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Baker says Mass. hospitals will ‘curtail’ inpatient elective procedures amid COVID-19 spike

Governor Charlie Baker gave a coronavirus update in Gardner Auditorium on Monday.
Governor Charlie Baker gave a coronavirus update in Gardner Auditorium on Monday.Pat Greenhouse/Globe Staff

In a troubling echo of the pandemic’s early days, Governor Charlie Baker said Monday that Massachusetts hospitals will temporarily curtail inpatient elective surgeries to make room for a further influx of patients with COVID-19.

Starting Friday, hospitals will limit “elective procedures that can be safely postponed,” Baker said at State House briefing. “This action will free up necessary staffing and beds.”

Hospital officials said last week that they are prepared for an increase as they keep watch on the steady increase of patients hospitalized with the coronavirus. On Nov. 7, the seven-day average of hospitalizations was 510. On Sunday, it was 1,361. As of Monday, Massachusetts had more than 1,500 patients hospitalized with COVID-19, 302 of them in intensive care.

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In March, hospitals across the state canceled elective surgeries, causing procedures at some large facilities to decline 30 to 50 percent. Medical specialists said then that they were also postponing some low-risk cancer surgeries and cardiac bypass surgery in cases where the patient was stable.

This time, the restrictions are more narrow and focused on conserving bed space, said Massachusetts Health and Human Services Secretary Marylou Sudders.

“Unlike the spring where we stopped everything, we are curtailing in-patient elective treatments and procedures that impact inpatient capacity,” Sudders said. “So ambulatory outpatient surgeries could continue. We obviously want to keep out-patient visits such as pediatric visits, all those things, mammograms that we had stopped in the spring, we want those to continue.”

Baker has been under increasing pressure from medical experts and local mayors to increase the lockdown measures in place to limit the spread of the virus. The state reported 30 more deaths on Monday.

Pressed on whether more COVID-related restrictions could be coming, Baker said, “We’ll have more to say about that soon.”

“We’re taking a good look at the data as we have been post-Thanksgiving,” he said. “And I fully expect that at some point we’ll make some decisions with respect to that.”

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For now, though, Baker limited his action to the restriction on elective surgery, which could hit the bottom line of some hospitals.

Dr. David Hoyt, executive director of the American College of Surgeons, a professional association that represents 85,000 surgeons across the country, said many hospitals are still catching up on a lengthy backlog of elective surgeries that had been delayed last spring, during the initial surge of the virus.

While the need to scale back on such procedures differs across the country — some hospital systems have more capacity than others — many surgeons are feeling the impact.

In a survey of 5,000 surgeons last spring, about half had to limit their own salaries or cut back on office staff to keep their practices running, he said.

He expected there would be a similar impact over the coming months. In a typical year, he said, about 20 million elective surgeries are performed. It isn’t clear how many fewer there have been this year.

“What we do know is that COVID is having a tremendous financial impact on surgeons and hospitals across the country,” he said.

Officials at the Massachusetts Health & Hospital Association said their main concern remains patients’ access to care.

“COVID-19 continues to devastate both the health of our communities and the financial stability of our health care institutions,” said Steve Walsh, president of the Massachusetts Health & Hospital Association. “Hospitals from all regions of the state have operated under distressed circumstances throughout 2020.”

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Before receiving federal aid, many hospitals were losing money, he said.

“Now, with the second wave upon us and uncertainty lingering over the future of financial support, we are bracing for what could be another difficult year ahead,” Walsh said. “As providers treat an influx of COVID-positive patients and make the investments necessary to deliver safe care, it’s crucial that they can remain financially viable and fully accessible to their communities.”

The Mass General Brigham system will be reducing elective procedures by about 30 percent, said Paul Biddinger, head of emergency preparedness at Massachusetts General Hospital and the Mass General Brigham hospital system.

That will free up approximately 100 beds across the system, he said.

“It’s really important for the public to understand that we don’t consider the vast majority of care to be elective. For care to be elective — or not necessary — it can still be more or less urgent,’' he said.

At Tufts Medical Center, officials said they didn’t expect the governor’s announcement would have a significant impact on their bottom line, noting that much of their elective procedures don’t affect the inpatient capacity.

“There may be a bigger impact if we need to reassign those staff members to other care areas, as the COVID census increases,” said Jeremy Lechan, a spokesman for the hospital.

But he said there are other problems.

“We are always concerned when care is delayed, which is why we are selecting cases to postpone carefully,” Lechan said. “We are only choosing cases where care can be deferred for up to a month without adversely affecting the patient’s health.”

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With infections increasing at a rapid clip, hospitals are bracing for a surge of patients, and the state has opened its first field hospital in months, a 240-bed facility at the DCU Center in Worcester. On Sunday, it accepted its first five COVID-19 patients. The facility is ready to accept as many as 25 patients in its first week and will be able to ramp up capacity quickly, officials said.

Demand for coronavirus tests has climbed in recent weeks, putting the state’s system under heavy strain. On Monday, the Baker administration announced an expansion of free testing sites in areas that have had relatively few locations, along with greater capacity at several sites to handle thousands more tests weekly.

The move follows widespread criticism of long waiting lines and times for test results as the virus surges across Massachusetts.

Expanded testing, the administration said, will be added over the next several weeks in Hampshire, Franklin, and Berkshire counties in the Western part of the state, and in Barnstable County on Cape Cod,

At the same time, three sites in Eastern Massachusetts — New Bedford, Framingham, and Lynn — will expand to regional testing locations that should be able to accommodate about 1,000 people a day. They will be run by Project Beacon, the company that currently operates a site in Revere. The drive- through sites, which will require an appointment, should be up and running by the end of December, officials said.

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During the pandemic, Massachusetts has performed more tests per capita than all but three states — North Dakota, Rhode Island, and Alaska — data from Johns Hopkins shows.

That has not kept cases from surging in recent weeks. At his news conference, Baker reiterated, his voice rising slightly, that residents must take precautions to protect themselves and others.

“Now that everybody’s inside, and you can’t be outside as much as you used to be, it’s critically important for people to up their game,” Baker said.

He also repeated the timeline for vaccine distribution, saying the state expects to receive 300,000 doses of a COVID-19 vaccine by month’s end.

“Those doses will be prioritized to front-line health care workers first, and then to long-term care facilities,” Baker said. “We have a comprehensive plan to distribute the vaccine in a safe and effective manner.”

More details should be available Wednesday, he said.

Baker acknowledged that mayors in some cities would like to see more aggressive state action to limit the spread of the virus.

“I talked to several mayors over the weekend who are frustrated with me, and frustrated generally, OK?” Baker said. “But to a person, they all said that they see in their communities, all the time, people engaging in risky activity that we have all been talking about as the sort of thing that you should seek to avoid.”

But as the holiday season moves forward, vigilance is vital, he said.

“I haven’t had a meal with my dad since February,” Baker said. “I don’t like that. But those are the rules in this game that we all need to play by to keep ourselves and others safe.”

Kay Lazar of the Globe Staff contributed to this report.


David Abel can be reached at david.abel@globe.com. Follow him on Twitter @davabel. Travis Andersen can be reached at travis.andersen@globe.com. Follow him on Twitter @TAGlobe.