More Maryland hospitals shifted Monday into crisis mode in response to spiking COVID-19 hospitalizations in the state.
The University of Maryland Baltimore Washington Medical Center in Glen Burnie and the Luminis Health network, which includes hospitals in Annapolis and Lanham, shifted Monday to “crisis” and “contingency” standards of care. That means the hospitals can take emergency measures to ease some of the burden on doctors and nurses, including postponing some patients’ surgical procedures, cutting back on documentation for now, and converting physical spaces to other uses as needed.
Fueled by COVID-19′s new omicron variant, Maryland government leaders and medical professionals are racing to keep up as the strain on the health care system becomes more severe. Omicron has gained tremendous speed in the last month, forcing a new round of business and restaurant closures, interfering with in-person schooling and disrupting airline travel, all while placing increased demand on health care workers.
Representatives from UM Baltimore Washington Medical and Luminis Health said their decisions were made after exhausting all other avenues to address the challenges at hand and to avoid denying treatment to urgent cases.
“Unfortunately, we are just at the beginning of this surge. The weeks ahead will only become more challenging,” said Kathy McCollum, the Glen Burnie hospital’s president and CEO. “This is the right step to support our teams and to serve the many patients in our community who rely on us and trust us with their care.”
The variant’s grip on the Baltimore region tightened even further Monday, after health officials logged record-breaking case counts over Christmas and increases in the already-rising rates of people testing positive and hospital-bed occupancy.
Baltimore County Executive Johnny Olszewski Jr. declared a local state of emergency and instituted a countywide indoor mask mandate, following his Democratic counterparts in Howard, Montgomery and Prince George’s counties and Baltimore City. Democratic County Executive Steuart Pittman of Anne Arundel said he would provide updates Tuesday on the county’s COVID response efforts.
Dr. David Marcozzi, COVID-19 incident commander at the University of Maryland Medical System, said Marylanders seeking hospital care will especially feel the effects of the virus’ rage when they visit emergency department waiting rooms.
“It is reasonable to be prepared for an extended wait in the [emergency room] and please have patience with our team members. They are working as hard as they possibly can to care for everyone who comes in the door,” Marcozzi said. “Right now, our most significant constraint is staffing, and we are working with state agencies to do everything we can to support the staff we have and add team members where we can.”
Marcozzi said emergency departments, such as BWMC’s, are seeing large increases in emergency department volumes and COVID-19 cases, leading to changes in how care is delivered.
Harford County’s University of Maryland Upper Chesapeake Medical Center — part of the medical network that declared a hospital disaster Friday — reported a 733% increase in COVID-19 cases over the past month, Marcozzi said.
At Luminis Health, which oversees Luminis Health Anne Arundel Medical Center in Annapolis and Luminis Health Doctors Community Medical Center in Lanham, the system has seen a 325% increase in treating admitted patients with COVID-19 since Dec. 1, the medical group said Monday in a news release.
“Please avoid the ER for non-life threatening issues,” said Deneen Richmond, president at Luminis Health Doctors Community Medical Center, in a statement. “With that said, do not avoid getting care for more serious illness or injuries at the ER.”
Harford County Executive Barry Glassman, a Republican, said he would not call at this time for an indoor mask mandate or local state of emergency. He instead encouraged vaccinations and non-pharmaceutical interventions, such as social distancing.
“With this pandemic, there’s no playbook,” Glassman said Monday in an interview. “From the information I’ve read, most of the hospitals in the state are under the same type of pressures. Upper Chesapeake, it may be a little bit worse.”
Carroll Hospital is also under duress, Garrett Hoover, the hospital’s president, wrote in a guest commentary last week in the Carroll County Times. He urged county residents to “use good judgment” over the holidays and cooperate with the latest public health guidance, which encourages getting vaccinations and wearing masks in indoor public spaces. The hospital has redeployed outpatient nursing staff, reduced the number of elective surgeries and is operating at a “critical” level, Hoover wrote.
Meanwhile, Maryland’s challenges are compounded by COVID-19 testing shortfalls and new limits on the inpatient and outpatient therapies that can treat patients with severe infections.
The Maryland Department of Health asked providers last week to conserve lifesaving monoclonal antibody therapies for certain patients based on need after the federal government found much of the current supply to be ineffective against omicron. Oral antiviral pills, authorized last week for emergency use by the U.S. Food and Drug Administration, are expected to be in short supply for some time.
Andy Owen, a spokesman for the health department, said the state should start receiving Pfizer’s antiviral medication, Paxlovid, as early as this week, albeit in low quantities at first. The federal government will funnel more doses to states in January as supply ramps up, he added. The state encouraged doctors to prioritize patients most at risk for serious disease progression until then.
The state also will soon receive Merck’s antiviral pill, said Dr. Howard Haft, senior medical advisor for the Maryland Primary Care Program, in a Monday letter to clinicians. Again, providers should conserve those doses for those “at risk for progression to severe disease based on underlying conditions and for whom alternative COVID-19 treatment options are not accessible or clinically appropriate,” Haft said. Also, it is not recommended during pregnancy.
Such conditions and competing considerations mean individuals must make tough choices in the weeks and months ahead, said Brian Castrucci, an epidemiologist and president and CEO of the de Beaumont Foundation, a public health organization in Bethesda.
Many more people will be exposed to or infected with the coronavirus, Castrucci said, based on mathematical models and projections of omicron’s rapid spread. But there are ways to blunt its impact, he said.
“We can make sure we’re vaccinated and boosted, wearing high-quality KN95 and N95 masks, getting tested, limiting contact with others, distancing when you can and supporting the health care workers and public health workers in your community,” Castrucci said. “Most of the burden remains on the individual.”
For Castrucci, that means avoiding crowded bars and restaurants on New Year’s Eve and doing his part to ensure his kids can attend in-person school in January.
“You’ve got to figure out what’s important to you, and take those calculated risks,” he said. “We can do those things most important to us as safely as we can.”
On Monday, more than 1,700 patients were being treated for the coronavirus in state hospitals, the highest volume since January, before COVID-19 vaccinations became widespread. The jump has occurred in tandem with the rise of omicron, identified about a month ago by the World Health Organization as a “variant of concern.”
It is likely more transmissible and more capable of penetrating through vaccinations’ protective shield, according to public health experts and government officials from the U.S. Centers for Disease Control and Prevention. And it’s moving quickly: At the beginning of December, omicron accounted for less than 1% of the cases analyzed via genomic sequencing. By Dec. 18, it made up over 70% of the sequenced cases.
Several thousand Marylanders have tested positive this month, including some 25,000 over the Christmas weekend and an additional 5,376 added to the tally Monday. Though omicron cases may be more likely to cause mild cases than previous strains, more people contracting the illness means more burden on an already rundown medical system. The once-dominant delta strain may also still be circulating.
Dr. Ted Delbridge, executive director of the Maryland Institute for Emergency Medical Services Systems, said while there are beds available, providers at a given hospital might not have the bed type or caregiver that a patient needs. There will be mismatches, he said, but it’s MIEMSS’ job to locate and arrange for a patient to connect with the best place of treatment.
As of Monday, 355 patients were hospitalized with COVID-19 in intensive care units across the state, with another 1,452 in acute care units, Delbridge said. Some 121 intensive care unit beds and 691 acute care beds were available.
Delbridge said the state is experiencing larger demands on its health care system than it typically does at this time of year, which tends to be busier. Staffing shortages in Maryland and elsewhere, especially with nurses, compound the problem, he said.
“The busier the system gets, the more limits that will occur,” said Delbridge. “There’s always opportunity for care to be delayed when it gets busier.”
Baltimore Sun Media reporters Jason Fontelieu and Lilly Price contributed to this article.