A little more than two weeks ago, on Nov. 9, there were 707 people receiving COVID-19 treatment in Maryland hospitals.
On Wednesday, the state Department of Health reported that the bed-count had nearly doubled, to 1,406.
With the state adding more than 2,000 new cases each day — far more than the highest single-day total ever recorded during the first wave of the pandemic — hospital officials know they are about to get slammed.
Privately, there is some discussion of a “catastrophic scenario” where the number of coronavirus cases eclipses the state’s bed and staffing capabilities.
Even if that doesn’t happen, intense strain appears to be inevitable — and leaders of the state’s health systems and its smaller, independent facilities are preparing for the second surge.
“If we don’t keep things under control and get them better under control, we’re going to overwhelm the health system,” warned Bob Atlas, president of the Maryland Hospital Association.
Anne Arundel County Executive Steuart Pittman (D), who consulted with the leaders of the Johns Hopkins Medical System this week, said he is particularly concerned about staffing shortages as the second wave intensifies.
“The state of Maryland is between 6th and 8th [in the nation] for rate of spread,” he said in an interview. “That is the number that we should really be worrying about, because that predicts the future.”
“I worry about our health care workers the most, and the scenario where there just aren’t enough hospital beds, whether you have COVID or a heart attack or whatever else it is,” he added. “We absolutely have to push down the numbers.”
Hospital administrators from around the state will soon conduct a daily conference call to discuss their COVID-19 census counts, said Atlas.
“There’s going to be a Critical Care Coordinating Group, being set up as we speak by the head of the Maryland Institute of Emergency Medical Services Systems,” he said this week.
“They are going to be creating a setup for a daily huddle of the heads of intensive care for the major providers, so they can share knowledge and make sure that there’s smooth communication, leading to smooth movement of patients if it comes to that,” Atlas added.
Half of Maryland’s hospitals belong to one of three major systems — the University of Maryland Medical System (with 13 facilities), MedStar Health (with seven, and three more in the District of Columbia) and Johns Hopkins Medicine (with 4, and an additional facility in D.C.).
As individual hospitals reach their capacity, Atlas said, they can arrange for patients to be moved to a facility that has space.
“It’s a fairly small and very well-connected hospital community in Maryland,” he told Maryland Matters. “So if a hospital in the national capital region needs to be in touch with a hospital in the Baltimore region, they know who to call, and they all take each other’s calls.”
“Back in the spring… I was making some of these connections,” he added. “I no longer have to make those connections. Everybody knows everybody.”
The state now has 38 infections for every 100,000 people, more than double the springtime peak of 18, which Maryland hit on May 7 and 21.
But the situation is far more dire in the state’s western panhandle. In Allegany County, there are 167 cases for every 100,000 residents. Garrett has 107, Washington has 57.
While Western Maryland’s hospitals are comparatively small, Atlas said, they now have partnerships with large, out-of-state health systems.
Garrett Regional Medical Center, a 50-bed hospital in Oakland, is now part of the West Virginia University Health System and can send patients there if they get overwhelmed.
The former Western Maryland Health System in Cumberland is now part of the University of Pittsburgh Medical System.
“Everybody at this point has connections to each other and they’re using them,” Atlas said. “They have resources.”
Atlas said it is increasingly likely that Maryland will make use of three overflow facilities that opened during the spring surge — the Baltimore Convention Center field hospital, the recently reopened Laurel Hospital and Washington Adventist Hospital in Takoma Park.
He said there are currently about 120 patients in those three facilities, “with the capacity to take more.”
Concerns about a ‘catastrophic scenario’
After talking with experts at Hopkins who plotted several different scenarios, including some that showed a crush of patients hitting Maryland hospitals, Pittman took to Facebook to urge Gov. Lawrence J. Hogan Jr. (R) to do more to limit social interaction.
“What I really worry most about is our hospital workers,” he told Maryland Matters. “There’s nobody to replace them.”
“We can put out a lot more beds and we can have convention centers and all kinds of space available, which was a lot of the surge planning back in the spring. But back in the spring we were talking about recruiting hospital workers from states that didn’t have high rates of COVID yet, and now the whole world is in the same position. So there’s nowhere to recruit from.”
In a statement, the Maryland Department of Health said hospitalization rates are being monitored “to ensure that the state’s hospitals do not become overwhelmed,” particularly as flu season intensifies.
“As hospitalizations continue to increase, public health officials will continue to assess immediate needs and contingency plans in the event that hospitalization rates spike suddenly,” the statement added.
Atlas, who is communication with hospital leaders on a daily basis, said Maryland is in a good position to weather the storm, in part from having been “battle-tested” in the spring.
Unlike states where governors are reluctant to impose mask orders or champion social distancing, he said, Maryland has leadership in the executive and legislative branches that is supportive of public health messaging and resources.
“Some of these projections are assuming that no new measures are taken to clamp down,” the association chief said. “But measures are being taken to clamp down. They may not be an absolute, total stay-at-home kind of response, but they are tightening things down.”
He said he is gratified by reports that many people have canceled plans to travel over Thanksgiving. “Obviously we’re worried about gatherings around Thanksgiving. I do have some faith that Marylanders are smart. They’ve been largely compliant heretofore.”
“They are certainly COVID-fatigued and would like not to have to do these things. But people are doing it.”