Please keep our health care workers in mind as you make decisions about what COVID risks to take over the coming weeks.
As of Tuesday, December 14, there were 1411 people hospitalized with COVID in Massachusetts, of which 326 were in the ICU and 176 were intubated. That is well below the level in the first April 2020 surge when hospitalizations peaked at almost 4,000, yet for a combination of reasons, the hospital system is feeling a lot of strain.
Steve Walsh, President of the Massachusetts Hospital Association testified at a hearing on December 16 about the state of the hospital system. He made the following points in his testimony:
- Like many employers across the country, hospitals are having difficulty recruiting staff — nurses and behavioral health specialists are most in demand, but all hospital jobs are hard to fill.
- Caregivers are exhausted and burnt out — many are leaving for other fields or retiring.
- In the early days of COVID, it was possible to recruit travel nurses — acute surges were happening in only a few states. Now, travel nurses are in demand everywhere.
- Although hospital leaders feel that, to protect patients, all hospital workers should be vaccinated, the loss of some employees due to vaccine mandates has added to the strain.
- As COVID patients stream into the understaffed hospitals, they are competing with patients who have deferred other kinds of care, many of whom are also very sick.
- COVID patients are also competing with behavioral health patients. The “epidemic within the pandemic” is mental illness. More are seeking psychiatric care than ever before. People with behavioral healthcare needs appear in emergency rooms and there is no place to send them. These patients “board” in the emergency room — safe, but without access to the care they really need. These behavioral health boarders take up ER beds that could be used by other patients.
- Statewide, roughly 500 are boarding in emergency rooms on any given day of which 150 to 200 may be children. Staffing shortages are currently preventing the use of several hundred behavioral health beds that already exist — we could solve half the boarding problem if we just could staff those beds.
- Staffing shortages extend to patient transportation — some patients who would be ready to leave to rehabilitative care cannot access transportation and continue to take up hospital beds.
- In each region of the state, hospital leaders confer every morning to discuss capacity issues and transfer patients as needed. As capacity tightens, they make decisions to defer optional hospitalizations. If there are patients in acute need and the region is out of capacity, they reach to other regions or out of state.
- So far, collaboration has assured that all urgent needs are being met, but with “capacity stretched more than it has ever been,” the rising case load due to Delta and Omicron is a cause for real concern, said Mr. Walsh.
Mr. Walsh’s testimony was well-received. The legislature recognizes the health care workforce challenges. In our recent $4.5 billion ARPA spending bill, we devoted $1.15 billion to public health and health care, including substantial investments in building the behavioral health workforce. An additional broad bill dedicated to strengthening the behavioral health system is moving forward.
But nothing we do legislatively can immediately add staff to the system. That means we all have to continue to do what we can to prevent spread of the disease.
The legislature and the Governor are continuing heavy investment in vaccination and testing. The main discussion right now is whether we should strengthen statewide rules on social distancing, especially masking.
I personally favor a statewide indoor mask mandate, applicable to all public spaces. It would take pressure off the many local health agencies who are enforcing mask mandates.
In the absence of mandates, we each strike our own uneasy balance between social distancing and staying connected. The risks of indoor unmasked crowds remain very real and if we elect to take those risks, we may be adding to the burden on health care workers who have already endured too much.