Amid surging COVID-19 infections, overflowing hospitals, and exhausted healthcare workers, Massachusetts hospital leaders are hanging on a glimmer of hope: some treatments, vaccines, and hard-won knowledge from the earlier outbreaks have meant fewer severely ill COVID patients.
And those who do need intensive care generally are recovering more quickly, doctors say.
“The proportion of [COVID] patients in the ICU has gone down slightly and the average length of stay for the ICU has gone down slightly,” said Dr. Paul Biddinger, director of emergency preparedness at Mass General Brigham, the state’s largest hospital system.
But doctors are not letting their guard down.
“This is encouraging to be sure, but no one should be blasé about this,” said Dr. Richard Schwartzstein, chief of pulmonary, critical care, and sleep medicine at Beth Israel Deaconess Medical Center.
“There are patients getting as sick as they were before and still dying, despite these advanced therapies,” Schwartzstein said. “But the vast majority are the ones who are not vaccinated,” he said.
A snapshot of COVID-positive patients in Beth Israel’s intensive care units over two days last week underscored that point: fewer than half were vaccinated.
At Tufts Medical Center, the discrepancy is even starker. Six of seven COVID-19 patients in critical care on Thursday were unvaccinated. And those without shots represented almost 60 percent of the total hospitalized patients with COVID there.
“The key is that those who are vaccinated leave earlier, leave faster, and aren’t as sick,” said Terry Hudson-Jinks, chief nursing officer at Tufts. “That is the theme every single time.”
Of those developing serious illness and dying from COVID, most are “the oldest patients, 80s and 90s,” said Todd Ellerin, director of infectious diseases at South Shore Hospital in Weymouth. And, he said, they are also the patients who have weakened immune systems or multiple underlying health problems.
Across Massachusetts, all hospitalized patients are tested for COVID, so such a diagnosis could be incidental to what landed a person in the hospital. State data does not distinguish between those hospitalized for COVID-19 care and those diagnosed with the virus but admitted for other reasons, nor does the data from most hospitals.
The latest state data show that just 2 percent of the roughly 5 million fully vaccinated people have so-called breakthrough COVID infections. And a more detailed breakdown of such cases requested by the Globe shows that a much smaller number of people, roughly 0.5 percent of all the breakthrough cases, are hospitalized and die. Roughly half of that group were 80 years or older, the data show.
Now, as more vaccinated people get booster shots, the percentage of vaccinated patients admitted to hospitals for COVID treatment is declining, said Dr. Eric Dickson, chief executive of UMass Memorial Health.
“The booster is starting to have a positive impact in reducing the number of breakthrough cases,” he said. “It’s still largely three-quarters a surge of the unvaccinated.”
Compared to the early days of the pandemic, fewer COVID patients are dying, hospital administrators said, in part due to lessons learned that improved care. Hospitalized patients now are often given high-dose oxygen as soon as possible in hopes of avoiding placing them on ventilators, machines that pump air into their lungs, but can produce long-term complications.
Another advancement is the use of dexamethasone, a powerful steroid that helps reduce inflammation and has been shown to be helpful in people with severe COVID who are hospitalized and on ventilators or who require supplemental oxygen. Many people had not heard of the drug before October 2020 when President Trump received it during his treatment for COVID-19.
Newer in the armament is Tocilizumab, a monoclonal antibody that reduces inflammation and had been used in the treatment of other diseases such as cancer. It was authorized in June by federal regulators to treat COVID in ventilated patients and those receiving oxygen. Doctors still use the antibodies from Regeneron and Eli Lilly that were approved earlier in the pandemic, but as the Omicron variant storms across the country, some monoclonal antibodies have been found to have significantly diminished potency against the new strain.
Monoclonal antibodies, the laboratory-made proteins that mimic the body’s immune system and stop the virus, can keep people with COVID from getting seriously ill if taken within 10 days after symptoms appear. Doctors say these drugs have been remarkably effective in keeping people from needing hospitalization.
“Some of the patients with monoclonal antibodies end up being hospitalized, but they are not as sick,” said Dickson, of UMass Memorial Health, which has been administering about 200 such treatments per week in its outpatient center and a small number in the hospital.
One monoclonal antibody that is holding promise of standing up to Omicron is a new drug, called Evusheld, recently authorized by the Food and Drug Administration, that can be given to patients with weak immune systems before they’re exposed to COVID, in hopes of limiting severe illness.
“We don’t have it available yet, but I think it will be here before the end of the year,” said Biddinger of Mass General Brigham.
As the number of people hospitalized for COVID in Massachusetts continues to rise sharply — it has more than doubled over the past month, to 1,499 — Biddinger and other hospital leaders say the deluge is overwhelming their already strained operations and bone-weary staff.
“The demand for care is as high as it’s ever been,” Biddinger said.
Hospitals, anxious about being swamped early in the pandemic, postponed many procedures, such as colonoscopies and joint replacements, to make room for COVID patients. Now patients with advanced cancers, heart disease, and other chronic illnesses who delayed care are swamping hospitals, sicker than ever.
Many of the facilities are also facing staffing shortages. And now, Biddinger said, patients frustrated at having to wait hours and even days for a hospital bed are taking their anger out on staff.
“Things are much more crowded and you spend 18 hours on a hallway stretcher, you get cranky,” he said.
“Not all [visiting] family members wear their masks the way they should,” Biddinger added. “Many times a day, nurses have to remind a family member to follow our infection-control procedures. It’s just exhausting.”
The anxiety among hospital leaders is palpable as they talk about the weeks ahead, when the current surge of COVID cases from the Delta variant is expected to swell to a tsunami with Omicron, too.
“There was so much hope that perhaps [vaccination] would prevent another surge,” said Hudson-Jinks, the chief nursing officer at Tufts. “It’s very disappointing that we are here again, seeing the numbers of COVID patients increase in the community and in here. It’s exhausting.”