As Maryland’s surge of COVID-19 cases and hospitalizations begins to decline around Baltimore and Washington, D.C., after several weeks, other parts of the state may have longer to wait before relief comes.
Spreading first in more densely populated and urban areas before fanning out to rural regions, the coronavirus tends to follow a similar pattern with every wave, according to public health researchers and medical experts. That means the outermost parts of Maryland may be on a different timeline than the rest of the state.
“It’s not all coordinated,” said Eili Klein, associate professor of emergency medicine at Johns Hopkins who researches how individuals contribute to the spread of infectious diseases, in an interview earlier this month. “Eastern and Western Maryland are behind ... those areas are going to be stressed a little bit longer.”
As challenging as omicron has been for the state’s weary health care workers in the Baltimore area — where several hospitals shifted to crisis-mode standards of care in recent weeks — the surge may be especially painful in the state’s outer edges, where resources are more scarce and vaccine acceptance is less prevalent.
Already, state data shows the infection rates falling in Central Maryland while continuing to rise on the Eastern Shore and in Western Maryland. As of the latest data, Dorchester County led the state in the 14-day average case rate, with more than 30 cases per every 1,000 people, according to the latest figures. Allegany County followed, with more than 25 cases per every 1,000 people. Wicomico County, Dorchester’s neighbor, trailed close behind with more than 24 cases per every 1,000 people.
In the Baltimore area, the city’s case rate stood at about 16 cases per every 1,000 people, followed by Harford and Howard counties with about 13, Anne Arundel and Baltimore with about 12 and Carroll County with more than 11.
Driving this latest surge is the new and more contagious omicron variant, which quickly became the dominant strain in Maryland and nationwide after being identified by the World Health Organization right after Thanksgiving. It now accounts for more than 95% of all Maryland’s lab-confirmed COVID-19 cases, Maryland Gov. Larry Hogan said Thursday.
The high volume of people contracting the virus has translated to a crush of patients needing hospital care at once. Faced with limited testing options, many people flooded emergency departments to find out whether they were infected, which state officials have sought to counteract by opening new testing centers and making at-home kits more available.
The daily case totals, while improving, remain high — with close to 2,700 infections recorded statewide Monday. The testing positivity rate now stands at around 15%, down from a peak of nearly 30%.
Until the situation improves, Dorchester County Health Officer Roger Harrell said he will pick and choose his battles.
Despite the health department’s outreach and state and federal partners helping to get more people immunized, Dorchester’s vaccination rate remains stubbornly low in certain areas, he said, which he attributes to some residents’ cultural attitudes about vaccines. His focus has pivoted to other measures that can keep his county safe, such as handing out high-quality face masks and keeping testing options open.
“We’ve done the best we can, but it’s all going to come down to behaviors. Are they going to follow what they’re asked to do?” Harrell said. “Be it COVID, [sexually transmitted diseases] or teenage pregnancy, how do you change those behaviors?
“We give you the tools, and if you don’t use them, I can’t use them for you. We give them as much support as possible.”
Less than 55% of Dorchester’s population is fully vaccinated, according to state data. But Harrell said he’s encouraged by the number of masks the department has distributed lately, taking it as a sign that residents are heeding the department’s warnings.
In Allegany County, where nearly half of residents are fully vaccinated, health officer Jenelle Mayer said her staff also is focused on testing and has seen volumes soar over the past several weeks.
Six months ago, about 40 people would show up at the Allegany County Fairgrounds testing site each day. That number has ballooned to as high as 400 on a given day, Mayer said.
While the county’s case rate remains well above the state’s, Mayer said internal projections show a slowdown coming soon.
“We continue to encourage county residents to get vaccinated and boosted, wear a mask, get tested if experiencing symptoms, and follow [U.S. Centers for Disease Control and Prevention] isolation and quarantine guidelines,” Mayer said in an email.
Boosters have been especially critical in keeping people from contracting acute illness as a result of omicron, the CDC said Friday, but Americans have been slow to get them and many people remain ineligible because they are still within six months of receiving their second shot. About 39% of vaccinated Americans have been boosted, according to the CDC.
Meanwhile, in highly vaccinated Maryland, close to 44% of the vaccinated population has gotten a booster, data shows, or just over 1.9 million people. Nearly 4.4 million people have been fully vaccinated, according to state figures.
Health care officials on the Eastern Shore said the majority of patients needing hospital care for COVID-19 have not been fully immunized. Of the patients seeking treatment at the University of Maryland Shore Regional Health facilities, less than 5% have received a third dose, chief medical officer Dr. William E. Huffner said.
As of Friday, Shore Regional — which serves Caroline, Dorchester, Kent, Queen Anne’s and Talbot counties — had 34 COVID-19 patients receiving inpatient care and an additional four in waiting rooms. More than 90% of beds were full, Huffner said, higher than typical bed occupancy.
In addition to booster shots, Huffner said Eastern Shore residents should seek out tests, as well as wear masks in public places and keep distance from others until the case rates fall. He said the Eastern Shore typically lags behind statewide declines by about two weeks.
“It’s frustrating to know that the most important tool to combating COVID is vaccination, and we see so many patients choose not to. It’s unfortunate,” said Huffner, also the COVID-19 incident commander for the Eastern Shore facilities. “It’s sad when we have so many sick people.”
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The situation is similar at TidalHealth, which operates medical centers in Salisbury and Seaford, Delaware. Most of the patient population is not vaccinated, said Sarah C. Arnett, vice president of patient care services and chief nursing officer at TidalHealth.
The medical network shifted its hospitals to crisis-mode standards of care on Jan. 10 and Jan. 11, allowing them to delay some surgical procedures, cut back on documentation and paperwork duties temporarily, and redeploy staffs to different units.
Arnett said that though TidalHealth’s staffs are discouraged, they may better understand patients’ reservations about getting vaccinated compared with their peers in more urban areas.
“We are a representation of our community, and there are varied opinions [about vaccines] in our health care workforce as well,” Arnett said. “Overall, people are frustrated and tired, but ... the concern is we’re not able to provide the level of care we want to provide.”
Aside from physical limitations on where to house patients, Arnett said, a shortage of staff — particularly nurses, respiratory therapists and other ancillary support workers — makes matters worse. She said providers can sense tensions rising in the community, too.
“There’s been an increase in aggressive behavior and verbal aggression toward staff and toward other patients who are waiting. We understand there will be longer waits for care and service than people are accustomed to; it’s stressful for our health care providers to know that,” she said.
“We’re hoping in about two weeks, or at the end of [the] month at least, there will be sustained plateau where we can come out of crisis mode and return to a more normal, operational approach to our care.”