Maryland could be on the cusp of yet another fall and winter COVID surge, local health experts fear.
Some forecasts show that while COVID-19 related deaths would stay below the peaks of last winter, Maryland could see sharp spikes in daily case numbers and hospitalizations by Thanksgiving. Those estimates have some health officers watching current trends and preparing for the potential effects on an already stressed healthcare system.
“I feel like we’re as prepared as anyone in the country is and are effective in managing COVID-19,” said Dr. Earl Stoddard, acting health officer for Montgomery County. “I think that no one is looking forward to any increase. We’ve obviously talked about the fact that we’ve developed tools in our tool kit that don’t require some of the harsher closures moving forward.”
Maryland, as with the nation, is seeing a decline, albeit modest, in daily cases, hospitalizations and infection rates.
Still, many of those metrics are much higher than the same time last year.
And just as cooler weather drives the increases that became the fall and winter surge, those higher-than-a-year-ago measurements could form the basis for yet another surge.
“It’s not a one-for-one (comparison),” said Stoddard. “What I mean by that is obviously we have decoupled transmission from hospitalization rate with vaccinations.”
Stoddard and others pinned some hope on federal approval for vaccinations for children 5-11 years old. There are more than 100,000 eligible children in Montgomery County alone.
On Wednesday, Maryland’s rolling-seven day average for cases was 1,170, a number 110% higher than the year before. Total hospitalizations stand at 788. One year ago, there were 360 hospitalized patients. The infection rate Wednesday of 19.36 is more than double that of a year ago.
“I don’t think it’s 100% predictive,” Stoddard said. “I do expect as the weather cools, behavior changes, more indoor activities happen, more transmission occurs indoors. It does not take a scientific degree just to understand that the opportunity for COVID to spread will increase as the weather cools.”
A number of statistical models forecast increases for the fall and winter.
The Institute for Health Metrics and Evaluation at the University of Washington projects Maryland could reach more than 6,700 daily cases by Thanksgiving. Total hospitalizations could climb to 1,900 including nearly 400 patients in intensive care.
“There’s a pretty wide range of possibilities as well, from seeing a steep increase to seeing it level off to seeing a decrease in hospitalizations,” said Dr. Nilesh Kalyanaraman, the health officer in Anne Arundel County. “I think that points to what’s really going to be happening over this cold and flu season. We’re looking at the next six months to help determine what our new equilibrium is with vaccines and what COVID looks like during cold and flu seasons.”
Flu could be a wild card this winter.
“We were closed a lot last year,” said Stoddard. “We had a lot of restrictions in place as a country and certainly as a county that kept people not going to bars and restaurants. What that effectively did is we reduced a whole host of things. Flu was essentially very minimal. We were down on traffic accidents. We were down on a whole host of other medical conditions that would normally show up in our hospitals.”
Stoddard said there are gaps between the total number of beds and those that are staffed and ready for patients.
“Candidly, I have a lot of concerns,” Stoddard said when asked about the potential effect on hospitals should some of the forecasts become reality. Staffing is already hard to come by, he said.
“There is a huge disparity between the number of physical beds and the number of staffed beds right now,” said Stoddard. “That tends to fluctuate as volume comes in. That said, we’re trying to recruit nurses now. We’ve been trying to recruit nurses for well over a year pre-COVID but COVID has really exacerbated it.”
Further worsening the situation, he said, is an expected increase in flu cases over last year.
“Now we’ve got COVID, which is a small percentage, maybe 5, 6, 7% of our hospital beds,” said Stoddard. “Unfortunately, under a given year outside of COVID, 5,6,7% is all we really operated with during winter when flu was at a much higher level. So, I think we’re going to be in for some tough periods with our hospital settings over the next three, four, five months. I’ll be thrilled to be wrong on that.”
Prince George’s County, the second-most populous jurisdiction in Maryland, has posted the most cases and most COVID-related deaths in the state. Dr. George L. Askew, deputy chief administrative officer for Prince George’s County Health and Human Services, said numbers are declining but said there is still reason for concern and for continued efforts to hold the virus at bay.
On Wednesday, County Executive Angela Alsobrooks announced she would expand indoor mask requirements for anyone at least 2 years old. Previously, the order applied only to children 5 and older and adults.
“With respect to forecasts, that’s the exact reason we want to make sure we don’t let up,” said Askew. “Even though our numbers are starting to take a dip and we anticipate a dip and maybe even take a big nosedive down. The lower we get them down, and the more folks we continue to get vaccinated, the less likely it is that we see a significant surge in that November time period where we start to go into Thanksgiving and we go into Kwanzaa and Christmas and New Year’s and Hanukkah and gathering together in traditional holidays for folks.”
The potential for another surge comes more than 18 months into the pandemic. Hospitals are struggling with staffing. Gov. Larry Hogan and others have been focusing on pumping more nurses and other health care workers into the system.
“We’ve already seen a number of yellow alerts which are high-volume alerts,” said Stoddard.
“This is earlier than we typically see those,” he said. “We see them in bad flu years for sure. It’s not like it’s an unheard of thing, but we’re seeing them earlier than I am used to seeing them and it makes me nervous about what we could see in a month or two.”