It is one of the key indicators of the spread of coronavirus and whether it will overwhelm our health care system: How many people are currently hospitalized with COVID-19?
But right now it is impossible for the Massachusetts public to know this number, just weeks ahead of the projected peak of in-state coronavirus patients, in mid-April.
State officials managing the overall capacity of the medical system ahead of the anticipated surge do not require hospitals to report a daily census of COVID-19 patients, according to the Massachusetts Department of Public Health, and while some hospitals voluntarily disclose the numbers on their own, others do not say how many infected patients are in their beds or the ICU.
DPH gives daily updates on coronavirus tests performed, and the number of infections and deaths from the disease. The state releases daily numbers about the total number of infected patients who have ever been hospitalized during their illness, but that number is cumulative, a spokesperson has said, and does not reflect hospitalizations on a given day.
This number is critical, experts say, as the country and state try to avert what happened in Italy, where a shortage of hospital beds and specialized equipment, such as ventilators, forced doctors to make life-and-death decisions about who deserved the highest level of care. The central goal behind the social distancing directives has been to slow the rate of spread so that hospitals have enough capacity to care for those who are seriously ill at any one time.
On Wednesday, state officials reported 682 cumulative hospitalizations, likely an undercount, because another 4,716 cases are deemed “under investigation.” That means the state received the coronavirus test results from a private, clinical, or commercial lab, and still needs to follow up with the patient, a family member, and the clinician who ordered the test to find out if the person has been hospitalized, according to DPH.
If that figure of 682 were assumed to be the number of people hospitalized, Massachusetts would have a 9 percent hospitalization rate among its infected population, a remarkably low number compared to data from other states. Many states exhibit roughly a 20 percent hospitalization rate, data shows, and this number is another key metric of the intensity of the pandemic as well as whether it’s trending up or down.
State officials said they track hospital capacity and the state’s overall patient census, including those hospitalized for cancer, heart disease, or other conditions, but hospitals do not report their daily number of coronavirus inpatients.
The Globe has attempted to compile a list of total current hospitalizations due to the virus but has had inconsistent success. Most of the state’s largest hospitals, such as Mass. General, Brigham and Women’s, and UMass Memorial Medical Center, have readily provided information about how many coronavirus patients have been admitted, with the exception of Baystate Medical Center in Springfield, which has refused repeatedly. “It is what it is,” said Baystate spokeswoman Shelly Hazlett when asked for reasons for the denial.
The latest figures obtained by the Globe show that the state’s big hospitals are not yet near capacity, but patient beds are filling up, particularly for those requiring intensive care. For instance, as of Wednesday, Mass. General was treating 245 patients for confirmed or possible coronavirus infections, including 55 in the ICU. Brigham and Women’s Hospital on Wednesday had 87 admitted patients with confirmed or suspected cases, including 19 in its ICU.
Holyoke Medical Center, the Western Massachusetts hospital in the city staggered by a COVID-19 outbreak at a soldiers’ home, said Monday that it had 6 confirmed cases at the hospital and 19 suspected cases.
The figures can be harder to come by at some community hospitals, which represent about 60 percent of the state’s 61 acute care hospitals.
Sturdy Memorial Hospital in Attleboro, for example, declined to provide such information to the Globe despite multiple requests, including after news that two residents of an assisted living facility in a nearby town had been hospitalized with COVID-19 symptoms.
Steward Health Care, which operates nine hospitals in Massachusetts, including Good Samaritan in Brockton and St. Elizabeth's in Boston, announced on March 17 that it was turning one floor of Carney Hospital in Dorchester into a special COVID-19 unit. But after touting what it claimed was "the nation's first" coronavirus treatment unit, Steward refused to release information about how many such patients it was treating or testing, instead directing questions to the Executive Office of Health and Human Services.
Some hospitals have claimed they’d like to disclose hospitalization numbers but were told by the state Department of Public Health to keep quiet about coronavirus admission numbers. However, a spokesman for the state has denied any such edict has been issued.
On Tuesday, a Department of Public Health spokesperson said in a statement that the state asks hospitals on a regular basis “about their available ventilators and available beds as well as if they can convert any other spaces in the facility to adult ICU or adult medical surgical beds. We are also asking that they report current inpatient census overall.”
The state Executive Office of Health and Human Services said in a statement that, “A core function of the COVID-19 Response Command Center is working with hospitals to identify their capacity and resources in order to prepare the Commonwealth for a surge in COVID-19 medical needs and hospitalizations.
“This surge capacity planning involves daily communications with hospitals, health systems, and other health care facilities to identify capacity, monitor trends in hospitalization, and plan for medical surge alongside public health and infectious disease efforts. Additionally, the Commonwealth has engaged its emergency management and logistics resources including the Massachusetts Emergency Management Agency, the National Guard, and the U.S. Army Corps of Engineers to identify and prepare additional facilities for future surge.”
Calculating available beds for the surge of coronavirus patients is challenging. State data shows that Massachusetts’ 61 acute care hospitals have about 14,000 beds, though not all are designed to be used for very sick patients infected by the virus and that number doesn’t take into account current efforts to expand capacity to handle the surge of COVID-19 patients.
Also, a large number of existing beds are already taken up by other patients sickened by other conditions unrelated to the pandemic.
New forecasts from the University of Washington predict that the demand on Massachusetts hospitals will peak around April 14, and that by summer the virus will have taken nearly 1,800 lives in the state.
Governor Charlie Baker on Monday said the epidemic is likely to begin peaking in Massachusetts between April 7 and 17. In preparation, he said, the state has moved to add 1,000 nursing home beds, recruit retired clinicians to help, cancel elective surgeries, and asked the federal government to send 1,000 ventilators, the Globe has reported.
Lizbeth Kowalczyk, Priyanka Dayal McCluskey, Evan Allen, and Felice Freyer of the Globe staff contributed to this report.