As new cases of coronavirus infection swelled again this fall, setting new daily records starting in mid-November, Maryland officials watched warily as hospitalizations crept up.
While initially lagging the growing caseload, hospitalizations caught up this week, with the number in hospital beds reaching 1,729 on Friday, more than doubling from a month earlier. There are more patients hospitalized with COVID-19 in Maryland now than at any other time during the pandemic, stretching resources and straining the workforce.
The surge in cases and hospitalizations is happening nationwide, with the country hitting the grim milestone this week of more than 3,000 deaths in a single day. Several states report dangerous hospital crowding with few, if any, beds left for more patients.
Maryland still has a cushion of hospital beds, and more could be set up if needed. But officials fear the situation will worsen during the holiday season, even as localities tighten restrictions to curb infections and health care providers get better at treating the sick.
“We’re very concerned the numbers may go up,” said Bob Atlas, president and CEO of the Maryland Hospital Association. “We’re two weeks beyond the Thanksgiving incubation period when people show symptoms and then symptoms start to make them go to the hospital. So we’re bracing for what might come in another week or two.”
Atlas said the hospitals used the lead time to prepare, but he and others also are “urging people to do the right thing” to stem cases that number nearly 230,000 so far in the state. More than 4,900 have died.
That means people should continue to take precautions and avoid family gatherings, which Gov. Larry Hogan called the state’s No. 1 means of transmission of COVID-19.
Hogan ordered the hospitals to prepare surge plans if more than a total of 8,000 people were hospitalized for any reason. He urged them to consider forgoing some procedures that require a bed and intensive care.
He stopped short of telling them to stop performing nonemergency procedures as he’d done in the spring, a policy that caused financial hardship, staff furloughs and concerns some weren’t seeking needed care.
The Republican governor did not increase public restrictions this week, though Baltimore and several counties did. Democratic Baltimore Mayor Brandon Scott cited increased hospitalizations in announcing a ban on indoor and outdoor dining and other measures.
“These restrictions today, while they may seem harsh, are being implemented to save lives and to reduce the stress on our medical system,” Scott said. “The vaccine is on the way, but we must take action now to address the rise in cases and hospitalizations.”
The U.S. Food and Drug Administration approved the first vaccine, from Pfizer and BioNTech, for emergency use Friday evening and the first doses are expected to be delivered within days. However, widespread vaccination isn’t expected for months.
State health data showed that hospitalizations topped late April’s previous pandemic high of 1,711 on Wednesday and grew a little more Thursday and Friday. However, the number of people requiring intensive care for COVID-19 remains well off the May 10 peak of 611 at 416 Friday.
There are almost 7,400 people now hospitalized in Maryland for any reason, still hundreds below Hogan’s surge benchmark. There are an additional 1,100 beds staffed but unoccupied and about 1,800 unstaffed beds, hospital data shows.
Atlas said non-COVID-19 cases, such as car crash and heart attack victims, have dropped in the past month in the hospitals but remain the bulk of the hospitalizations. There also have been dozens of people hospitalized due to a multistate outbreak of hepatitis A, a contagious liver infection often linked to drug use and some sexual behavior. Maryland has reported 265 cases this year, many times the normal number, and close to three-quarters of them have required hospitalization.
Across the country, bed availability is shrinking, according to data released by the U.S. Department of Health and Human Services on hospitals in 2,200 counties.
An analysis of the data by the University of Minnesota’s COVID-19 Hospitalization Tracking Project found hospitals were at least 90% full in 126 counties, including those in Georgia, Minnesota, Oklahoma and Texas. There are now close to 104,000 people hospitalized from the coronavirus across the country.
Caseloads vary among hospitals, and Maryland officials have formalized an emergency program that facilitates patient transfer to other facilities where they could receive trauma or other specialty care.
So far about 35 patients of all kinds have been moved using the program, which is operated by the Maryland Institute for Emergency Medical Services Systems, said Dr. Theodore R. Delbridge, MIEMSS’ executive director.
“The advantage of the critical care center is that we have insight where there are beds throughout the state, in near-real time,” Delbridge said. “It changes day to day and hour to hour.”
He said the state’s hospitals are not at capacity, but MIEMSS is maintaining a close census on beds and staff. State officials have put out a call for retirees, students, school nurses and others to work in hospitals.
Delbridge said hospitals have added about 900 nursing school students to their force, giving them credentials that go toward their degree for their service, and about 200 more students are “in the queue.” The state also has created pathways for emergency medical technicians and paramedics to expedite their training, Delbridge said.
Dr. Brian Garibaldi, medical director of the Johns Hopkins Biocontainment Unit, said Friday during a news briefing hosted by the Hopkins Coronavirus Resource Center that extra staff is helpful. But he said with so many seriously ill COVID-19 patients, some workers end up in unfamiliar roles in intensive care and isolation units.
He said, however, a core work force on the job for months has grown accustomed to working in protective gear and has experience treating patients. For example, they can deliver enough oxygen to some patients without putting them on a ventilator that can harm their lungs.
Garibaldi also said there are treatments now available, including the antiviral drug remdesivir that can shorten the length of illness and hospitalization and dexamethasone and other steroids that reduce inflammation and may help prevent death in the sickest patients.
Monoclonal antibody treatments also are promising in treating newly infected people, though he said it’s not yet clear if they will keep people out of the hospital. Such treatments require an infusion, and that requires health care staff, though he noted the state had established an an outpatient infusion center at the Baltimore Convention Center field hospital and testing site.
Still, Garibaldi said the hospitals remain under threat.
“Our greatest challenge I see is the hospital system becoming overwhelmed,” he said.
Other hospitals said they are concerned about the increase in patients, but say so far they are managing.
Michael Schwartzberg, a spokesman for the University of Maryland Medical System, said the 13-hospital system is busier now than in recent months with all kinds of patients, but it had prepared for a fall and winter surge.
“Hospitals are typically very busy at this time of the year, and it is also important that we continue to provide non-COVID-related care for Marylanders who are ill, injured or recovering from surgery,” Schwartzberg said in an email, adding that of the more than 2,300 system patients, about 15% are COVID-positive.
“Since the start of the pandemic,” he said, “we have implemented more efficient system-based processes to ensure patients are matched to a bed that fits their care needs — even if that means being transferred to another unit within a hospital, another UMMS facility or to one of the state’s alternate care sites.”
Hospital executives speaking at a Greater Baltimore Committee event this week said no one hospital is overburdened yet, thanks to increased communications and partnerships formed among systems.
”We’re more prepared,” said Kenneth A. Samet, president and CEO of MedStar Health, “but I don’t want anyone to hear that to mean we’re not in an incredible crisis moment, an incredible pressure moment.”