-19 cases, hospitals rapidly are run- ning out of beds to house the ill. The hospitals’ response to this problem is to discharge patients believed to be COVID-19 free and send them to rehab and LTC facilities for continued care. While this seems like a logical response to aid struggling hospitals, this decision puts LTC residents, staff and care providers at significant risk for contracting the virus.

Based on some of the early testing data, approximately 30 percent of negative test results should have been positive because the test is not accurate. If these statistics are true for discharged hospital patients, then it is not a matter of if but when an infected individual will get admitted into one of our facilities. Just like the wildfires spreading through California, a patient infected with coronavirus can cause devastation as the virus rolls through our LTC facilities. These people are not just patients. They are our parents, grandparents, brothers and sisters, our veterans and first responders who have dedicated their lives to protecting others. And now they need to be protected.

It is better to quarantine patients coming from the hospital who have tested negative and who are presumed to be free of COVID-19 for a minimum of two weeks in a separate facility rather than being releasing them directly into the public or admitting them into long-term care facilities. This could be done several ways. Local empty hotels could be contracted to house quarantined patients. We could set up medical units with displaced medical personnel from the medical offices that have closed or who have been furloughed. Additionally, many hospitals have reduced staff hours due to a decrease in elec- tive surgical procedures. Local hospitals could support such an effort from their reserve funds as well as city services emergency funds.

If hospitals still insist on sending patients to LTC facilities, then at least place isolation trailers in the facility parking lots to keep the patients separated. LTC facilities are not set up to be isolation units, nor are they designed to handle droplet vectors that can become airborne respiratory disease with nebulizer treatments like COVID-19. The close quarters, shared ventilation system, lack of isolation facilities and multiple comorbidities of our elders make LTC facilities a tinderbox, waiting for a spark to ignite another nursing home wildfire. Let’s not add the spark to start it.

I am pleading with community members to call your elected officials to seriously consider some of these suggestions to protect our elderly family members before the situation continues to worsen. With your help, we can make a difference.

DR. JAMES J. HATCHER, CHRISTINA HOLLOWAY

Virginia Beach

Dr. Hatcher is a pulmonologist/internal medicine specialist, who is medical director of two nursing homes in Virginia Beach as well as a hospice company. Ms. Holloway is a family nurse practitioner who works with Dr. Hatcher at the two facilities.