A day after Gov. Glenn Youngkin issued an executive order giving students the ability to opt out of school masking policies, Dr. Colin Greene, the newly appointed state health commissioner, addressed the directive in an email to local health district directors. “I suspect there are those who find this rule hard to hear,” he wrote, adding that they could discuss “the pros and cons of masking at length” in a planned monthly Zoom meeting. When it came to the Virginia Department of Health’s public stance, though, Greene was clear. “I respectfully remind all health directors that VDH is an executive agency, under the leadership, oversight and discipline of the governor,” he continued in the email, which was obtained by the Mercury. “Compliance with the word and intent of this executive order on the part of any VDH employee is not optional.”

More and more people in Virginia are being deemed mentally unfit to stand trial, crowding already-struggling state mental hospitals with patients who, in many cases, have only been charged with minor crimes like trespassing or disorderly conduct. But the lengthy process of restoring them to competency often means patients spend more time waiting to be evaluated and treated than they would face in jail if ultimately found guilty, creating civil rights concerns, officials who work in Virginia’s behavioral health and legal systems say.

In early April, Sentara — one of the largest health systems in Virginia with 11 hospitals scattered across five regions — sent a letter to Anthem, the state’s largest insurer. Lance Torcom, Sentara’s chief managed care officer, informed Anthem that the system would be terminating its contract with the insurer’s Medicaid and Medicare lines of business. Effective Oct. 12, in other words, any patient who received government-provided health coverage through Anthem would no longer be able to use their insurance at Sentara’s facilities. Those include not only the system’s acute care hospitals, but seven affiliated surgery centers and six physician groups that also fall under its ownership.

In mid-August, as the delta variant was surging across Virginia, hospitals reached out to Gov. Ralph Northam’s administration for help. “This rise in infections is once again placing significant stress on general hospitals and nursing facilities within the commonwealth,” wrote Sean Connaughton, president of the Virginia Hospital and Healthcare Association, in a letter to Health Commissioner Dr. Norman Oliver and Health Secretary Dr. Dan Carey. At the time, the seven-day average for new hospitalizations mirrored that of March, when Virginia was still recovering from a massive holiday surge.

In Virginia, most students are headed back to the classroom without that regular testing in place. VDH has mapped out a statewide program for the 2021-22 school year, but the department is still selecting a vendor to run the tests. “We are anticipating that the pooled testing program will be ‘live’ by early October,” Dr. Laurie Forlano, deputy commissioner for population health, wrote in an email — about a month or more after most students have started school.

In the early weeks of Virginia’s COVID-19 vaccine rollout, hospital systems in five local health districts requested, and received, tens of thousands of doses — a disproportionately larger share than pharmacies, community health clinics and even the local health departments charged with overseeing the state’s immunization plan.

To schedule its COVID-19 vaccine appointments, Virginia turned to PrepMod, software developed by a Maryland-based company that advertises an “end-to-end electronic system” for pandemic management. Virginia Department of Health spokesman Logan Anderson said the state paid $746,195.65 for the program, which “went live” on Jan. 21 “with a handful of pilot sites.” But as local health departments transition to the software, it’s become clear that PrepMod is frequently unworkable — forcing many districts to abandon the platform or develop their own workaround solutions.

A little over a week after Gov. Ralph Northam announced plans for a phased reopening of Virginia’s K-12 schools, Virginia Beach Superintendent Aaron Spence wrote a frustrated email to a top official at the state’s Department of Education. “This variance option — and the ongoing statement that all parents have to do is lobby their school board and superintendent if they want us to vary from the state plan — has injected politics into this decision,” he wrote to James Lane, the state superintendent of public instruction, forwarding an angry email he received from a faculty member at a local private school. “Without context, we are going to be hung out to dry here,” Spence added.

An early survey by the Virginia Association of School Superintendents — which captured responses from 113 of the state’s 133 divisions — found that public schools are facing an enrollment loss of 35,000 students so far this year. Collectively, that drop represents a prospective loss of $146 million in basic aid funding from the state

As colleges and universities across Virginia reopen their campuses to students — leading, in some cases, to surging cases of COVID-19 — many have done so with plans that weren’t vetted by the Virginia Department of Health or even, in some cases, their local health departments.

Faculty members are raising concerns about the reliability of the tests being used to screen students at three prominent Virginia universities for COVID-19 before they return to campus. George Mason, William & Mary and Virginia Commonwealth University all contracted with Kallaco, a newly-formed corporation, to provide at-home testing kits and health tracking software for the thousands of students expected to return to campus. But faculty leaders, who released a letter to university administrators and the Virginia Department of Health on Friday, said the partnership raised red flags from the beginning.

In mid-July, even residents of Galax were surprised to see their small city of 6,625 make national news when a White House report listed it as one of Virginia’s coronavirus “red zones.” The same week, the New York Times reported it had the highest rate of COVID-19 in the state (it’s since been supplanted by nearby Martinsville and Franklin, both set close to the North Carolina line).

Virginia’s largest insurer for local school divisions had a clear message for administrators on Monday: Don’t worry about COVID-related worker’s compensation claims from school employees.

In Virginia, hospitals can release patients to nursing homes without COVID-19 testing as long as the patient isn’t displaying any symptoms of the disease, despite repeated pleas from industry groups over the past two months to change course. The state isn’t alone — current recommendations from the U.S. Centers for Disease Control and Prevention specifically emphasize that “testing should not be required prior to transfer of a resident from an acute-care facility to a nursing home.” But amid a disjointed federal response, a nationwide wave of virus deaths at nursing homes and strong evidence of asymptomatic spread among early nursing home outbreaks in Washington, some states are taking matters into their own hands.

A new federal report finds systemic failures in how the Virginia Department of Education monitors and responds to special education complaints against local school districts. VDOE is contesting several findings in the June 23 letter, sent to Virginia Superintendent of Public Instruction James Lane by the U.S. Department of Education after a two-day site visit in late May 2019. But other experts framed it as a victory for the families and advocates of students with disabilities, who have spent years raising concerns over the state’s oversight process.

At a news conference on Monday, Gov. Ralph Northam called nursing homes, which have accounted for more than half of the state’s COVID-19 deaths, a “top priority,” adding that his administration is doing “everything we can” to take care of them, including the provision of personal protective equipment. “If they need more PPE, we have the PPE,” he added. “And hopefully they’ll know the proper channels to go through and we’ll be able to deliver it.” But hours earlier, the Virginia Hospital and Healthcare Association — a key player in the state’s emergency management program for health care systems — sent an email to long-term care facilities, warning that coronavirus was continuing to limit supplies.

For six weeks, the Virginia Department of Health has been allowing local health districts to release the names and addresses of individuals with COVID-19 to 911 dispatch centers. The policy — first ordered by Health Commissioner Dr. Norman Oliver, according to internal emails from VDH — was introduced at a time when shortages of personal protective equipment were creating anxiety among first responders.

Across the country, states have struggled with widespread shortages of testing materials and personal protective equipment, an ongoing challenge when it comes to boosting the rate of testing. But Virginia has appeared uniquely unable to overcome those barriers. Interviews with state health officials indicate that a sluggish response to testing shortfalls, combined with a continued lack of medical equipment, has stymied efforts to adequately track the spread of the virus.

The outbreak at Canterbury Rehabilitation & Healthcare in Henrico was one of the first in Virginia, and by far the most deadly. But health experts and insiders say that existing vulnerabilities within the long-term care industry, coupled with critical gaps in knowledge and delays on the part of state health officials, compounded the spread of disease in ways that likely led to similar outbreaks in other facilities.

Two years after passing legislation that opened the doors to short-term rentals on sites such as Airbnb, Montgomery County still lacks the resources to enforce more than a thousand potential violations. The lack of enforcement has angered community members, who argue that the proliferation of unlicensed units — especially apartments and condominiums used exclusively as short-term rentals — contradicts the county’s oft-stated commitment to affordable housing.