Boston’s major hospitals so far staying ahead of high demand for ICU beds

Hospital officials say rising infection rates still require vigilance against overcapacity in intensive care units

An ambulance crew wheeled in a patient to Boston Medical Center on Wednesday.John Tlumacki/Globe Staff

Boston’s major hospitals are largely staying ahead of the surging demand for intensive care beds in the coronavirus pandemic and, so far, leaders are cautiously optimistic they will avoid the overwhelming crush of patients that has hit other cities.

Though some doctors predict infections and deaths will continue to climb for about two weeks, two hospital leaders said they believe advanced planning and social distancing efforts are paying off, potentially allowing the health care system to sidestep worst-case projections.

“I don’t believe we will get there,'' said Dr. Daniel Talmor, chief of anesthesia and critical care at Beth Israel Deaconess Medical Center. ”I am quite confident we won’t get to Italy or New York.''

Hospitals have rapidly opened new intensive care unit beds by moving ventilators and other equipment into regular hospital rooms that have piped-in oxygen and into post-anesthesia recovery units. They have also moved regular floor nurses to work with specialized ICU nurses.

Some hospitals have opened new ICUs for coronavirus patients even if they had space in their regular ICUs, so they could keep infected patients separate from those without infections. Physicians at the city’s four largest hospitals said they still have capacity to add at least several hundred more ICU beds if necessary.

This glimmer of hope comes as the caseload in Massachusetts continues to jump. On Friday, the state reported the number of confirmed infections had increased by 2,033, to 20,974, and the number of deaths climbed by 96, for a total of 599 deaths so far in the state.

During a press conference Friday, Governor Charlie Baker said that current predictive models show that the state’s peak in new COVID-19 cases, which has been estimated to arrive anywhere from Friday to April 20, now “might be closer to April 20.”

The models suggest that, at the peak, the state will see 2,500 new cases per day.

Dr. Paul Biddinger, chief of emergency preparedness at Massachusetts General Hospital, said he expects the number of hospitalized coronavirus patients, including those sick enough to require intensive care beds and a ventilator, will continue to rise steadily for the next 10 to 14 days.

Intensive care units are where the sickest patients of all types are treated, including those with severe lung damage that can be caused by COVID-19, and also patients with heart failure, cancer, and other life-threatening conditions.

Beth Israel Deaconess Medical Center, which normally has 77 ICU beds, has steadily increased that number and had 102 patients in ICU beds on Thursday — more than half with COVID-19. The hospital could expand to 200 ICU beds and even beyond that if it moved patients into repurposed operating rooms as some New York City hospitals have done, Talmor said.

As of Friday afternoon, Mass. General had 111 patients with COVID-19 in its ICUs. Mass. General typically has 150 ICU beds but can expand to about 300, which would include putting patients in operating rooms, Biddinger said.

"I don’t think we would get there,'' he said. "More recent data projections have suggested we will not hit our most extreme scenario. It’s definitely going to get worse but not a worst-case scenario.''

Still, the mounting number of COVID-19 patients admitted to Massachusetts hospitals in the past week is a sobering reminder of the devastating impact of the virus and the unprecedented challenge for medical providers. On Tuesday, public health officials issued guidelines to help hospitals make dismal decisions about how to ration ventilators and ICU beds to patients with the greatest chance of long-term survival — a possibility doctors hope won’t be necessary but a sign that officials are not taking anything for granted.

And Baker Friday also indicated it was not time to back off efforts to combat spread of the virus. He said the state Department of Public Health would issue an advisory urging members of the public to wear masks or face coverings when they are out in public.

The governor said Massachusetts plans to have an additional 3,500 acute care and ICU beds available above normal capacity as hospitals expand and divert less serious cases elsewhere. The state this week opened two pop-up field hospitals — one in Worcester, the other in Boston — for those who are less seriously ill. Right now, 55 percent of hospital beds in the state are occupied, he said, leaving room for a surge in patients.

Still, he said, "our health care system will be stretched like never before.''

The latest figures from the Massachusetts Health and Hospital Association show that, for 44 hospitals that have agreed to publicly release their data, about 1,660 confirmed coronavirus patients were hospitalized Thursday. Hospitals say they can manage that amount in part because they have canceled non-urgent elective surgeries.

Of the total, about one in three patents was in intensive care. At academic medical centers like Beth Israel Deaconess, Mass. General, and Brigham and Women’s Hospital, which accept transfers of the very sickest patients from smaller hospitals, the percent of COVID-19 patients requiring intensive care was between 40 and 50 percent. Beth Israel Deaconess, for example, has taken ICU patients from hospitals in Milton and Cambridge.

Boston Medical Center, which treats more poor and minority patients than other hospitals in the city, is the only large teaching hospital so far that temporarily closed its doors to new intensive care patients and re-routed ambulances heading its way.

On Sunday, the hospital sent nine coronavirus patients who needed intensive care to other Boston hospitals, in large part because it did not have enough specialized nurses in place to care for them. ICU nurses normally care for one or two patients each and more of these patients required one-on-one care than expected, said Dr. Alastair Bell, the hospital’s chief operating officer.

"It bought us a bit of breathing room,'' Bell said. "We knew other organizations had capacity.''

In the past week, the number of coronavirus patients at Boston Medical Center has grown rapidly, more than doubling to 176 on Thursday. The hospital normally has 63 ICU beds but has expanded, and on Thursday had 72 intensive care patients — more than half with confirmed coronavirus. BMC has plans to expand to 120 ICU beds if needed.

The impact of this pandemic on BMC is even more intense because of the number of patients admitted with possible coronavirus who are awaiting test results. These patients are treated as if they were infected, requiring staff to wear full protective gear. Including those patients, BMC had a total of 218 coronavirus-related hospitalizations — more than half its total number of adult beds.

Boston Medical Center also appears to have fewer full-service ventilators than other major hospitals, but Bell said he believes other Boston institutions will continue to be a release valve for the state’s largest “safety net'’ hospital. Residents in the Boston neighborhoods of Mattapan and Dorchester, which are part of BMC’s primary service area, are being particularly hard hit by the pandemic.

"Hopefully if there is a disproportionate impact, we’re able to distribute care appropriately,'' he said.

Doctors said that Boston appears on track to avoiding an overwhelming number of patients needing hospitalization, perhaps because of social distancing measures that were put in place weeks ago. The hospitals also benefited from not being the first hot spot, Bell said, and were able to learn from what their health care counterparts encountered in Seattle and New York.

Coronavirus patients in Boston’s ICUs seem similar to those in other cities and countries, they said. Most are older than 60 and many have underlying health conditions that make them more susceptible to serious cases of the virus. But there are also patients in their 20s and 30s who have no apparent extra risk. Preliminary state and city data suggests Black and Hispanic infection rates are higher than average, though race data is not available for a large percentage of cases.

Amid the relentless increase in the number of deaths, doctors are starting to successfully wean patients off ventilators — at least 20 so far at Mass. General.

"There are fantastic stories of people who are critically ill and are recovering,'' Biddinger said.

Massachusetts Health and Human Services Secretary Marylou Sudders said Friday the state is slated to receive another 200 ventilators from the federal stockpile next week. That shipment would bring the total the state has received from the federal government to 400.

However, Sudders was cautious about the new delivery. She said that, until they actually arrive in Massachusetts, “we don’t count them.”

Martin Finucane of the Globe staff contributed to this report.