As the delta variant of COVID-19 drives a resurgence of cases in Maryland, weary hospital leaders and front-line workers say they have renewed concerns about their capacity to care for a potential onslaught of patients — especially as flu season approaches and children head back to school.
Hospitals are filling, and not just with COVID-19 patients, but also with those who delayed visiting doctors for other issues over the course of the coronavirus pandemic, said Bob Atlas, president and CEO of the Maryland Hospital Association.
Though fewer patients are being treated for the coronavirus than during previous waves of the last 18 months, and Maryland is faring far better than many southern states, hospitals could reach a breaking point if the situation worsens, he said.
“Hospitals did not entirely eliminate the extra capacity and a lot can be restarted fairly quickly now,” Atlas said. “The real constraint isn’t beds — it’s people.”
An already depleted health care workforce is nearing exhaustion as the demands of a public health crisis drive more people out of the industry or to higher paying temporary positions elsewhere, Atlas said. The staffing shortfalls are especially pronounced among nurses, who often spend the most time with patients.
So far, there isn’t a statewide hospital worker shortage, but rather “mismatches,” with some hospitals short and others not, Atlas said. And, he said, the problem is being exacerbated by the expiration Sunday of a state emergency order that gave hospitals flexibility to hire nurses with expired or out-of-state licenses.
In an email, Maryland Department of Health spokesman Charles Gischlar said Republican Gov. Larry Hogan is evaluating the daily coronavirus data.
“We ... will make appropriate adjustments as needed to protect the health and well-being of Marylanders,” he said.
Public health experts, medical professionals and government agencies have long warned that uncontrolled spread of the coronavirus could have dire implications for hospitals, which operate with finite reserves of equipment, beds and workers. Hospitalizations and infections fell dramatically this spring and summer as COVID-19 vaccinations scaled up, but have ticked up again as the new and more contagious delta strain circulates widely.
As of Sunday, 546 people were hospitalized with COVID-19, according to the state, well below the winter peak of more than 1,900 on a single day. Infections jumped all last week, with more than 1,000 cases added to the case count Thursday and Saturday and nearly 900 Sunday. The state’s seven-day average testing positivity rate stood at 4.54% after falling below 0.5% in June.
The variant accounts for nearly all of the country’s COVID-19 cases, according to the U.S. Centers for Disease Control and Prevention’s latest genomic surveillance data. The agency considers delta far more contagious than the original strain. It’s also more adept at breaking through the protections provided by vaccination, though the shots prevent people from becoming seriously ill.
Few of those breakthrough cases have ended up in hospitals so far, but Dr. David Marcozzi, COVID-19 incident commander for the 13-hospital University of Maryland Medical System, still worries more cases will arrive, and another variant could make matters even worse.
Beds are full, Marcozzi said, and more COVID cases would displace people who finally have been able to get heart surgery or other critical care put off by the pandemic.
More COVID cases among unvaccinated patients also will “further frustrate staff and will test their resilience,” he said. For now, they are handling the load.
“We’ve been through this fight before, we know the game,” Marcozzi said. “It may be changing because of the variants, but we as a health care system, we have not stopped having conversations around planning. For delta, for children, the medical system continues to work.”
“The real constraint isn’t beds — it’s people.”— Bob Atlas, president and CEO of the Maryland Hospital Association
The federal government is still evaluating the potency of delta among children, but Maryland hospital leaders said more kids and young adults are testing positive for COVID-19 now, and more are requiring hospitalization.
“Many COVID patients are younger than before. ‘Younger, quicker, sicker’ is our description,” said Dr. Stuart Bell, vice president of medical affairs at MedStar Good Samaritan and MedStar Union Memorial hospitals in Baltimore. “Certainly, more are getting sick than had previously.”
Dr. Ted Delbridge, executive director of the Maryland Institute for Emergency Medical Services Systems, said 2% of the patients hospitalized for COVID-19 over the past two months have been children younger than 19, twice the volume as in the beginning of the public health crisis.
Older adults used to make up higher proportions of those hospitalized, he said, until vaccine coverage among those groups became widespread. Now, patient demographics are changing, he said, and staffs are concerned about the resources and clinical expertise they have on hand.
“We are far away from where we were in terms of the need to hospitalize people last spring and winter. What’s different now is hospitals are busier with the work they do routinely,” Delbridge said. “The resources hospitals usually rely on when in seasonal staffing crunches aren’t as ubiquitous.”
Hospital officials and workers said the federal government’s authorization of COVID-19 vaccines brought a much needed shot in the arm to weary staffs who had experienced death and severe sickness at mass scales. But morale has shifted since.
“As a nurse myself, it’s devastating,” said Leslie Simmons, chief operating officer at LifeBridge Health, a network composed of Sinai Hospital, Levindale Hospital and Grace Medical Center in Baltimore, Northwest Hospital in Randallstown and Carroll Hospital. “We’re watching what’s happening to every other state and are worried it’s a matter of time.
“We’re not staffed for 150 to 200 more beds across the system.”
More than 90% of those hospitalized due to COVID-19 are not vaccinated, according to state data and the Maryland Hospital Association. This includes not only those who have declined immunizations due to personal and religious beliefs, but also people with certain medical conditions, allergies and children under 12 who are not yet eligible.
Vaccinations may not be 100% effective at preventing a COVID-19 “breakthrough” case — the description for infections in those who are vaccinated — but they are able to keep people out of hospitals, said Dr. Maura Rossman, health officer at the Howard County Health Department.
The county, which reported last month to have vaccinated 80% of its eligible population, now is classified by the CDC as having “substantial” transmission within its borders. As of Friday, all Maryland counties were classified as having “substantial” or “high,” levels that the CDC says warrant indoor masking requirements.
Rossman said reverting to nonpharmaceutical interventions, such as masking, might feel like a “step backward” to some, but it will help keep people who are not yet vaccinated safe and prevent more breakthrough cases.
“Vaccines are highly effective, almost perfect, at stopping severe disease and death, so to remain unvaccinated means you are at substantially higher risk of getting severe disease and dying,” she said. “The virus has changed. This is a novel, new disease, so as we learn more, we want to adjust our actions.”
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Rossman said some might look at the breakthrough cases as evidence that vaccinations don’t work. But the percentage of cases remains small and less severe, even as such post-vaccination infections increase with overall infections. It’s the unvaccinated that provide the virus opportunity to mutate.
“The virus will stay alive and keep changing so it can find different ways of infecting more folks,” she said. “We need everybody to get vaccinated.”
Top U.S. officials, including Dr. Anthony Fauci, the nation’s top infectious disease expert, previously said 80% to 85% of the U.S. population would need to be inoculated against COVID-19 so as to achieve herd immunity, the threshold at which a virus runs out of viable hosts.
But the delta variant has changed that calculus, said Dr. Gabe Kelen, director of the emergency medicine department at The Johns Hopkins Hospital.
Nearly everyone will need to be inoculated against COVID-19 with very little wiggle room for exceptions in order to keep the virus at bay and the health care system afloat, said Kelen, who also directs Johns Hopkins’ Office of Critical Event Preparedness and Response.
Even though not as many people are dying from COVID-19 as they were before, Kelen said the delta variant could have profound “ripple effects” on hospitals and public health.
“There are psychological impacts, people will be afraid to come to the hospital, cancer diagnoses and treatments will be delayed, surgeries will be delayed,” Kelen said. “The overwhelming majority has to get vaccinated, otherwise we’re going to be living like this, lurching from crisis to crisis, for years to come.”