Dr. Danny Avula wasn't used to getting phone calls at home from nursing home administrators at 9 o'clock on a Wednesday night. So when the phone rang on March 18, 2020, he didn't know what to expect. Avula, now mayor of Richmond, was then director of public health for both the city and Henrico County, which was about to become the epicenter of the worst outbreak of COVID-19 infections and deaths in the United States.
Dr. Danny Avula, then Richmond and Henrico health director, who led coordination of Virginia's vaccination efforts, gets a Johnson & Johnson COVID-19 vaccination April 1, 2021 at Richmond Raceway. Avula is now Richmond's mayor. The callers that night included the administrator and medical director at
Canterbury Rehabilitation & Healthcare Center in western Henrico, which had just confirmed the first case in one of its residents of a disease that had killed 46 residents of a nursing home in Kirkland, Washington, outside of Seattle, as the first wave of the pandemic broke in the U.S. Two Canterbury residents died of COVID less than a week after the phone call to Avula. In the next six weeks, Canterbury surpassed the death toll from COVID-19 at the
Life Care Center of Kirkland , with 51 deaths from the disease, then the most of any outbreak in the country. "You could just hear in the voices of the medical director and the administrative team the weight of that," Avula recalled on Wednesday. "It really took its toll on their staff." Dr. Jim Wright, then the medical director at Canterbury, said a year later, "Every day I grieve for the residents I lost." Virginia recorded its first confirmed case of COVID-19 in a U.S. Marine at Ft. Belvoir in Fairfax County on March 7, 2020, - five years ago on Friday. The state recorded its first death from the disease the following week, when a man in his 70s died of respiratory failure in James City County. Since then, more than 25,000 Virginians have died of COVID, according to the state health department, and more than 138,000 have been hospitalized, according to the Virginia Hospital & Healthcare Association. When the health department stopped counting last year, it had tallied 2.6 million cases. In Henrico alone, with more than 60 long-term care facilities, 560 people died from COVID-19 in the first year of the pandemic. But the lessons of the public health emergency have become blurred in political debate over the measures that government took to prevent the spread of the virus - the closing of public schools and businesses, limits on public gatherings, requirements for face masks and, ultimately, vaccinations, which immediately diminished the mounting death toll, especially in nursing homes and other long-term care facilities housing the most vulnerable Virginians.
Virginia Governor Ralph Northam (left) listens as Dr. Laurie Forlano, deputy state health commissioner for population health and the leader of a task force Northam appointed to respond to the public health threat in long-term care facilities, speaks during the COVID-19 press briefing inside the Patrick Henry Building in Richmond, VA Tuesday, May 26, 2020. "It became political, and that made it difficult," said then-Gov. Ralph Northam, a pediatric neurologist in Norfolk. Northam, governor from 2018 to 2022, presided over an unprecedented state response to the public health emergency during President Donald Trump's first term. "I'm obviously a physician," Northam said in an interview on Wednesday. "I was worried about keeping people safe." The vaccinations, developed at the end of Trump's term and distributed primarily under President Joe Biden through the American Rescue Plan Act beginning in 2021, slowed the increase in confirmed cases and sharply reduced the number of deaths and hospitalizations. "It stopped it," said Keith Hare, president and CEO of the Virginia Health Care Association, representing nursing homes, and the Virginia Center for Assisted Living. "It was going up, going up. Then all of a sudden, it went off the cliff, in a good way."
In January 2021, a health care worker administered a COVID-19 vaccine dose at Richmond Raceway. Henrico, partnering with Westwood Pharmacy and Richmond Raceway, administered more than 170,000 vaccines at the racetrack in early 2021, helped by a massive army of volunteers from the county and rest of the region. "For my career, I have never seen anything as humbling," Henrico County Manager John Vithoulkas said on Thursday. Avula, whom Northam tapped to lead the state vaccination push, called it "the most meaningful body of work I've ever been a part of in my life." COVID-19 hasn't gone away in Virginia, despite the most recent vaccine booster shots distributed last fall. In the first week of February 2025, about 1,000 people with a COVID infection went to an emergency room, according to the state health department. Meanwhile, nine times as many flu patients checked themselves into an ER. But COVID is still more deadly than the flu. In the past eight months, COVID has caused more than 400 deaths in Virginia, far more than influenza or RSV, a respiratory virus that is the leading cause of infant hospitalizations in the U.S.
Schools and masks
Nothing about the pandemic has been more polarizing in Virginia than Northam's extended
closing of public schools beginning in March 2020, and, after reopening them, requirements that students and staff wear face masks to prevent the disease from spreading in classrooms. In 2021, Republican Glenn Youngkin won the governor's race, in part, by campaigning on eliminating the face mask requirement in schools and addressing learning loss from school closures he considered unnecessary. In February 2022, Youngkin signed legislation to do away with the mask requirement.
Gov. Glenn Youngkin signs legislation to remove mask mandates in Virginia public schools Feb. 16, 2022 on the South Portico of the state Capitol. “Today we are reestablishing and restoring power back to parents,” he told students, parents and lawmakers gathered at the South Portico of the state Capitol. “But we are also establishing our expectations that we will get back to normal. And this is the path.” Virginia experienced some of the nation’s biggest COVID-era drops in reading and math scores from 2019-2022, and
continues to cope with learning loss . Youngkin has blamed Virginia's "devastating learning loss" on what he termed
"extended, and unnecessary, pandemic school closures." Northam, who as a pediatric physician knows how children spread germs, said, "It's very easy to Monday morning quarterback. People were dying." "Under the circumstances, we made the decisions that were necessary to keep people safe," he said. Avula said many people recall life during the pandemic differently, based on their profession and income, where they live, their cultural background and their level of exposure to the disease. As public health director in Richmond and Henrico in the early days of the pandemic, he recalled that 40% of positive cases for the disease were among Latinos, who constituted just 7% of the population. African American communities historically had been reluctant to take vaccines because of racist experimentation during the Jim Crow era, but COVID-19 hit Black families and institutions hard, so they knew the dangers of the disease, he said. "The reality of the people on the ground, seeing their loved ones, seeing people in their communities die from the disease, it's the reason that (Richmond Public Schools) had a very different response than most school systems did," Avula said. "Because the lived experiences of their students and their teachers, and the risks in a more minority, more low-income population, are very different than they were in the West End of Henrico." Even after Avula said he gave Richmond school officials studies that showed how the spread of the virus could be managed in school classrooms, he said, "when the superintendent surveyed his families and surveyed his teachers, it was a very different response."
Lockdown lessons
Still, public health officials learned from the experience. If Virginia had to enter another lockdown, Dr. Laurie Forlano, director of the Office of Epidemiology at the Virginia Department of Health, says she would place greater attention on the effect that isolation has on a person's mental health. Health experts believe the lockdown contributed to an increase in drug use and overdoses and greater stress and anxiety in teens and school-age children. "We were thinking about it, but perhaps we could have done a better job there," Forlano said. Public health officials had to improvise in dealing with a disease that behaved differently than anything they had seen before, and so did nursing home operators and local governments. "There were just so many unknowns," Northam said.
Dr. Jim Wright, former medical director at Canterbury Rehabilitation & Healthcare Center, is shown at Our Lady of Hope Health Center in Henrico County. Again, Canterbury showed the way. By late March, 2020, Avula's team was struggling to determine how the virus spread and how to contain it. After the nursing home in Kirkland, Washington, conducted a "point prevalence survey" that showed more than half of its residents who tested positive for the virus didn't show symptoms, Henrico health officials tested all residents and staff at Canterbury at once, the first time that the health department had done so in Virginia. The results were shocking: 92 residents were infected with COVID-19 and 54 of them, more than half, showed no symptoms. "It was a much higher rate than any of us realized because so many folks were asymptomatic," Avula said. The point-prevalence survey quickly became standard practice in responding to outbreaks in nursing homes and other institutional settings, including the state's mental hospitals. Canterbury also revealed how employees contributed to the spread in an industry that paid low wages. Many employees at Canterbury worked shifts at other long-term care facilities in western Henrico, contributing to the spread of the virus. "They were going from facility to facility," Vithoulkas said. The health department also trained employees how to use personal protective equipment - gowns, masks and gloves - which were in short supply among all health care providers in Virginia and across the country. Health staff even used masking tape to outline "hot areas" and "cold areas" at Canterbury to minimize the spread of the virus throughout the building. Vithoulkas clashed with management at Canterbury over access to the facility at the beginning of the outbreak, but he soon threw the county's resources behind the stricken center. The county hired a private ambulance service and built a shower facility for employees. It recruited employees from local hospitals to help address the staffing shortage at the center.
In April 2020, Henrico County Manager John Vithoulkas joined Dr. Danny Avula, then Richmond and Henrico health director for a briefing about Henrico's efforts to deal with the COVID-19 outbreak. Vithoulkas says "COVID taught us a lot of lessons that we have continued to use in other emergency situations." It produced a 56-page manual of COVID-19 resources for all long-term care facilities in Henrico and shared testing supplies with them. "COVID taught us a lot of lessons that we have continued to use in other emergency situations," Vithoulkas said, citing the distribution of water after a shutdown of Richmond's water treatment plant in early January triggered a regional water supply crisis. Public health officials and health care providers learned how to conduct large-scale events to test people for COVID and to distribute vaccines. They improved disease surveillance — health experts began to look for COVID in wastewater before it caused an outbreak — how they analyzed information and how they provided accurate and timely recommendations to the general public. "I don't think many people knew what an epidemiologist was before the pandemic," said Forlano at the state health department. "I'm glad people know what that work is now." In the early days, public health leaders had very few tools to combat the virus — no testing or vaccines, and all treatments were experimental or supportive. The day that Wright and his team at Canterbury called Avula about their first positive case, he and five other nursing home directors asked Northam to relax restrictions on testing for COVID-19. Faced with a shortage of test supplies and limited laboratory capacity, the state health department required doctors to clear several hurdles, including a negative flu test, a chest X-ray and a test to rule out the common cold. Ultimately, the state health department hired more than 1,000 temporary employees to perform contact tracing and investigate outbreaks. Health officials worked to quarantine sick residents of nursing homes and to support overwhelmed hospitals so they could still help non-COVID patients and perform regular duties, such as delivering babies. While others worked remotely, Forlano, who chaired a long-term care task force, attended daily press briefings the governor and state health commissioner held. "It feels like a very long time ago and a blink of an eye all at the same time," she said.
A year of COVID: Richmond stories about living through a pandemic the last year
One year after COVID-19 hit Virginia, the Richmond Times-Dispatch is looking back at how the pandemic has shaped, changed and challenged all of us.
A year after Virginia’s first COVID-19 death, the virus has left a wake of almost 10,000 people who will never celebrate another birthday.
Monica Murray lost her mom to COVID-19 in October as she and her family were still grieving the loss of her father nine months earlier to cancer.
Business was looking strong for Nadira Chase in early 2020.
The way he sees it, he doesn’t deserve a shot if he can’t use it to help others.
One year after COVID-19 hit Virginia, the Richmond Times-Dispatch is looking back at how the pandemic has shaped, changed and challenged all of us.
One year after COVID-19 hit Virginia, the Richmond Times-Dispatch is looking back at how the pandemic has shaped, changed and challenged all of us.
It all started innocently enough last March.
One year after COVID-19 hit Virginia, the Richmond Times-Dispatch is looking back at how the pandemic has shaped, changed and challenged all of us.
“We’ve gone through a lot,” Bonnie Burke Ball said in a phone interview, “but if you aren’t laughing, you’re crying, and I’d rather be laughing.”
“We’ve just seen so much illness and death,” she said. “I’m shocked every day by how sick people are. Not just old people. One week a few months ago, all my patients were under 40. It’s just really shocking how unpredictable this virus is. It hits people differently. Some people don’t have any symptoms, while some people are massively ill.”
COVID's lasting impact
* Virginia is still coping with
learning loss . The state remains almost a full grade level below 2019 levels in math, according to researchers at Harvard and Stanford universities. *
Virtual learning is an option for school systems making up for lost hours and school closures, but some parents consider it a burden and an inadequate substitute for classroom instruction. *
Remote work is a balancing act for workers and employers. * The state overhauled operations at the Virginia Employment Commission, which was overwhelmed by nearly 1.4 million claims for
unemployment compensation in 2020, 10 times the number that it received in 2019. * The pandemic shuttered many Richmond-area restaurants and
changed dining habits , with a turn toward fast-casual, takeout and delivery. Many restaurants continue to struggle. * The rise of hybrid work continues to affect
commercial real estate . Nationally, the average sale price for office buildings dropped 11% in 2024, from $196 per square foot to $174 per square foot, Commercial Edge reports. * COVID and the resulting social isolation broadly affected
mental health , with significant increases in anxiety and depression, according to the World Health Organization. * Many Americans continue to experience lingering effects from the illness. The Mayo Clinic says symptoms of "
long COVID " can include feeling extremely tired, lightheadedness and problems with memory, taste or smell.
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