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Maryland hospitals hope to avoid nationwide surge of coronavirus cases but are planning for the worst

The University of Maryland Medical System installed a 4,500-square-foot modular care unit, foreground, with all the medical equipment needed to serve 16 coronavirus patients on a parking lot across the street from its downtown Baltimore hospital. The unit will be ready in mid-December.
The University of Maryland Medical System installed a 4,500-square-foot modular care unit, foreground, with all the medical equipment needed to serve 16 coronavirus patients on a parking lot across the street from its downtown Baltimore hospital. The unit will be ready in mid-December. (Kenneth K. Lam)

As the United States sets records for new coronavirus cases, overwhelming hospitals in states including Texas, Utah and the Dakotas, Maryland still has beds and supplies to spare.

Cases have been climbing in Maryland this month, reaching a high since Aug. 1 of 962 new cases Thursday. Hospitalizations topped 500 Wednesday, after falling to a low in late September, but still remain well below the peak in early May of more than 1,700 hospitalized.

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Hospital officials and public health experts say the challenge will be keeping that rise to a creep rather than a surge as cooler weather, loosening restrictions and the upcoming holidays potentially spur riskier behavior among pandemic-fatigued residents.

“Essentially everywhere across the country we’re seeing some rise in cases, and how big this current surge is going to ultimately be depends on what governments do and what individual people do,” said Dr. Eric Toner, a senior scholar with the Johns Hopkins Center for Health Security and a pandemic preparedness expert.

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“If people wear masks and maintain distance and avoid indoor crowded spaces, we won’t be too bad,” he said. “In Maryland, most people are doing that, but in other parts of the country people don’t do that."

Toner said the current increase in cases in Maryland is likely related to an easing of restrictions on gathering in public spaces in summer and fall and more opportunities to interact. Colder weather and the holidays likely will draw more people together indoors where the virus can spread more easily. Flu cases also are expected in the mix.

Some members of the University of Maryland Medical System modular care unit steering committee stand in front of the 16-bed, 4,500-square foot hospital unit installed on a parking lot across the street from the main hospital. The unit will be ready in mid-December.
Some members of the University of Maryland Medical System modular care unit steering committee stand in front of the 16-bed, 4,500-square foot hospital unit installed on a parking lot across the street from the main hospital. The unit will be ready in mid-December. (Kenneth K. Lam)

The state’s hospitals say they are preparing for more patients, but they don’t expect a return to the crush from earlier this year when most existing beds were full and extras were added, staff was working overtime in makeshift ICU units and non-emergency procedures were halted to conserve resources.

There are about 9,400 hospital beds normally available for all services, which are typically about 82% full with victims of accidents and serious illnesses, as well as those undergoing non-emergency procedures that include everything from cancer surgeries to knee replacements.

Beds are currently about 84% full, said Bob Atlas, president and CEO of the Maryland Hospital Association.

Patients with COVID-19, the illness caused by the coronavirus, fill 7% of the occupied beds, down from 27% in early May.

If there were a sustained surge of coronavirus cases, there are more than 2,000 beds at the ready but unstaffed. Gov. Larry Hogan had ordered the extra beds based on worst-case-scenario planning when the pandemic began. Some were inside the hospitals themselves and others were created in tents and makeshift buildings in parking lots and at the Baltimore Convention Center.

This week, Maryland had the ninth-fewest COVID-19 patients occupying beds in the country relative to its population, Atlas said.

The state has 74 coronavirus patients hospitalized per million people, compared with the national average of 127 per million people, he said. That compares, for example, with North Dakota (357 per million people), South Dakota (414 per million people) and Montana (334 per million people).

Also, Atlas said, patients are less sick now than they were during the spring peak when one in three patients was in the ICU. Now it’s one in four patients. Potential reasons include the experience of doctors in treating COVID-19 and the younger, relatively healthier status of patients. Early in the pandemic, many more patients were fragile seniors from nursing homes.

As for equipment such as masks, gowns, gloves, testing supplies and medications, supply chains remain stressed by demand, but stocks are higher than during the peak, Atlas said.

“The story is hospitals are managing effectively,” he said. “If you ask them if they are worried about a surge of coronavirus cases, plus the flu, I think everyone would say they are prepared. ... You don’t want to bet on hope.”

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There already have been more than 143,000 COVID-19 cases and about 4,000 related deaths statewide.

It’s not clear whether the seasonal flu, with similar respiratory symptoms to COVID-19, will make matters worse at the hospitals during this current uptick. It’s also not known when a coronavirus vaccine will be available, though several vaccine candidates are in late-stage trials and could be approved in coming months and begin the manufacturing and distribution process, which will take months more.

Dr. Aaron Milstone, a Johns Hopkins epidemiologist, said he’s been watching cases rise in Maryland in recent weeks and worries that people are tiring of precautions such as masking and distancing.

He suggested continuing to meet others outside, even in the chilly air. And when it comes to holidays, consider leaving candy for Halloween outside rather than handing it out, watching sports or a movie with masks at Thanksgiving rather than sharing a meal, or sharing a meal in separate rooms — measures that reduce but don’t eliminate risk.

“We’ve been anticipating a second surge for a while now, and we’ve had time to stock our shelves and learn from our experiences,” Milstone said. “With that said, the spring was tough on health care workers. It was emotionally and physically exhausting to handle that surge and that degree of suffering. We’re hopeful people continue compliance with precautions.”

At Hopkins, the University of Maryland Medical System and other hospitals, officials continue to meet regularly to assess needs.

Construction is underway for an auxiliary ICU on a parking lot across from the University of Maryland Medical Center, and other system hospitals have special tents at the ready, said Dr. David Marcozzi, who leads COVID-19 preparedness for the system’s 13 hospitals.

The University of Maryland Medical System installed a 4,500-square-foot modular care unit, foreground, with all the medical equipment needed to serve 16 coronavirus patients on a parking lot across the street from its downtown Baltimore hospital. The unit will be ready in mid-December.
The University of Maryland Medical System installed a 4,500-square-foot modular care unit, foreground, with all the medical equipment needed to serve 16 coronavirus patients on a parking lot across the street from its downtown Baltimore hospital. The unit will be ready in mid-December. (Kenneth K. Lam)

He said the system has other measures in place, such as an extensive telehealth program that efficiently allows for virtual treatment while conserving resources. The system also is acquiring extra protective gear and medications in case of a big jump in patients, though staffing still could be a hurdle if cases really surge, he said.

“We’ve done a good job in the state of Maryland with masking and distancing, but there will be more people infected and more hospitalizations unfortunately,” Marcozzi said. “The level will reflect the public health precautions that we maintain. We’re hoping it’s not a mountain we need to ascend. Maybe it will be a hill.”

Other hospitals are taking a similar look at resources. MedStar Health, operator of 10 hospitals in Maryland and Washington, D.C., has ample beds and supplies of personal protective equipment, or PPE, that can be moved where needed, its officials say.

That’s what officials also are doing at LifeBridge Health, operator of Sinai, Carroll and Northwest hospitals.

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“Because of our planning and preparation in the spring, we have our surge capacity plans and beds already in place,” said Sharon Boston, a LifeBridge spokeswoman. “Should the need arise, we also have our surge tents up, but not in use.”

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State health officials say they are keeping tabs on all the hospitals, and relying on data and “worst-case” projections COVID-19 and flu cases for planning, said Charlie Gischlar, spokesman for the Maryland Department of Health, in a statement.

The health department “tracks the patient hospital census in real-time to determine if a hospital should activate surge beds and how MDH and partners can assist the institutions,” he said. “MDH is monitoring PPE usage based upon an algorithm developed with our partners and has PPE supplies on order and will be placing additional orders”

Every state needs to be keeping track of potential needs and urging residents to follow public health advice, said Nancy Foster, vice president of quality and patient safety policy at the American Hospital Association.

She said there are “concerning reports of surges” of coronavirus patients, particularly in the Midwest and Mountain West. The rural hospitals have the least ability to expand care, but staffing could be a wider problem, Foster added.

“While hospitals can add beds, it is much harder to bring in additional health care workers, many of whom are justifiably experiencing a significant emotional and physical toll due to the impact of the pandemic,” she said. “In addition to getting a flu vaccine, we continue to urge everyone to wear masks, maintain social distance and wash their hands.”

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