Thanks to all who have sacrificed their jobs and their social life and thanks also to our health care leaders and working professionals who have scrambled to build enormous new capacity to handle COVID-19 patients, we have avoided the social catastrophe we have seen in some places, an overwhelmed health care system with dying patients waiting for care.
Not that we can declare victory or diminish our efforts, but we should celebrate a successful beginning to a long struggle.
Mary Lou Sudders, the commander of the Governor’s COVID-19 response effort, reported a telling statistic in a recent call with legislators. When public health workers traced contacts of an infected person back in March, they would on average identify about 10 close recent contacts per person. Now the average is down to two. That fivefold reduction is the result of the sacrifices we are all making.
The virus has rampaged through our nursing homes and poverty neighborhoods where people cannot get away from each other. But statewide, the reduction in contacts is having its intended effect. The infection curve lies well below the exponential growth curve we were on in March.
Even with the sacrifices we have all made, COVID-19 patients needing intensive care would have over-taxed the system but for the efforts of hospital leaders and the Governor and his team to build hospital bed capacity to meet the surge. In a recent briefing for Senators, the head of the Massachusetts Hospital Association stated that the current use of ICU beds stood at 113% of the capacity that existed before preparation for the surge.
With the extra beds in place, the use is only at 68% of capacity — a decent margin of safety. ICU beds are available in every region of the state.
As the patient count was on the upswing, we began difficult conversations about how to ration ICU care and the use of ventilators. While ICU needs have gone beyond the pre-surge capacity, no hospital has had to close its doors to patients and no patient in need has been declined a ventilator.
Now, health care leaders are worried about the unmet needs of patients with serious conditions other than COVID-19. The head of the hospital association reported a 40- 50% decline in emergency room visits, a 60-65% reduction in patients with stroke symptoms, a 37% decline in patients with heart attacks and a 14% decline in patients with appendicitis.
While staying home might reduce some kinds of injuries that bring people to emergency rooms, these statistics suggest that some patients in need are not seeking care. Health care leaders want people to know that the hospitals have the capacity right now to treat non-COVID-19 patients with urgent needs. People with urgent needs should not wait.
In preparation for the COVID-19 surge, hospitals deferred all elective procedures and other care. As a result of the loss of revenue from elective care and the extra expenses of building out to prepare for COVID-19, the state’s hospitals are collectively losing $1.4 billion per month, according to the hospital association.
While other hospitals in some other states have been authorized to return to elective care or are contemplating returning soon, they report that progress is slow. Hospitals need more testing capacity and personal protective equipment for both patients and staff as they return to elective care. They also have to maintain available capacity in case of a resurgence of COVID-19.
Massachusetts has a deep and collaborative health care leadership team. They will take a careful step-by-step approach to reopening hospitals for elective care. I’ve watched their efforts so far with great admiration and have confidence that they will do their part effectively in the months to come.