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‘Strained to the gills’: Even with COVID numbers lower than last year, Maryland hospitals face capacity problems

This time last year, Maryland hospitals were in dire straits.

The number of people infected with COVID-19 in state hospitals hit 3,462 on Jan. 11, 2022, a pandemic peak that has not been approached since. One-third of the state’s acute care hospitals were operating on “crisis standards of care,” a set of emergency protocols that allowed clinicians to prioritize the sickest of patients.

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Now, with 835 people hospitalized with the respiratory illness statewide as of Thursday, according to the Maryland Department of Health’s COVID-19 dashboard, the situation isn’t an emergency the way it was last year.

But medical centers across Maryland still face steep demand for treatment.

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Throughout last week, an average of 92% of medical-surgical and intensive care beds statewide were occupied, according to data shared by Bob Atlas, president and CEO of the Maryland Hospital Association.

“We’re not in crisis stage right now,” Atlas said Wednesday. “We’re just strained to the gills.”

Hospitalizations from COVID-19 started climbing again in mid-November, increasing by about 300 in a month. But after hitting 907 on Saturday, according to data from the Maryland Department of Health, they dropped to 802 on Sunday. They rose to 830 on Tuesday, but have yet to increase past 900 again.

Maybe that means hospitalizations from the respiratory illness have peaked already for the season in Maryland, Atlas said.

But the state isn’t out of the woods yet in terms of demand for hospital services, he said. A new, highly transmissible variant is on the rise in the country — XBB.1.5 — which could lead to more people being hospitalized with COVID-19, even though there hasn’t been any evidence that the strain is deadlier than others.

Hospitalizations for the flu and respiratory syncytial virus — two respiratory illnesses that started circulating faster and earlier than usual in fall 2022, striking fear of a “tripledemic” — are also down in Maryland.

Pediatric intensive care units are no longer overflowing with RSV patients, Atlas said. Influenza-associated hospitalizations also have peaked for the season, according to the Maryland Department of Health’s tracker for the illness.

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Compared with this time last year, a much larger share of Maryland hospital populations are made up of patients who aren’t sick with COVID-19.

A year ago, about 40% of medical-surgical and intensive care beds statewide were occupied by COVID-19 patients, according to data that Atlas provided. Last week, an average of about 10% of beds were occupied by patients sick with the virus.

Baltimore’s 500-bed Sinai Hospital has been seeing a rise in patients who have COVID-19, but it’s an increase that’s manageable, said Dr. Esti Schabelman, the hospital’s chief medical officer.

Instead, he said, what’s been causing the medical center to be “frequently” overwhelmed — with many people sitting in its emergency department, waiting for a bed upstairs — is the sheer volume of patients asking to be admitted.

Many are experiencing the same sorts of illnesses and conditions the hospital often treated before the pandemic, but they’re sicker and they have to stay in the hospital longer, Schabelman said.

Although he couldn’t say for certain, he guessed the reason is that so many people missed out on preventative care appointments during the pandemic, or went for a long time without seeing a doctor for a routine visit.

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A survey released last year by the Prevent Cancer Foundation found that half of Americans had an in-person medical appointment during the pandemic that they missed, delayed or canceled.

And findings from the University of Michigan’s National Poll on Healthy Aging showed that nearly a third of people over 50 with a scheduled procedure, primary care visit or dental visit in 2021 had a COVID-related delay.

Dr. Ted Delbridge, executive director for the Maryland Institute for Emergency Medical Services Systems, compared the consequences of people falling behind on doctor’s appointments during the pandemic to the consequences of children falling behind on school.

It likely will take time for the implications of both to become clear, he said.

“I’m just sure there are implications, and I’m sure there’s going to be recovery time,” he said.

Ongoing staff shortages have only increased the pressure on Maryland hospitals.

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At the University of Maryland Medical Center in Baltimore, about 22% of positions are unfilled, said Dr. David Marcozzi, the center’s chief clinical officer and senior vice president. Most are nursing jobs.

“If you have an increased patient volume and decreased staffing, that creates a significant challenge for any hospital system or any hospital. And that is really where we are today,” he said. “More patients requiring care and less staff to be able to provide that care sets every hospital in the nation, in our state and certainly at the medical system up for challenging days.”

Experiencing similar shortages, many hospitals in Maryland have been further straining their resources by relying on expensive contract staff members, Atlas said.

Maryland, and pretty much every state in the nation, Atlas said, is faced with the challenge of recruiting more faculty to train future health care professionals and helping people of diverse racial and economic backgrounds through the educational process of filling much-needed hospital jobs.

“As the General Assembly opens today, we’re asking them to consider ways that they can help us with growing and retaining our workforce,” he said Wednesday.


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