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‘The worst is yet to come’: Escalation of hospitalized patients for coronavirus continues

A medical staff member worked in a tent at the Somerville Hosptial on Wednesday.
A medical staff member worked in a tent at the Somerville Hosptial on Wednesday.David L. Ryan/Globe Staff

Concerns about the capacity and preparedness of the state’s hospitals intensified Wednesday, as the number of suspected coronavirus patients continued to escalate in Boston and beyond.

At UMass Memorial Health Care, based in Worcester, the number of patients with possible coronavirus — either already hospitalized or waiting for a bed in the emergency department — increased from about 40 on Sunday to 100 on Wednesday. So far, five patients there have tested positive for the virus. Dr. Eric Dickson, the chief executive, predicted that patient numbers would continue to rise for at least three weeks. “The worst is yet to come,” he said.

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North Shore Medical Center in Salem had 18 admitted patients who are still awaiting test results. And suburban Harrington Hospital in Southbridge had one confirmed case of COVID-19, a woman in stable condition, and 15 possible cases on Wednesday.

Meanwhile in Greater Boston, the number of admitted patients with potential cases continued to climb.

During a Wednesday afternoon meeting at Massachusetts General Hospital, doctors told executives that 73 admitted patients awaited test results, up from 53 Tuesday. There were also seven patients admitted with confirmed coronavirus, one more than the day before.

The number of providers with coronavirus inched up in Boston Wednesday, to at least 12 known cases; five at Tufts Medical Center; two at Brigham and Women’s; three at Mass. General; and two at Mass. Eye and Ear. Many more providers were in quarantine, either exposed to the virus when caring for patients or during their day to day lives. Brigham and Women’s Hospital alone has 100 employees at home on quarantine.

Hospitals are increasingly at the center of the pandemic, as patients sick with the coronavirus and those suspected of having it begin to fill medical floors and intensive care units across the state. Delays obtaining virus test results are particularly acute in some hospitals, hampering their ability to properly triage and evaluate patients.

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Researchers at the Harvard Global Health Institute predict that even under a best-case scenario for the spread of the virus, hospitals in the Boston area could be hit with more patients than they have room to treat.

The state typically has about 3,600 regular hospital beds and 400 intensive care beds available at any given time. Researchers have said that if one out of every five residents in Massachusetts becomes infected with the coronavirus — which some consider potentially conservative — some 225,000 patients would need hospitalization at some point and 45,000 need intensive care beds. Those projections, however, don’t account for social distancing and other measures that could slow the virus’s spread.

To avoid an overwhelmed system, hospitals and public officials would have to take extraordinary steps to increase capacity, such as repurposing schools or other buildings to treat patients, said Dr. Ashish Jha, director of the institute, in a call with reporters Wednesday.

Hospitals are prepared to repurpose their medical space as needed. For example, Mass. General, the state’s largest hospital, has 150 intensive care beds with plans to expand to 300 if needed during the pandemic.

The uptick of admitted patients — while currently manageable within the system — remains worrying to many hospital officials.

Wednesday felt like “the calm before the storm” at Tufts Medical Center, said Dr. Michael Apkon, the chief executive.

“We are working through … one of the most significant civilian mobilizations that we’ve seen as a society, in terms of a health care industry prepared to accommodate a level of activity that none of us have ever contemplated, with a smaller workforce than any of us have ever had to work with, given the level of activity,” Apkon said.

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Tufts had admitted 13 patients with possible coronavirus as of Wednesday, all of whom were awaiting test results. No Tufts patients have tested positive yet — but five hospital workers have confirmed coronavirus.

While the hospital had many empty beds on Wednesday because doctors canceled elective procedures, Apkon said he was concerned about being able to provide critical care, including ventilators, for all the patients who would need it in the coming days.

Boston Medical Center had admitted 50 patients to the hospital with suspected coronavirus Wednesday, up from 32 on Tuesday. Their tests are pending and so far, no patients have tested positive.

At Berkshire Medical Center, 17 patients have tested positive for the virus, though not all have been sick enough to be admitted to the hospital.

Some hospital officials complained of long delays in getting test results for patients, despite assurances by the state Department of Public Health of a 24-to-48-hour turnaround time. The waits are leading to another problem, said Harrington president Edward Moore: Nurses are wasting precious masks and other protective equipment, wearing it while treating patients who may turn out to be negative.

“With lack of testing, we’re all way behind the eight ball,'' he said.

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Because of the aggressive cancellation of nonurgent elective surgeries, most hospitals are not near full, but concern was deepening Wednesday about what is essentially a race against time.

The question is whether measures like social distancing, closing restaurants, and shutting schools can slow the rate of infections enough to keep hospitals, doctors, and nurses from becoming dangerously overwhelmed with ailing patients. It is too soon to tell whether these dramatic measures are working — and if the state has effectively “flattened the curve” on infection rates so hospitals can reasonably handle the flow of sick patients.

Still, the situation worsened by the day on patient floors and in conference rooms at some hospitals where hospital leaders were urgently mapping out responses.

Across the 12-hospital Beth Israel Lahey Health system, patients with confirmed coronavirus rose from three Tuesday to seven Wednesday, while those awaiting testing rose from 207 to 249.

UMass Memorial, also, has been able to accommodate patients so far and has a plan to add 50 additional intensive care beds if needed. But already, 40 workers were out on quarantine because of possible exposure to the virus, and hospital staff were going through protective equipment so quickly that Dickson, the chief executive, feared running out in just a few days.

None of UMass Memorial’s workers have tested positive for coronavirus yet. But, he said, “It’s inevitable that some of them are going to get it. That’s what I’m losing sleep about.”

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“Like in war, there’ll be some casualties,” said Dickson, a former Army medic.

Meanwhile, testing for the coronavirus has been lagging, and it’s unclear how many of the patients suspected to have the virus will end up testing positive. Until they receive test results, hospital workers must treat these patients as if they have COVID-19, which means suiting up in precious full protective gear and keeping patients isolated when possible.

The fear is that even worse shortages could be down the road.

For the first time in a four-decade career, Moore, the Harrington Hospital president, is trying to plan for the terrible possibility that doctors will have to ration life-saving equipment like ventilators, as doctors in overwhelmed Italian hospitals have been forced to do. Ventilators are machines that mechanically push air into and out of patients’ lungs to help them breathe.

“If you’re down to your last ventilator, and you have five patients in your ER who are super sick, what do you do?” he asked.

There could also be a shortage of health care providers themselves.

Moore said that even if he can keep his staff safe with masks and gowns, the shutdown of schools and day cares has meant that some staff have no way to come into work. On top of all his other regular responsibilities, Moore has found himself in a new and surprising position: child-care coordinator. “How do I, overnight, get them baby-sitters?” he asked.

Felice J. Freyer of the Globe staff contributed to this report.



Liz Kowalczyk can be reached at lizbeth.kowalczyk@globe.com. Priyanka Dayal McCluskey can be reached at priyanka.mccluskey@globe.com. Follow her on Twitter @priyanka_dayal. Evan Allen can be reached at evan.allen@globe.com. Follow her on Twitter @evanmallen.