As COVID-19 cases again spike around the country, the rapidly spreading omicron variant is gaining a foothold with nearly 3% of U.S. cases now attributed to the coronavirus variant. In New York and New Jersey, it’s already more like 13%, though Maryland and surrounding states are among the nation’s lowest at 0.5%
That number from the U.S. Centers for Disease Control and Prevention, however, may understate omicron’s effect because Maryland health officials haven’t reported the total number of COVID-19 cases, or specific variants, since a cybersecurity breach more than 10 days ago.
That means local health departments and hospitals are struggling to predict what may happen in the coming days, never mind what more may occur this winter, when the current surge may accelerate. Already almost every hospital bed in Maryland is full, driven by COVID-related hospitalizations that have more than doubled since mid-November.
Maryland health officials haven’t said when data may be available again. But in an update Wednesday about the breach, officials said COVID testing and vaccination services continue and “surveillance data has been partially restored” and are “intensely focused on the full restoration and reporting of surveillance data.”
Dr. Nilesh Kalyanaraman, Anne Arundel County health officer, said during a news conference Tuesday they weren’t exactly “flying blind,” but they had “fuzzy” vision.
Officials such as Kalyanaraman use data on infections to direct resources such as vaccines and test kits. Hospitals use the case counts to anticipate when more people will need their care.
In Maryland hospitals, 93% of about 8,250 acute care beds are occupied, according to Bob Atlas, president and CEO of the Maryland Hospital Association.
About 15% of those patients have COVID-19, the association reports. Up to three-quarters of them are not vaccinated. Many, but not all, of the vaccinated patients have underlying health conditions.
Atlas said there are long waits in emergency departments, so he urged people without real emergencies to seek urgent care centers, doctor offices and telehealth services.
“There is no reason not to get vaccinated at this point,” he added.
Even without data, the state’s hospitals anticipated a crush of seriously sick patients a week or so after the Thanksgiving holiday and reinstituted some pandemic protocols.
Many are considering what services they can curtail without causing more harm to patients later. They are moving around staff, transferring patients within their health systems and to others. Atlas said adding more beds would be a challenge given the widespread staffing shortages around the country due to burnout and poaching by staffing agencies that pay higher wages to go elsewhere.
Gov. Larry Hogan made some of these actions official Wednesday as part of the state’s ongoing pandemic planning, and asked hospitals to submit specific surge plans in anticipation of more delta and omicron cases.
For its part, the state established a Surge Operation Center to manage, for example, patient transfers when hospitals are at capacity. Hogan specifically ordered hospitals to reduce non-urgent medical surgeries when hospitalizations reached 1,200 and implement their pandemic plans at 1,500.
Hospitalizations were at 1,151 Tuesday, up from a recent low of 490 on Nov. 14, according to the state’s coronavirus dashboard. The number of COVID-19 cases has not been updated since Dec. 3 when 1,866 cases were added.
Hogan also continued his calls for people to get vaccinated and boosted against COVID-19 and also against the flu, shots that can be given together.
That is a crucial message, said Leslie Simmons, chief operating officer at LifeBridge Health, which operates Sinai hospital and others.
She said many hospitalized patients are younger, ages 25 to 55. Few are vaccinated and none have had booster shots now authorized for those 16 and older. She recalled two unvaccinated patients — one 26, the other 52 — who had no underlying health conditions and recently died from the virus.
Simmons said the situation is so severe and the threats so strong that she called for reinstatement of a mask mandate, which Hogan and many other executives have resisted after public backlash.
She said the missing state data could help push that message by showing people just how bad things are getting and how fast.
Even without it, she said, hospitals already are overwhelmed and staffs are severely burned out. A bed or provider may not be readily available when people need them.
“I get it, people want to celebrate the holidays with their families,” Simmons said. “People don’t want to wear masks anymore. But vaccination alone will not do it. Do the responsible thing to help us cope. Get vaccinated, get the booster, stay distant, wash your hands, and yes, wear a mask indoors and at gatherings.”
Modeling from the University of Washington’s Institute for Health Metrics and Evaluation shows cases nationwide are expected to remain high through the end of January. Under a worst-case scenario, cases could spike to levels not yet seen during the pandemic, or, with universal masking, they could plummet.
Eili Klein, associate professor of emergency medicine at Johns Hopkins who researches how individuals contribute to the spread of infectious diseases, said the picture is less clear in Maryland where data gaps are clouding the view.
Omicron, he said, seems more transmissible but is probably not accounting for the current surge in hospitalizations. The change in weather, increase in indoor activities, and relaxation of mask mandates and social distancing requirements are more likely driving the uptick, he said.
Usually, more hospitalizations are caused by more cases, but with Maryland’s infection tally still unknown, the state’s models will not be complete.
“We’re not clear on what’s happening now, so that’s the big question,” Klein said. “We have these challenges that become acute when things rise dramatically, because it’s difficult to pivot quickly. If we knew in three weeks or six weeks in advance that we’re going to need more beds, you can more easily change around procedures and processes.”
The Maryland Department of Health confirmed the first three cases of omicron Dec. 3. Andy Owen, a spokesman, said officials won approval Dec. 1 from a state spending panel for an emergency procurement of additional supplies to expand the state’s capacity to detect COVID variants and extended its contracts with university labs to continue sequencing samples.
“Through agreements with the University of Maryland and Johns Hopkins University, our goal has been to sequence at least 10% of the positive samples identified in the state each week, and we have consistently done so over the course of 2021,” Owen said.
Luke Tallon, scientific director of the Genomics Resource Center, the analytics lab at the University of Maryland School of Medicine, said his lab has identified a “handful” of additional omicron cases in the state since Dec. 3. He said, however, reporting to national data platforms is difficult since the state health department’s breach.
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“What [the hack] has impacted is that for some of the specimens we’ve received outside of the system, we don’t always have access to the demographic metadata we need to report to public databases, metadata like date of collection, age,” he said.
He said the lab is sending findings to the health department, but that the information is incomplete.
Tallon said it’s still early to project how quickly omicron is going to spread in the state.
“But it’s pretty reasonable to assume based on the data we got from South Africa and the United Kingdom and other states that it’s likely omicron will spread quickly in the coming weeks and months,” he said. “We don’t yet have enough data from our lab, so the biggest challenge is encouraging people to get tested so we have samples to look at statewide.”
Tallon didn’t provide information about the new cases. The three cases already identified in Maryland were in the Baltimore area, one involving a person who had traveled to South Africa where the variant was first identified. The second person lived in the same household, and the third case was unrelated and had no travel history. None were hospitalized.
Two of those people were vaccinated against COVID-19, though they did not have booster shots that studies are showing can add significantly to protections. The vaccines still are considered effective against serious illness requiring hospitalization.
Omicron has been labeled as a “variant of concern” by the World Health Organization for the global spike in cases. Studies are still trying to determine just how much more contagious and dangerous it may be and how much the vaccines are affected — and how much more it may contribute to the delta-fueled surge in coming weeks.