At North Shore Medical Center in Salem, an influx of 82 patients with coronavirus symptoms has administrators scrambling to make room for more. The ranks of COVID-19 patients at Beverly Hospital swelled after a recent outbreak at a nearby nursing home. And at Beth Israel Deaconess Hospital-Milton on Tuesday, more than half of the facility’s beds were filled with patients who had confirmed or potential infections.
Though routinely toiling in the shadows of the elite Boston teaching hospitals, the state’s community hospitals are shouldering a heavy load in the effort to cope with the coronavirus pandemic. Newly released data reveals that many of their beds are filling up quickly with critically ill COVID-19 patients. In many ways these hospitals are being hit harder than the larger hospitals, with tougher puzzles to solve in managing tight resources and treating severe cases. And as the crisis escalates, some are already feeling the strain.
"I am worried. We are handling our current volume, and we have a plan for a moderate surge. We don’t have a clear-cut plan for the worst-case scenario,” said Dr. David Roberts, president of North Shore Medical Center in Salem. “We have to have that plan so we are ready for it.''
Community hospitals face extraordinary challenges in this pandemic, with fewer resources and less flexibility compared to large academic medical centers such as Massachusetts General Hospital, Beth Israel Deaconess Medical Center, and Brigham and Women’s Hospital. Of the state’s 61 acute care hospitals, 42, or roughly 70 percent, are community hospitals. They account for more than half of the roughly 14,000 beds in Massachusetts.
Community hospitals’ staffing is more limited because, unlike teaching hospitals, they can’t tap into the ranks of residents in training. Also, “academic medical centers have large numbers of doctors who are part-time physicians who they can mobilize at critical moments to substantially increase the workforce,” said Dr. Ashish Jha, professor of global health at the Harvard T.H. Chan School of Public Health. “That is generally harder for community hospitals that don’t have those reserves.”
Some community hospitals may lack physicians with the most advanced training in intensive care, Jha added. Often “they rely on academic medical centers where they send sicker ICU patients. Even if they have ICUs, they might be for people who are not very sick and they might be very small.”
Community hospitals also often lack the buying power of large hospitals when it comes to acquiring critical supplies, said Dr. Assaad Sayah, chief executive of Cambridge Health Alliance, a health system with locations stretching from Cambridge to Revere. Officials at Cambridge Health Alliance are still waiting for equipment they ordered that would enable them to run coronavirus tests themselves, said Sayah. As a result, they’re sending tests to other labs and waiting two to six days for results.
Of Cambridge Health Alliance’s 128 medical/surgical beds at its campuses in Cambridge and Everett, only 15 were unfilled Monday. And of 18 ICU beds, just four were still free. The system had admitted 15 confirmed COVID-19 patients as of Monday, including six in intensive care, and was treating 17 more suspected of having the infection and awaiting test results.
“The number of cases and the acuity have gone up in the last few days,” Sayah said.
Like other operators of community hospitals, Cambridge Health Alliance is not equipped to handle all patients who need critical care, and it transfers its sickest patients to the big teaching hospitals. It is a valve that may tighten as the pandemic crests here.
“What’s going to happen downstream when the downtown hospitals are filled to capacity?” Sayah said.
Data collected daily by the Globe shows that Boston’s major hospitals are not yet full, but they are seeing an increase in the number of patients, particularly those requiring intensive care. As of Monday, for instance, Mass. General had admitted about 200 patients with confirmed or possible coronavirus infections, including 47 in the ICU, its highest number so far. Also Monday, Brigham and Women’s Hospital had admitted 82 patients who were definitely or possibly sickened by the virus, including 17 in its ICU.
Meanwhile community hospitals in the Beth Israel Lahey Health system — including in Beverly, Milton, and Needham — are seeing their own rise in coronavirus patients in the past several days.
“The situation in Milton and Needham is not unlike many of our community hospitals,” said Dr. Richard Nesto, chief medical officer at Beth Israel Lahey Health. “The acuity or severity of patients coming in their front doors is greater than usual because of this infection. It’s worse than the regular flu. The patients have more serious complications."
Beth Israel Deaconess Hospital-Milton is transferring its sickest patients to Beth Israel Deaconess Medical Center in Boston so it doesn’t become overloaded, Nesto said. The latter hospital as of Tuesdayhad 139 patients with possible or confirmed cases of infection, including more than 40 in the ICU.
On the North Shore, Beverly Hospital has seen a particular spike, with 27 coronavirus patients and another 46 suspected to have the virus and waiting for test results as of Tuesday. Nesto said that’s due largely to an outbreak at a nearby nursing home in Danvers — Hunt Nursing and Rehabilitation Center, which reported on Friday that it had eight residents who had tested positive for COVID-19. Beverly typically sees many patients who are older and tend to have chronic conditions, he noted.
Six of Beverly Hospital’s 14 ICU beds were occupied Tuesday by patients who had confirmed or suspected coronavirus infections.
“It’s community hospitals that are really on the front lines of this pandemic,” Nesto said. At small hospitals, “an influx of four or five very sick patients to the emergency room can immediately stress their resources.”
As Beth Israel Lahey’s community hospitals start to fill up, they are transferring patients to other facilities in the system, including Beth Israel Deaconess Medical Center in Boston and Lahey Hospital & Medical Center in Burlington.
Hospital executives discuss bed capacity and hot spots of coronavirus cases each morning, though the numbers change throughout the day.
“The trouble will occur when we run out of capacity everywhere,” Nesto said. Then hospitals will need to execute “surge” plans that allow them to add temporary beds.
As the pandemic has rolled through Massachusetts, it’s been difficult to pin down firm numbers on how many people are hospitalized, especially at community hospitals. Some have flatly refused to disclose numbers to the Globe.
Meanwhile as the pace of infections accelerates, community hospitals are rapidly adjusting to the pandemic’s new realities.
The first coronavirus patient went into the ICU at North Shore Medical Center, a Partners HealthCare hospital, around March 21. By Monday, 13 patients with confirmed or suspected COVID-19 infections were in the ICU, and the hospital has opened two new intensive care units, to take overflow patients from its usual 20-bed ICU.
As of Monday afternoon, North Shore Medical Center had 32 admitted patients with confirmed COVID-19 infections, and 50 more suspected coronavirus patients awaiting test results.
Roberts said that the hospital is not yet full, but that administrators are intensely planning for that likelihood. It has 223 medical surgical beds and can add another 103 beds by expanding into areas such as the post-surgery recovery and endoscopy units, assuming it can find additional staff to care for them. But he does not expect the need for expansion will stop there.
"We keep rolling out more units,'' said Roberts, who noted that one possibility was to repurpose a floor in the hospital’s 120-bed psychiatric unit.
"The downside to that is [psychiatric] patients back up in the ER,” Roberts said. “There is a downside to everything we do.''
Rebecca Ostriker can be reached at firstname.lastname@example.org. Follow her on Twitter @GlobeOstriker. Priyanka Dayal McCluskey can be reached at email@example.com. Follow her on Twitter @priyanka_dayal. Liz Kowalczyk can be reached at firstname.lastname@example.org.