Even as hospitalizations have crept up this spring and COVID cases proliferated across the state, Massachusetts residents may have missed some good news: ICU admission rates for COVID patients plunged to their lowest levels since the start of the pandemic.
On Wednesday, 814 patients with the virus were hospitalized, one of the higher levels since mid-February. But, of those, only 79, or 9.7 percent, were in the ICU.
By comparison, in mid-February, around 19 percent of patients hospitalized with COVID were being admitted to intensive care.
“The good news is we’re seeing fewer patients with critical illness from COVID,” said Dr. Paul Biddinger, chief preparedness and continuity officer at Mass General Brigham.
This week’s rates are a few notches higher than they were on April 24, when ICU admission rates bottomed out at 6.3 percent of the 396 COVID-positive patients in the hospital.
Several factors are contributing to the lower rates and helping decouple cases from serious illness, including rising rates of vaccination in Massachusetts, the use of boosters, and the number and greater availability of therapies. Some seasonal trends may also be playing a role.
“It is a much more complex conversation than it was earlier, where more cases predictably translated to more hospitalizations and more severe illness,” said Biddinger. “We’re seeing a changing relationship between the number of cases and numbers of hospitalizations from COVID.”
On Thursday, Massachusetts reported 3,485 new confirmed coronavirus cases. The seven-day average of daily new cases was 2,975, down from a recent peak of 4,062 on May 17. Levels of coronavirus detected in Eastern Massachusetts waste water, which are an early indicator of the virus’s spread, have also turned downward in recent days, raising the possibility that our current wave may be cresting.
Overall, fewer people who contracted COVID this spring have been severely ill, compared to last winter. State data show that since mid-April, approximately one-third of COVID-positive patients were hospitalized primarily for COVID, compared to 40 to 50 percent in January and February, when the state began releasing a breakdown of causes of COVID-related hospitalizations.
Among the reasons for the decrease in severe illness has been the state’s robust vaccination and booster programs. As of May 26, 5.38 million Massachusetts residents had been fully vaccinated — over 290,000 more than in early January. Of those, 3.05 million had received a booster — almost a million more than in January. In March, the FDA authorized a second booster dose for older adults, and as of late May, approximately 463,000 people had received one.
“The good news is we are nearly 80 percent fully vaccinated in Massachusetts,” Biddinger said. “We have pretty good rates of boosters. Vaccination and boosters are by far the most important strategy we have for limiting severe illness and death.”
Hospital systems also have more tools to fight serious disease. Though the FDA authorized Paxlovid to help prevent serious disease in December 2021, supply was initially limited. More of the drug is now being produced, and hospitals have amped up efforts to provide access.
Mass General Brigham is prescribing 400 to 600 courses of Paxlovid every day and communicating with primary care physicians and patients to streamline access. Since Jan. 8, the health system has written more than 15,000 prescriptions for oral therapies including Paxlovid.
The health system is also using remdesivir, monoclonal antibodies, and Evusheld for high-risk immunocompromised individuals.
Even with reports of some patients rebounding and becoming infectious again after Paxlovid treatments, data show the treatment prevents many people from becoming seriously ill.
“It’s a layered strategy — get vaccinated, get boosted, get tested, get therapy early,” Biddinger said. “That’s our best strategy for protecting the health care system and ability to take care of all the other patients.”
UMass Memorial Health has also delivered approximately 8,000 courses of either Paxlovid or the monoclonal antibody therapy bebtelovimab since last July — almost 2,000 of which were delivered since April 10. It also hosts clinics for Evusheld for patients on Saturdays.
Dr. Eric Dickson, CEO of UMass Memorial Health, said the health system has expanded the number of monoclonal antibody treatments it can deliver in a day, to 45 to 48 appointments. The center has been operating at maximum capacity for the last five weeks, as the latest surge began.
Other factors, too, have made this surge less severe than last winter’s. In January, the highly infectious Omicron variant raced through the community, re-infecting people who had had prior COVID infections and causing transmissible illness even in vaccinated individuals. Community spread was likely compounded by the cold weather and holidays.
Biddinger pointed out that on Jan. 8, the seven-day average of new COVID cases was over 23,000 — more than six times higher than in mid-May. Such rapid community spread naturally led to a greater number of hospitalizations, even if the rate of hospitalization from COVID was decreasing.
“Now we have a significant number of people who were infected with Omicron over the winter, better vaccination and boosting, and warmer weather all playing a role in decreased community spread,” Biddinger said. “It’s incredibly hard to think about how to quantify the relative contributions of each factor, but the sum has led to a much lower peak.”
Despite fewer severe illnesses, the rising number of COVID patients this spring is still putting a strain on hospital resources. Mass General Brigham’s ongoing staffing challenges, due to a dwindling health care workforce statewide, were compounded by staff missing work due to COVID-19 infections, Biddinger said.
Dickson said UMass still has to isolate patients with COVID in negative pressure rooms, which filter the air and help prevent contagious diseases from spreading down hallways and corridors, even if they came to the hospital for another reason. Staff also need to use the full gamut of PPE when treating COVID patients, further adding to the sky-high supply costs.
Some surgeries were also being canceled as the hospital discovered COVID cases in patients who were asymptomatic. The health system was having a hard time discharging patients who need rehabilitation as well, given the staffing shortages at at nursing homes and rehab centers.
“This has changed hospital operations in a negative way,” Dickson said. “Regardless of whether or not a lot of people are dying from COVID, it has made it difficult to run a hospital in 2022.”
Dr. Richard Nesto, chief medical officer at Beth Israel Lahey Health, said that, of the system’s 175 COVID-positive patients, only 10 to 15 were in the ICU. Similar to state trends, two-thirds of the system’s COVID-positive patients had come to the hospital for something else.
The system has written at least 8,000 prescriptions for Paxlovid in the last couple of months, and was giving monoclonal infusions to patients ineligible for Paxlovid, such as those who had exceeded the five-day window since their symptoms started. Yet demand for therapies was less robust than anticipated, given the prevalence of COVID in the community, Nesto said.
Even though the virus isn’t currently causing severe illness in the majority of infected patients, Nesto warned that people should still take protective measures, avail themselves of treatments, and remain vigilant.
“The perception out there amongst some providers and patients is that this form of COVID is not so bad, since it’s so prevalent in the community,” Nesto said. “But who knows, six months from now, whether there will be another variant that will change the picture of what we’re experiencing. We would not want people to be lulled into a sense that COVID is here to stay and it’s not so bad. Patients still need to get vaccinated and boosted.”