On the night of May 1, Dr. Eric W. Dickson, chief executive of UMass Memorial Health Care, went to bed praying for a reprieve.
The Central Massachusetts hospital system, despite adding dozens of ICU beds to handle the expected surge in COVID-19 patients, had reached its limit. It could not take one more patient.
“I don’t get frazzled very often,” said Dickson, an emergency medicine specialist. “I was pretty frazzled the first week of May.”
Still, day after day, UMass Memorial squeaked by. That one-patient-too-many never arrived. Instead, just in time, COVID-19 cases leveled off and then declined.
Every hospital leader had the same nightmare in the run-up to this spring’s COVID-19 surge: that a moment would come when the number of patients would overwhelm hospital resources. All had read about the doctors in Italy who, short on lifesaving equipment, had to choose who would live and who would die.
But it hasn’t happened here.
“We were able to care for everyone who needed us,” said Dr. Paul Biddinger, director of the Center for Disaster Medicine at Massachusetts General Hospital.
In recent interviews, hospital leaders described how they did it — and how this spring’s challenges prepared them for a possible second surge in the fall.
For starters, hospitals proved nimble in increasing the number of intensive care patients they could treat, swiftly tripling the number of ICU beds statewide. Also, people with ailments other than COVID-19 avoided care in greater numbers than expected, freeing up space and staff.
In addition, hospitals planned for the worst-case predictions. Instead, transmission of the disease was kept in check because residents stayed home as advised, flattening the proverbial curve.
The predictive models were based on “what would happen if we did not put in shelter-in-place,” said Dr. Ashish Jha, director of the Harvard Global Health Institute. “We basically shut the entire Commonwealth down. If we had let things go, we would have 20 to 60 percent of people getting infected.”
UMass Memorial, hit later and harder than the Boston hospitals, was unusual in reaching capacity. Boston Medical Center, caught off-guard early in the surge, had to transfer nine patients to other hospitals on April 5. But that didn’t happen again.
Boston Medical Center and most other hospitals had room for more COVID-19 patients even on the peak days: April 21, when nearly 4,000 were hospitalized statewide, and April 26 when ICU occupancy reached 1,089.
Of the five field hospitals the state built to handle hospital overflow, three did not see a single patient, while the ones in cavernous convention centers in Boston and Worcester did not come close to filling up.
That happened even though Massachusetts had one of the country’s highest rates of coronavirus infections and deaths at the time.
“It taxed our teams significantly, but we did not get to the tipping point,” said Amy Hoey, chief operating officer of Lowell General Hospital.
Based on experiences in Italy, Seattle, and Wuhan, China, the Mass General Brigham hospital group (formerly known as Partners HealthCare) expected to see just under 2,000 COVID-19 patients during the surge, said Biddinger, who is the hospital group’s director for emergency preparedness. Instead, they treated 900, about half of them in the ICU, he said.
“That still required almost all of our hospitals to create surge ICU space beyond what they normally had as an ICU,” he said. For example, at the peak, Massachusetts General Hospital had 150 patients on ventilators — three times more than usual.
Dr. Dani Hackner, chief clinical officer of Southcoast Health, described a process of going through the group’s three hospitals bed by bed to assess which could be converted to ICUs. Similarly, the hospital vetted employees’ skills to determine how each could best aid the COVID-19 effort.
Everywhere, critical care nurses were in great demand. But nurses without critical care expertise could still be part of an ICU team, doing such work as turning patients who were attached to ventilators.
Some providers came out of retirement or flexed their skills to new populations.
“Our head of neonatology was taking care of an 84-year-old patient,” UMass’s Dickson said. “We needed every doctor.”
Given the hospitals’ success at expanding capacity, it may seem that the money spent opening five field hospitals with 1,500 mostly empty beds was wasted. But those involved regarded the extra sites, all now closed, as invaluable.
The two that did see patients provided a crucial relief valve for urban hospitals. And the three that stood empty offered a useful exercise on how to quickly build a spare hospital.
Besides, as Harvard’s Jha put it, “Would you rather have a couple of field hospitals that never opened, or have regular hospitals overwhelmed and people dying in the parking lot? Sometimes you want to overreact and do more than you needed to.”
The Boston Hope field hospital was no makeshift tent. Built at a cost of $12 million in the Boston Convention and Exhibition Center, it included 1,000 single rooms with sheetrock walls and electricity; oxygen lines ran to about 200 rooms, and six were equipped for intensive care.
What’s more, it’s still there, disinfected with all the equipment shrink-wrapped. With no large conventions expected in the near future, Boston Hope stands ready to “break glass and open up again” in the next calamity, said retired Brigadier General Jack Hammond, who oversaw the hospital’s creation and operation.
Boston Hope saw its first patient on April 10 and over the next seven and a half weeks treated around 720 patients, taking in people who would otherwise have occupied acute-care beds needed for sicker patients. They included homeless people who could not be sent back to the streets or shelters where they would infect others, and people recovering from COVID-19 but not needing hospital-level care.
The 200-bed field hospital at the DCU Center in Worcester provided a similar service. It saw 275 patients in total, and Dickson called it “absolutely critical” in managing patient flow.
“If we didn’t have that, hospitals would have really had issues discharging people who weren’t well enough to go home,” Dickson said.
The other field hospitals, in Dartmouth, Lowell, and Bourne, closed down without seeing a single patient.
“It actually felt good that we didn’t have to use it,” said Hackner, of Southcoast, which operated the field hospital at the University of Massachusetts Dartmouth. “The important thing about the field hospital is learning how to do it and do it well. … If we need to do it again we’ll do it faster and we’ll do it even better.”
Hoey, of Lowell General Hospital, appreciated just knowing the field hospital was there, inside a UMass Lowell gym. When it was dismantled, the materials were packaged carefully and stored. “We could bring it back online quickly if needed,” Hoey said.
All hospitals canceled elective surgeries to accommodate COVID-19 cases, but patient census dropped even lower than expected. Mysteriously, hospitals even saw fewer heart attacks and strokes — raising fears that patients were shrugging off serious symptoms. And with people staying home, serious accidents virtually stopped.
Lowell General Hospital typically sees four to five cases a week of injuries from severe motor vehicle crashes, gunshot wounds, falls from heights, and the like. During the pandemic surge, Hoey said, the hospital went 54 days without seeing even one severe trauma case.
But if COVID-19 surges again, as is widely expected, hospital leaders hope to take a more nuanced approach to nonemergency services. Shutting down completely had consequences for people’s health, and for hospital finances.
“If we have a second lockdown,” said Dr. Alastair Bell, chief operating officer at Boston Medical Center, “we don’t want to be in the position of just stopping care again. … I think we’ve learned a lot about how to manage COVID and non-COVID cases at the same time.‘‘
In contemplating the future, hospital officials expect personal protective equipment to remain a worry, especially as hospitals in new hot spots elsewhere report severe shortages.
Otherwise, hospital leaders say their experiences last spring prepared them well for the expected second wave as people start congregating indoors during the fall, potentially triggering a surge in COVID-19 cases that could coincide with the annual flu epidemic.
Doctors have a better understanding of how to treat the disease, potentially reducing the length of hospital stays. And the state is better equipped to monitor for a rise in cases, allowing hospitals time to prepare.
Jha says it’s best to think of COVID-19 in terms of tides rather than waves.
“We have much more time to plan, and we’ll see it coming,” he said. “We were so blind all of January, February, and early March. There was no testing capacity and all of a sudden we found ourselves in neck-deep water. ... Now, we’ll see the water level rising.”
Felice J. Freyer can be reached at firstname.lastname@example.org. Follow her on Twitter @felicejfreyer.