In a troubling sign of the coronavirus’s spread throughout the city, hospitalizations for COVID-19 are climbing slightly at several Boston area hospitals.
This week, Boston Medical Center reported an increase in inpatient hospital admissions due to COVID-19, officials said, with 16 patients hospitalized — up from eight patients on Oct. 7 and 10 patients on Sept. 30.
Although these figures are far below those during the outbreak’s surge in April, when Boston Medical Center was caring for more than 200 hospitalized COVID-19 patients daily, the increase raises concerns about the growing prevalence of the virus in Greater Boston.
“We are definitely diagnosing more cases — some of whom are quite ill — and we are also noticing many of the patients coming to the emergency department that are diagnosed with COVID don’t have a clear exposure they can point to,” said Dr. Elissa Perkins, an emergency medicine physician at Boston Medical Center. “For me, that’s quite alarming. For me, that suggests that there’s more COVID out and about.”
Boston is one of 63 communities designated as “high risk” for COVID-19 by the Massachusetts Department of Public Health. Although most of Massachusetts remains at low risk, reporting fewer than four coronavirus cases per 100,000 people, in Boston the average daily case rate over the last 14 days is 11.1 per 100,000 residents. For the week ending Oct. 10, according to the Boston Public Health Commission, 4.4 percent of COVID-19 tests came back positive, up from 4.1 percent the week prior. In late July, the virus positivity rate in Boston had dropped as low as 1.7 percent.
Public health experts fear a second surge of COVID-19 cases is on the horizon as the cold weather forces more people indoors, where the virus is easily transmitted.
“I think all of us have a bit of PTSD as we’re starting to see these patients again,” Perkins said.
Dr. Erica Shenoy, associate chief of Massachusetts General Hospital’s infection control unit, said Mass. General is closely monitoring the state health department’s metrics for a potential surge in COVID-19 hospital admissions. Although positive cases diagnosed in the Mass. General emergency department have held “generally steady” over the past two weeks, Shenoy said, the hospital has also seen a “slight uptick” in patients with COVID-19 requiring hospitalization.
Similarly, at Beth Israel Deaconess Medical Center, Dr. Tony Weiss, chief medical officer, said the hospital has also observed a “slight increase” in patients hospitalized with COVID-19 and in patients suspected of having the disease at the emergency department. As of Thursday, the medical center is caring for 13 patients with confirmed COVID-19 diagnoses in the hospital, a decrease from last week’s high of 18 patients but up from the “post-surge low" of eight to 10 patients, according to Weiss.
“However, this is complicated by the fact that we are entering cold and flu season, when respiratory ailments are more common,” Weiss noted in an e-mail. “Patients presenting with symptoms that could be consistent with COVID-19 are treated as such until tests confirm otherwise.”
Brigham and Women’s Hospital is logging between one and three new COVID-19 admissions per day, according to spokesman Mark Murphy, up from zero to one in August and September.
Dr. Gabriela Andujar Vazquez, an infectious disease physician and associate hospital epidemiologist at Tufts Medical Center, said more patients are visiting the emergency department suspected of having COVID-19, but so far, the number of patients needing hospitalizations or intensive care has remained relatively low and stable. But, she warned, “that may just be temporary.”
"We all know that we have to be diligent and vigilant in the next couple of weeks because we know the disease can sometimes get diagnosed and get complicated in the couple of days after getting diagnosed,” she said. “So we’ll see how the next couple of weeks go.”
Dr. Ali Raja, executive vice chairman of Mass General’s emergency medicine department, said hospital admissions haven’t risen as sharply because patients recently diagnosed with COVID-19 have tended to be younger and healthier. These patients usually have mild symptoms that can be treated by their primary care providers.
“A lot of the new cases are being driven by college students who are testing positive and younger adults who are getting tested by their primary care providers for minor symptoms,” Raja said. “Because they’re younger and healthier, they’re not needing to come [to the hospital]. Now, if that changes, if we start seeing more patients testing positive in nursing homes and more patients who are older and who have comorbid illnesses... I wouldn’t be surprised at all if we start having to admit more patients.”
During his press conference Tuesday, Governor Charlie Baker reminded residents to stay vigilant, citing the rise in cases among young adults in their 20s and 30s who are living in shared apartments and congregating in small groups.
Perkins said the COVID-19 patients she has seen recently in the emergency department have reported being “incredibly careful” to prevent catching the disease, but she still suspects “COVID-19 fatigue” has set in and vigilance has waned.
“We are exhausted and it’s really, really hard to keep your vigilance with masking and social distancing. They’re tired of living this way, which I understand,” she said, "but unfortunately, it has really translated to an increase in cases.”