A year into COVID-19, hospitals find a new normal

Hospital staff worked on 2-North, the COVID-19 floor at the West Roxbury VA Medical Center, in January.Erin Clark/Globe Staff

After battling COVID for more than a year and weathering two surges of sick patients, Massachusetts hospitals are settling in to a new normal.

They’ve shifted from managing a raging crisis to incorporating COVID into their daily work. For the foreseeable future, hospitals expect to continue treating COVID patients — though the number could rise as variants spread or fall as more people get vaccinated.

Hospitals across the state are treating about 700 COVID patients, 23 percent in intensive care, even as the economy reopens and more than 2 million people in Massachusetts are fully vaccinated.

Massachusetts hospitals are not as strained as hospitals in some other parts of the country — such as Michigan, which is in crisis again — but they have no plans to close their COVID units anytime soon.

“As challenging as the year has been, right now COVID is part of the patients we take care of. [It’s] part of our fabric. [It’s] part of what we do on a daily basis now for many other diseases,” said Dr. Ravin Davidoff, chief medical officer at Boston Medical Center, where about 20 people are hospitalized with COVID.

Like so much else, the level of hospitalizations will depend on two critical dueling factors: the pace of vaccinations and how rapidly the virus continues to spread.

Hospitals must remain prepared in case the contagious new variants — and a pandemic-weary public letting down its guard — lead to another spike in infection and illness. Already, the number of people testing positive for coronavirus and the number sick enough to be hospitalized ticked back up in late March and early April, after falling since January.

Hospitalizations in Massachusetts now appear to be on a plateau.

“We just need people to hang on just a little bit longer until we can get prevalence of the virus down to low levels and get vaccination rates up well north of 50 percent — closer to 70, 80 percent,” said Dr. Paul Biddinger, director of emergency preparedness for the Mass General Brigham hospital system.

Hospitalizations in Massachusetts soared to their record high a year ago, when 3,965 COVID patients were in hospital beds. During that first surge, hospitals curbed almost all non-emergency care and redeployed staff to manage the influx of patients sick with the virus.

After ebbing during the summer and early fall, hospitalizations increased again amid the winter holidays, hitting another peak of 2,428 on Jan. 4. Again, hospitals canceled surgeries so they could focus on COVID care, and that time, they transferred patients around the state daily so no one facility became overwhelmed.

Hospitals are no longer in surge mode, running daily command center briefings to manage the crisis. They no longer fear they will run out of beds for COVID patients or qualified staff to treat them.

Now, they’re busy trying to manage COVID and non-COVID care at the same time.

Once-unfamiliar protocols are now the norm. Patients are tested for the coronavirus before scheduled procedures and upon admission to the hospital. Visitors are restricted. Personal protective equipment, especially masks, is commonplace. Social distancing is required.

“The new normal is just managing [COVID] as part of our routine operations,” Davidoff said. Over time, he said, he expects to see fewer COVID patients.

Since the virus first emerged last year, the profile of the typical COVID patient has changed. Seniors, who largely are vaccinated, no longer make up the majority of people hospitalized with COVID. Patients now tend to be younger, in their 30s, 40s, and 50s, said Dr. Kevin Tabb, chief executive of Beth Israel Lahey Health.

“We’re concerned there’s a younger population that has stopped taking precautions . . . and think that if they get sick, it will be mild,” he said. “I would not discount the potential for young people to get very, very sick because we see that every day.”

Doctors and nurses know much more about how to treat the disease than they did last year, but they are exhausted from more than a year of the physically and emotionally draining work.

The trajectory of the pandemic remains tricky to predict. Variants of the virus are known to be circulating in Massachusetts, but data on their prevalence are limited.

State health officials have counted 1,402 cases of the B.1.1.7 variant, which originated in the United Kingdom, and 122 cases of P.1, a variant first detected in Brazil. Those figures are drawn from a sampling of coronavirus cases and don’t account for all cases in the state.

“It’s really hard to predict what’s going to happen,” said Dr. Sarah Haessler, hospital epidemiologist at Baystate Medical Center, where about 50 patients are being treated for COVID. “These variants are really a wild card.”

Haessler called the month of April “a really critical inflection point” in determining the course of the pandemic, as variants spread and more people get the vaccine.

Through the course of the pandemic, hospitals have become used to adding beds for COVID patients when numbers rise, and closing makeshift units when numbers fall. It’s a delicate balance: creating enough space to manage COVID patients while maintaining as many of their other services as possible.

On Cape Cod, where the P.1 variant has contributed to a mini-surge in infections and hospitalizations in recent weeks, Cape Cod Healthcare is running two COVID units, one in Hyannis and one in Falmouth, with a total of 36 beds, said Michael Lauf, the chief executive.

Those COVID units have been busy, but Lauf said he expects hospitalizations to gradually fall again. If needed, Cape Cod Healthcare could double the number of beds available for COVID patients.

“Where we are is where we’re going to be — with or without vaccines — at least for the remainder of the next six months,” Lauf said. “COVID is going to be with us. We’ve all learned to adapt.”