The Delta variant, spreading rapidly in a county where nearly half the population is unvaccinated, has sent a staggering influx of COVID-19 patients to BayState Health, the dominant health care provider in Western Massachusetts.
The Springfield-based hospital group is now caring for more people sick with the coronavirus than even the big Boston hospitals. BayState’s four hospitals had 89 COVID-19 patients on Thursday. In contrast, Massachusetts General Hospital, the state’s largest, had just 32.
“BayState has really been hit unusually hard by the fourth wave of the COVID-19 pandemic,” chief executive Dr. Mark A. Keroack said at a briefing Thursday.
“We are appealing to the community to help us,” Keroack said. “Everyone in the community has a role to mitigate the effects of this crisis and to help us be there for everybody who needs us.”
Keroack said he has approached civic and business leaders, imploring them to impose vaccine mandates on employees and to encourage masking and social distancing.
“We really want to dial down the demand for our services,” he said. “We don’t like living on the edge when it comes to capacity.”
Although the hospital has not yet needed to curtail elective surgeries and other services, it has begun examining which procedures can be safely deferred. “It may be a lever we need to pull,” Keroack said.
The situation is so dire that BayState came close to diverting patients to other hospitals during Tropical Storm Henri, when it prevented discharges — only to find that no one had room.
The latest surge came on quickly: BayState went from four COVID-19 cases on July 1 to more than 100 last weekend, Keroack said. On Wednesday, nearly one in five of all hospitalized COVID-19 patients in Massachusetts were at BayState.
Compounding the challenges, patients who are ready to leave the hospital often cannot be discharged because of a shortage of available nursing homes beds. Many of the region’s nursing homes are closed to new residents because they have COVID-19 cases or staffing shortages, Keroack said. As a result, patients are backing up in the emergency department waiting for beds to free up.
And the hospital, like many others, is struggling with its own staffing shortage, with 1,400 vacant positions among 12,000 employees. It has brought in more than 100 contract nurses to fill in and has boosted pay in the hope of attracting more staff, Keroack said.
The number of COVID-19 cases at BayState peaked at 104 on Tuesday, and then dropped to 97 on Wednesday and 89 on Thursday. But it’s too soon to tell if that signals a downward trend, Keroack said. (At the height of the pandemic in April 2020, the Baystate hospitals had 150 COVID-19 patients.)
Seventy-five percent of patients hospitalized at BayState are unvaccinated, Keroack said.
Vaccinated patients are older or have chronic medical conditions, Keroack said, and the vaccine’s protection means that those patients tend to have milder illnesses and shorter hospital stays.
Fourteen patients are in intensive care. The hospital has adequate ICU capacity and does not have immediate plans to convert other areas into ICUs as happened in the spring of 2020, Keroack said. Fewer hospitalized patients need intensive care than in the beginning of the pandemic because so many of the oldest and sickest people have been vaccinated, and doctors know more about how to treat COVID-19.
Hampden County, where BayState is located, has the lowest COVID-19 vaccination rate in the state, with 52 percent fully vaccinated compared with 66 percent statewide. Only 45 percent of Springfield residents were fully vaccinated by late August.
Hampden County has higher proportions of people who are young and who identify as people of color — populations that have been less likely to get vaccinated. It also has a comparatively high poverty rate, and poorer people face obstacles to vaccination — such as jobs that don’t allow time off, as well as transportation and child care issues.
Many have confronted racism in the health care system and have come to distrust it, said Cristina Huebner Torres, chief research and population health officer at Caring Health Center in Springfield. And many also have picked up misinformation on social media, she said.
“There’s a lot of different voices at the table,” said Dr. Jonathan A. Moseley, Caring’s chief medical officer. “All have their own reasons for choosing whether or not to get vaccinated,” ranging from questioning the science, to a political point of view, to objecting to a government role in health care decisions.
The Hampden County cities of Springfield and Holyoke are among the 20 communities included in the state’s Vaccine Equity Initiative, through which the state has provided some $37 million in grants to community organizations to administer vaccines to people who need it.
This typically involves a person-by-person labor of education and coaxing. Workers deployed through the vaccine initiative have knocked on 58,449 doors in Springfield and 11,892 in Holyoke, according to the state Department of Health.
The Behavioral Health Network, which provides mental health services primarily to people living in poverty and communities of color, goes to parks, malls, check-cashing outlets — “pretty much where we think there are people who couldn’t access vaccines on their own,” said Jessica DeFlumer-Trapp, the network’s executive vice president. They even delivered shots to the homes of people who can’t leave or are afraid to leave.
“There’s still a lot of hesitancy,” DeFlumer-Trapp said, particularly women of childbearing age and women of color, who have received misinformation about the vaccine’s effects.
Likewise, Caring Health Center sends its van to community gardens, pancake breakfasts, and other events. Community health workers and other clinicians — who mirror the ethnic and racial backgrounds of the people they serve — talk with people and draw out their feelings about vaccination.
“The teams have indicated people are receptive,” Huebner Torres said. “They like to talk to the team members.”
And it often works, Moseley said. “Those conversations are bearing fruit,” he said. “When we’re present, they choose to get vaccinated. There’s been a steady increase in vaccination.”
Data from the state Department of Public Health back up his impression. In Springfield, there has been a 1.6 percent increase in first-dose vaccinations over the past two weeks, compared with 1 percent statewide.