Hospital testing sheds some light on extent of asymptomatic COVID-19 in Virginia

Hospital testing sheds some light on extent of asymptomatic COVID-19 in Virginia
A woman is tested for COVID-19 in a parking lot in Richmond where the health department set up a temporary walk-up testing center. (Source: Ned Oliver/Virginia Mercury)

In the weeks since Virginia’s hospitals have reopened for non-life-threatening procedures, many have implemented wider COVID-19 testing protocols to protect patients and staff from the virus.

In some cases, the results have been illuminating. In a Thursday call with the Virginia Nurses Association, Melody Dickerson, the senior vice president and chief nursing officer for Virginia Hospital System in Arlington, said her facility had been testing all admitted patients for the last three to four weeks.

“I would tell everyone on the call that if you’re not doing that, it’s certainly something you should consider,” she added. Within the hospital’s labor and delivery department, 1.6 percent of mothers tested positive for COVID-19 with no symptoms. The number jumped to 1.8 percent for patients coming in for surgery, she said.

“To see two percent of those patients who are asymptomatic yet positive for this virus, it really speaks to the risk to all of us in the community,” Dickerson continued. “But also the risk that we present to our patients and likewise.”

In the absence of widespread prevalence testing, both in Virginia and nationwide, the data helps shed light on the extent of asymptomatic COVID-19 — one of the most difficult factors in controlling the spread of disease. In a May 28 editorial for the New England Journal of Medicine, researchers with the University of California, San Francisco, called asymptomatic transmission the “Achilles heel” of pandemic control, pointing to evidence that the virus can shed at high levels even among patients with no signs of illness.

Dr. Thomas Yackel, the president of MCV Physicians at Virginia Commonwealth University, said it was “precisely for that reason” that VCU decided to implement its own universal testing protocols for hospital patients once the resources became available. The health system has been seeing roughly the same numbers at Virginia Hospital Center, with roughly one to two percent of patients testing positive for the disease without any indicators.

“There are people who are positive who don’t have some of the symptoms, or they don’t recognize what the symptoms are,” he added. Recently, one of his patients called him after losing her sense of smell — a frequently reported but often underrecognized sign of the virus. Yackel called her in and she tested positive for COVID-19, even though she didn’t display any other symptoms.

“Sometimes these are people who are thinking they’re healthy enough to come in for surgery, an elective procedure, or to deliver a child,” Yackel said. “But they could be in one of those categories — either they will develop symptoms in the next couple of days or they’re asymptomatic but still carrying the virus.”

While Virginia’s testing numbers have been gradually increasing, with more than 10,000 PCR tests administered at least four days this week, the state’s resources are generally directed to high-risk populations, including nursing home residents and symptomatic health care workers. Among the total 42,533 coronavirus cases, as of Friday, five percent were reported as asymptomatic, with 57 percent symptomatic and 38 percent unknown or unreported, according to the Virginia Department of Health.

The Virginia Mercury is a new, nonpartisan, nonprofit news organization covering Virginia government and policy.