Why this wave of COVID hospitalizations in Mass. is different

For much of the past two months, the number of people hospitalized with COVID in Massachusetts has been rising again.

Hospitalizations have leveled off in recent days, but they’ve stressed a health care system already struggling with high demand and staffing shortages.

And yet, the latest wave of COVID in hospitals looks different.

This wave has been smaller and slower

Fewer than 700 people with COVID were hospitalized across the state by the end of May. That number had been ticking up for weeks — but not as quickly as overall cases. And it’s just a fraction of the more than 3,000 COVID patients in hospitals during the height of the omicron surge in January.

The latest state data indicate hospitalizations may have peaked at the end of May.

“We’re pretty far from what I would call a big surge,” said Dr. Richard Nesto, chief medical officer for Beth Israel Lahey Health. “The COVID numbers, they’re creeping more rather than jumping.”

This COVID “creep” has been easier for hospitals to manage than the steep rise of COVID in the winter. At the time, hospitals canceled surgeries and other procedures just to make room for all the COVID patients.

“It’s still an influx of patients that we didn’t have before,” Nesto said. “But it’s not like it was [a few] months ago.”

Most patients are not being treated primarily for COVID

An important trend that’s become clear in the data is that most people who have COVID and are hospitalized just happened to test positive for the coronavirus when they were admitted for a different reason. Only about one in three are being treated for a COVID-related illness, such as pneumonia.

An even smaller share of hospitalized COVID patients — about 10% — are in intensive care. This is very different from earlier points in the pandemic when hospitals worried about running out of ICU beds and ventilators for the sickest patients.

“We are absolutely seeing a lot of COVID in the community, but relatively fewer people needing hospitalization,” said Dr. Paul Biddinger, chief preparedness and continuity officer for Mass General Brigham. “The percent of people hospitalized for COVID illness is not correlating with the overall magnitude of cases we’re seeing in the community.”

Patients who have COVID as a secondary issue still add to the strain on hospitals. They usually need private rooms, and health care workers have to wear more protective equipment when taking care of them.

But doctors say it’s encouraging to see relatively fewer people getting seriously ill from COVID, compared with a few months ago.

One factor, they say, is immunity. Massachusetts has a highly vaccinated population, and infections are generally less severe for people who are vaccinated and boosted.

In addition, significant numbers of people had COVID just a few months ago, during the omicron surge, and likely still have some immunity from those infections.

People who test positive for COVID now also have access to new drugs, such as Paxlovid, which help prevent them from getting sick enough to need the hospital.

Mass General Brigham has prescribed Paxlovid to more than 7,000 COVID patients, Biddinger said, and only 24 of them needed to be hospitalized.

Most COVID patients in hospitals are being treated for a different problem. One-third are being treated for COVID. (Courtesy Mass. Department of Public Health)

Hospitals are still in crisis

Whether COVID cases rise or fall, hospitals are still struggling. They’re facing unusually high demand from people who need surgery and treatment for all kinds of diseases. Many of these patients had to defer care earlier in the pandemic and are now catching up on appointments and procedures they missed.

Each hospital bed for a patient sick with COVID is a bed that can’t go to someone else with an urgent medical need.

Hospitals are also scrambling to hire staff as many health care workers, exhausted from the pandemic, are leaving their jobs.

The staffing shortages have worsened during the latest COVID upswing, as health care workers themselves catch the virus and have to stay out of work for days. At large hospital systems, that could be hundreds of workers at a time.

Dr. Shira Doron, hospital epidemiologist at Tufts Medical Center, said hospitals are in crisis — and COVID contributes.

“Everyone is seeing really, really busy emergency rooms… really, really short staffing… and full beds,” she said.

Dr. Eric Dickson, chief executive of UMass Memorial Health Care, said these factors make the timing of the latest COVID wave particularly tough.

“As we started to see this uptick, we were really overwhelmed trying to catch up with a lot of work that had been put off for the last two years [and] dealing with staffing challenges,” he said. “We were starting from a position of weakness in health care, and then you’re laying this on top of it.”

The future: more peaks and valleys

Hospitals are working to increase staffing and open enough beds to take care of all their patients. Meanwhile, for the foreseeable future, COVID numbers are expected to swing up and down.

Hospital leaders say if case numbers are rising, everyone can play a role in slowing the spread by taking now-familiar precautions: wear masks indoors, use rapid tests, get vaccinated and boosted.

“We all need to kind of watch what’s going on and be good citizens,” Dickson said. “And when we see COVID on the rise, do everything we can to blunt the peak of the surge.”

Dickson is just recovering from a case of COVID himself. He thinks he was most likely infected at a Boston Celtics game where most people were unmasked.

Hospital leaders are almost certain they’ll see another wave of COVID when this one subsides, but the virus has been notoriously difficult to predict. Much depends on how the virus mutates and whether a concerning new variant emerges.