At peak times during the pandemic this past year, it seems the percentage of hospital beds filled with coronavirus-positive patients at the Ralph H. Johnson VA Medical Center in Charleston was often lower than most other hospitals in the area.
Experts don't know why this has been the case. Some believe that veterans are more apt to follow rules related to mask-wearing and social distancing. Others argue that the VA health system does a better job managing disease and offers more in the way of communication and telemedicine. This much is certain: Questions raised by preliminary data beg further research.
Take, for example, Dec. 4. The number of coronavirus cases recorded in South Carolina that day — more than 2,000 — mirrored the height of the virus' peak in July. A combined 66 patients were hospitalized at Roper St. Francis, Trident Health and Medical University Hospital facilities on that day, according to data provided by those health systems. Meanwhile, there were no COVID-19 patients at the VA hospital in Charleston.
A similar picture was observed on Jan. 26, when more than 3,000 new cases were reported across the state. On that day, 41 people at Roper Hospital and 50 people at MUSC were hospitalized with COVID. At the VA hospital, which sits right next door to Roper and MUSC in the medical district, only 13 inpatients had the coronavirus.
It's important to note that the VA hospital in Charleston is smaller than other hospitals in the community. MUSC, for example, has 685 general inpatient beds, according to the state health department, compared with the VA's 155.
Even accounting for size, though, at three peak dates during the pandemic, the VA hospital in Charleston almost always had a lower COVID census than other hospitals in the Lowcountry.
That said, it's unclear how veterans who have been hospitalized with COVID-19 in South Carolina and elsewhere in the U.S. have gotten health care outside the Veterans Health Administration system. Some veterans don’t qualify for VA health benefits.
Still, according to national data, there are fewer coronavirus cases relative to the VHA patient population than there are cases relative to the U.S. population.
Dr. Lancer Scott, an emergency room physician at the VA hospital in Charleston, said he thinks the numbers could be partly explained by compliance among veterans.
"They are compliant with masks. They are really compliant with staying at home," he said. "They’re compliant on a population level that I’ve never seen before. It’s quite impressive."
Dr. Megan Gerber, a primary care physician who works for the VA in Boston, echoed the same idea in an essay she wrote last year for the Journal of Internal Medicine.
"Unit cohesion is the bond that unites service members to one another and the mission," she wrote.
And for many veterans, Gerber told The Post and Courier, the pandemic feels like war.
"People who have served in the military have a sense of serving a greater purpose. ... There really is a sense of mission right now," she said. "For a lot of veterans, this really does feel like a deployment or active duty."
It isn't just this sense of serving the greater good that may be keeping veterans from becoming hospitalized with COVID-19. Gerber argued that the VHA does a better job following and monitoring its patient population. The VA is able to mail its coronavirus patients thermometers and pulse oximeters, she said. A VA team of health care staffers monitors any COVID-19 symptoms among their patients on a daily basis.
It sounds like common sense but it's actually rare for health care system to do that, she said.
"In my practice, I’m not seeing my patients hospitalized or going to the ED (emergency department) partially because we have the systems and the ability to proactively monitor them," she said. "We were just incredibly well-positioned at the beginning of the pandemic. ... Outside VA, they’re a little bit on their own. That might be part of what’s going on."
This doesn't mean some groups of veterans haven't been hit hard by the pandemic. In October, a state veterans home in Hawaii was cited by the federal government for posing "immediate jeopardy to resident health and safety" after 27 veterans and their spouses died during an outbreak. The home was fined more than $500,000.
In South Carolina, the Dorn VA Medical Center in Columbia had the second-highest number of active COVID-19 cases in the country in early February, according to an AARP report, and the fourth-highest number of known coronavirus deaths among VA hospitals since the start of the pandemic.
And nationally, while it seems VHA patients are less likely to contract coronavirus compared to the general population, veterans are also less likely to be tested for it and more likely to die if they do become sick with COVID-19.