With Maryland adding thousands of new COVID-19 cases and the new, more contagious omicron variant spreading like an out-of-control wildfire, health officials worry the state stands at the precipice of being overrun by the coronavirus.
Testing lines are long and hospitals already are at or near capacity. In the nearly three weeks since a cyberattack disrupted the state health department’s ability to report data on new cases, Maryland has added nearly 46,000 cases. That adds up to one in every 135 Marylanders becoming infected.
During that time, omicron — discovered only late last month — has spread so rapidly it’s now the dominant strain in the U.S. and accounts for 40% of the cases sampled in Maryland. The new variant is infecting both the unvaccinated and the vaccinated, but some research suggests it may be milder. However, the respiratory infection remains dangerous, especially for those who are unvaccinated or vulnerable for other reasons, and hospitalizations are surging statewide.
The number of people in the hospital with COVID-19 has tripled since mid-November, seriously straining the health care workforce and resources. There were 1,505 people hospitalized Thursday, with 300 in the ICU. That’s enough to trigger a threshold put in place by Gov. Larry Hogan, directing hospitals to focus on COVID-19 patients and less on other non-emergency procedures.
Hogan said this week that the 9% of Maryland adults who have yet to start getting vaccinated account for 75% of the state’s COVID-related hospitalizations.
That shows vaccines lower the risks for severe illness, which is how vaccines are supposed to work, said David Marcozzi, COVID-19 incident commander for the 13-hospital University of Maryland Medical System.
The threat from omicron can’t be overstated, Marcozzi said, as way more cases will mean more hospitalizations.
“Even if it’s less severe but more transmissible, that’ll put an unbelievable strain on the already taxed health care system,” he said. “Across UMMS, we are nearing or at capacity and implementing surge plans, ahead of the governor’s order. We have processes in place to open as many beds to patients who need them.”
At some point, however, there could be limitations on the system’s ability to deliver care, he said.
On Friday, the university system’s Upper Chesapeake Health in Harford County declared a hospital emergency at Upper Chesapeake Medical Center in Bel Air as the number of COVID-19 patients surged 733% in the past four weeks. The system is imposing new crisis protocols to free up resources for coronavirus patients, most of them unvaccinated.
While Upper Chesapeake Health is the state’s first hospital to adopt such measures, Marcozzi said, it won’t be the last.
Projections released Wednesday by the Institute for Health Metrics and Evaluation, an independent health research center at the University of Washington, showed a steep curve up in cases around the country and in Maryland through January and in hospitalizations through much of February.
In Maryland, the projections estimate infections could range from about 18,000 new cases a day to more than 122,000 if omicron continues apace — that’s between three and 20 times Maryland’s single-day record of 6,869 cases reported Thursday.
The IHME projections show fewer people would be infected if more people get a booster shot and they would drop by 40% if most people wore masks.
The projections show that hospitalizations for COVID-19 could exceed 2,200, exceeding the peak recorded in the state last January of 1,952. A total of more than 14,300 people could die by March.
Carroll Hospital is already at “max capacity,” wrote Garrett Hoover, the hospital’s president in a letter this week to the Carroll County Times, a sister paper of The Baltimore Sun. In the letter, Garrett laid out the stark reality facing the Westminster hospital, saying it had more COVID-19 patients than ever before and 45% more patients than normal.
“The hospital’s goal is to care for our community, and it is getting increasingly difficult with the number of extremely sick patients we have been seeing,” wrote Hoover, also a senior vice president of Lifebridge Health, which also has hospitals in Baltimore city and county. “We have closed many of our outpatient services to redeploy the nurses in those areas to the units that need the help the most.”
The UMMS system, in addition to the measures to increase bed space, has plans for other resources such as ventilators if they become scarce, Marcozzi said. Officials relied on a framework devised by a special committee formed in the state as a “guiding document,” he said.
The committee of ethicists, hospital systems and others developed a common set of standards for crisis care.
The state has not formally adopted the plan or officially asked hospitals to consider it, said Diane Hoffmann, a law professor in the University of Maryland Carey School of Law and director of the Maryland Health Care Ethics Committee Network, which oversaw the framework.
She said Hogan does not have to order rationing of medical resources now, but disseminating the plan would give hospitals time to prepare.
“Hospitals need this time to put staff and systems in place that are consistent with the plan,” she said. “Things are moving fast with the pandemic and hospitals are becoming filled to capacity so the need for allocating certain scarce resources may soon be necessary.”
Already the proportion of patients in Maryland hospital beds due to COVID is growing. About 19% of patients Wednesday were due to COVID-19, up from about 16% a week ago, according to the Maryland Hospital Association.
In all, hospitals were about 92% full, the association reported, and non-COVID patients were being moved to long-term care or rehabilitation facilities. Some patients are putting off procedures until after the holidays.
“Maryland hospitals continue to do everything in their power to stem the latest COVID-19 surge and stretch to care for their communities,” said Bob Atlas, president and CEO of the Maryland Hospital Association.
For now, the main concern is staffing, rather than equipment, which Atlas said is no longer scarce as it was early in the pandemic.
“Hospital personnel are stretched to their limits right now and we cannot demand much more from them,” he said. “Everyone must take the measures needed to protect ourselves and our precious health care workers. Wear masks when indoors with people not in one’s family, even if vaccinated. If not vaccinated or boosted, get the shots.”
The vaccinations include flu shots, as cases around the state also are beginning to rise after a year almost entirely off from the annual scourge.
Normally a network of doctors’ offices and hospitals report when patients come in with influenza-like illnesses (many are not formally tested). The numbers have not been reported since the cyberattack on the state health department, even though the state put some other data back online Monday.
Health officials said in an email, however, that while there are cases they are not yet at high levels. Providers have reported seeing 5,806 patients with flu-like symptoms and about 6.6% positivity rate from more than 17,000 tests that were performed.
This year’s flu vaccine protects against four strains, and three of the four are considered a good match this year so far.
Getting vaccinated against the coronavirus is a consistent message from health officials.
“As we move further into the holidays and winter season continues, getting vaccinated, boosted and tested are the most important precautions Marylanders can take to protect themselves against COVID-19 and the delta and omicron variants,” said state Health Secretary Dennis Schrader in a statement Wednesday.
Two doses of vaccine appear to keep people out of the hospital and a booster may prevent infections, Marcozzi said, urging everyone 16 and older and eligible to get three doses. He also pointed to other measures, such as wearing the most protective masks, N95s or KN95s.
He also called for people to get tested before gatherings, though that has proved difficult in recent days as demand has skyrocketed.
And he pointed to other tools on the way, such as antiviral pills developed by Pfizer and Merck that were given federal emergency authorization during this week. They appear to prevent many infections from worsening to the point of hospitalization.
Garrett also pleaded with readers of his letter to get vaccinated.
“We have patients begging for the vaccine as they are getting intubated; unfortunately, at that time, it’s too late for a vaccination,” he wrote. “Your neighbors, your friends, your relatives are dying from this virus and leaving behind families that would do anything for one more day with their loved one.
“Our message is straightforward: Get vaccinated, get your booster, wear your mask in public places, please use good judgment with your holiday gatherings and wash your hands frequently.”