One year ago, Maryland got its first known case of COVID-19. There have been 7,740 confirmed deaths in Maryland since.
As infection rates spiked last spring, the state’s 46 acute-care hospitals had to expand their capacity, increase staffing, hunt down equipment and supplies, and manage unprecedented testing programs — all while trying to keep staff from becoming ill or burned-out.
Reporter Bruce DePuyt spoke with Bob Atlas, president and CEO of the Maryland Hospital Association this week. The conversation has been lightly edited for length and clarity.
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Maryland Matters: What do you remember from March 4, 2020, when we heard about the first Maryland case?
Bob Atlas: I happen to have been at a conference of hospital leaders from six states in the region and we were starting to pick up the rumors. Then people started getting texts that we had COVID cases in Maryland. We kept going about our business for the next day, but then we all went back to our regular jobs and started hunkering down to really deal with it.
MM: People who get infected now are more likely to survive. And they’re less likely to get severely ill. Can you talk about the improvements in treatment over the last year?
Atlas: I’m not a doctor, so I can’t speak to the exact clinical interventions that we figured out. But there was a new drug that was brought out called Remdesivir that helped to reduce the intensity and length of hospital stays.
There was the discovery that a longstanding steroidal-type drug actually helped. There were learnings about whether patients needed to be intubated or kept in intensive care — or whether they could be given certain oxygen treatments that could forestall the need for intubation.
Also, what’s called proning, which is essentially putting the person on their front to ease the breathing. So all these things — and many more — made it possible to increase survival and reduce the burden on intensive care.
MM: What sticks out in your mind from last spring, when hospitals started to fill up?
Atlas: At the hospital association, we immediately pivoted to wherever needs seemed to arise. In the beginning there was everything from trying to clear out beds to deal with the surge, to trying to figure out where ventilators could be found. Even figuring out childcare for health care workers who needed to stay on the job.
There was early talk of certain mass transit shutting down. But we have so many of our health care workers who rely on mass transit workers to get to their jobs, so we worked out those arrangements.
Over time it has moved to helping with the supplies of Remdesivir and the newer therapies, called the monoclonal antibody therapies. And lately, since the middle of December, we’ve been all in on vaccine allocation.
There was considerable expansion of telehealth during the pandemic. It was a lifesaver for a lot of people. And even now we want to make sure that the benefits that were realized during the pandemic actually can continue, even after the public health emergency winds down.
MM: What sort of evaluation process will take place, to review the lessons of the last year and position us for any future pandemic?
Atlas: From the hospital perspective, we need to make sure that our preparedness is strong. Here in Maryland we were pretty well prepared, and we stepped it up pretty quickly.
Our hospitals are always prepared for some levels of emergency and we need to figure out what that looks like going forward. You can’t keep beds open and staffed, along with supplies and inventory. There’s a cost to all that.
We have to look at how we prevent and detect these kinds of things, and contain them, when they arise. There will be mutations of the virus, and new viruses will arise, forever.
MM: Hospital staff have worked such long hours. How big a concern is burnout — and the emotional toll?
Atlas: It’s become trite to say that the nurses and the others on the front lines are heroes, but it’s true. We need to learn how to do staffing and training not just in terms of the professional skills but also how to manage resilience in the face of these daunting challenges.
This was particularly bad because of all the isolation that was required for the patients. Visitors were kept away, so those clinical workers became the human touch for so many of the patients. They acquitted themselves tremendously well. And we have to take care of people as the epidemic falls into memory.
There are longer-lasting effects and there is an emotional toll — including the people who survived the disease and the survivors of those who passed. We in the health care field are looking at what we can do for the people who deliver the care.
MM: Are there any indications that this experience will lead to an increase in the number of young people choosing careers in medicine or science?
Atlas: The University of Maryland School of Nursing has expanded their class size, and all the openings were filled immediately. They and others are seeing that people are drawn to the profession. And that’s good. We need more nurses. The average age of nurses has been rising. And we need to replace those who will be retiring.
MM: I remember you saying last year that the hospital community in Maryland has always been fairly tight, but now the leaders of the different systems have each other on speed-dial.
Atlas: We’re very proud of the strength that we exhibited, the bravery that was displayed, overcoming tremendous hurdles, and the hope that was created by health care workers and by hospitals.
We’re also very proud of our hospitals and the more than 100,000 people who work in them. We hope we’re seeing the light at the end of the tunnel now with the decline in cases.