In calm before the storm, hospitals prepare for second wave of COVID-19

Boston Medical Center staff peered through the glass of a patient's room in April as a team performed a tracheostomy on a COVID-19 patient in the ICU.Erin Clark/Globe Staff//File

As COVID-19 cases tick up in Massachusetts, no one is eyeing the numbers more keenly than the hospital leaders who will have to respond to a second surge.

Hospitals officials are watching the case counts daily, with memories still fresh of legions of sick people filling wards in the spring. The number of people hospitalized with COVID-19 around the state remains low, but has been inching up in certain places in the past couple of weeks. So, too, has the rate of positive COVID-19 tests reported statewide. And any increase in cases in the community will eventually reach the hospital doors.

“We are very concerned about the rising [infection] rates that we have seen,” said Dr. Paul Biddinger, director for emergency preparedness at Mass General Brigham, the hospital group formerly known at Partners HealthCare.

Hospitals in Springfield and Boston reported slight upticks in COVID-19 patients, but Mass General Brigham, the largest hospital group, had only 49 cases on Tuesday and has not seen an increase in recent weeks. Statewide, COVID-19 hospitalizations have held relatively steady since July 24, with 396 reported on Wednesday, compared with nearly 4,000 on May 1.

A total of 338 new confirmed cases were reported Wednesday and two deaths.

The percentage of positive COVID-19 tests in Massachusetts rose to 2.2 percent, up from the mid-July low of 1.7 percent, according to Wednesday’s report from the state Department of Public Health.

Usually hospitalizations start to spike about two weeks after positive tests results go up, and intensive care unit admissions increase two weeks after that.

“The key is to recognize changes so that we can act quickly,” Biddinger said.

In the spring, hospitals cobbled together the space and staff to care for hundreds of severely ill patients — in many cases more than ever before seen — and the lessons on how to do that will guide the response to whatever the fall brings. Advances in understanding how to treat the illness might lead to shorter lengths of stay or fewer admissions. And improved testing capacity means hospitals are no longer in the dark about how many patients might show up at their doorstep.

But hospital officials also foresee new challenges that weren’t encountered in the spring.

The annual onslaught of flu and other respiratory viruses will complicate efforts to respond to COVID-19.

With the coronavirus flaring throughout the country, it will be harder to find traveling nurses to back up the staff, still exhausted from the spring ordeal.

And hospitals hope to avoid completely shutting down elective services as they did in the spring, which resulted in people missing or delaying necessary care. That will make it harder to find space for COVID-19 patients.

Hospital officials emphasize that the severity of the fall illnesses can be mitigated — but only if a pandemic-weary public can stick with disease-prevention measures for quite a while longer.

“If you look historically at pandemics, there is almost always a second surge,” Biddinger said. He has no idea when that second surge might occur, but sees two factors that could bring it on: a “loss of vigilance” against the virus as people tire of staying apart and wearing masks, and the tendency to gather inside as temperatures cool.

As the percentage of positive COVID-19 cases creeps upward, some public health experts have called on Governor Charlie Baker to roll back the reopening of the state’s economy, and Baker said he would consider doing so if cases continue to rise.

Baystate Health, a four-hospital system in the Springfield area, has seen “a slow but steady increase” in COVID-19 patients, said Dr. Andrew W. Artenstein, chief physician executive and chief academic officer, who runs the incident command for the Baystate’s pandemic response.

Some 30 COVID-19 patients are currently hospitalized at Baystate, about double the number a week ago, Artenstein said. That’s still well below the patient counts hovering around 200 in April.

“There seems to be more infection in the community,” he said. “It suggests the Northeast is not going to be protected for that much longer.”

At Boston Medical Center, the number of COVID-19 patients has doubled from six in early July to about 12. On April 30 amid the height of the surge, the hospital had 245 inpatients with COVID-19.

“We’re seeing some gradual changes which are not in the right direction,” said Dr. Alastair Bell, chief operating officer. But he said it’s hard to know whether these increases presage the start of another surge.

Looking ahead to the fall, as students return to schools and colleges, hospitals are also thinking about the arrival of seasonal respiratory viruses. Whenever there is a bad flu season, hospitals fill up. Now they will have to make room for COVID-19 patients, as well.

Baystate’s Artenstein said that patients may get infected with both the coronavirus and the flu, and it’s unknown how the two will interact.

Another concern is employee fatigue.

“Across the health care workforce, lots of people are still tired and feeling stressed and that makes it harder for us to gear up and do it all over again,” Biddinger said.

Hospitals tried to give doctors, nurses, and other staffers some time off during the summer, but at the same time, patients were streaming in for care they’d postponed during the shutdown.

“There is a lot of effort to recover lost volume, but there is a need for those same workers, who have been working very, very hard, to get some respite because they will be needed in fall and winter,” said Dr. Dani Hackner, chief clinical officer and physician-in-chief for medicine at Southcoast Health, which owns hospitals in Fall River, New Bedford, and Wareham.

“We need to prepare folks for a much longer fight than anyone had thought,” Hackner said.

And two critical problems linger from the spring: inadequate testing and the continuing struggle to obtain enough personal protective equipment or PPE — the gowns, face shields, masks, and gloves that staffers need to avoid infection.

Testing is essential to determine when hospital employees can return to work, and whether patients need to be isolated and cared for only by people in full PPE.

Baystate Health does not “have the capability to do point-of-care, rapid-turnaround testing,” said Artenstein, who called for a coordinated federal response. “We have not yet received the equipment or reagents to do that kind of testing. Without that, we don’t have the ability to make decisions quickly.”

Amy Hoey, chief operating officer at Lowell General Hospital, said testing supplies expected by her hospital “are being redeployed to other parts of the country.” Distributors who promised 500 tests a week a month ago can only deliver 100, she said.

To counter that, she said, Lowell General is deploying three testing methods, so if supplies needed to process one type of test run short, there will be alternatives.

Hospital leaders also expressed continuing concerns about the supply of PPE, saying they had enough for now but worried about what the future might hold.

“We’ve met the requirements for what we need to have in terms of stockpile,” Artenstein said. “We don’t have a stockpile for a rainy day. It’s going to be raining soon.”