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More Maryland hospitals could be pushed into ‘crisis’ amid omicron surge

With hospitals seeing their highest numbers of COVID-19 patients since last winter’s spike in cases due to the spread of the highly transmissible omicron variant of the virus, more are making the difficult decision to implement emergency protocols, redistributing supplies, staff and space to serve their highest-need patients.

So far, five Maryland hospitals have moved to these protocols — known as contingency or crisis standards of care — but more will likely follow, according to hospital officials.

“I’ve received some phone calls from some hospital leaders in the last 36 hours that would suggest that more are coming. Maybe a couple more this week. If, as it was forecasted, the holidays lead to an even greater surge in COVID cases, that’s when we could see an even higher surge, and that would likely push even more hospitals into crisis,” said Bob Atlas, president and CEO of the Maryland Hospital Association.

Contingency or crisis standards of care are steps taken by hospitals to prioritize and ration resources during periods when demand for care is especially high; “contingency” protocols tend to be less severe than “crisis” protocols. Measures can include reducing the amount of paperwork nurses and other medical professionals must complete, in order to free them up to work with patients; deploying staff members to work outside of their typical jobs; and rearranging surgery schedules and limiting non-life-threatening procedures.

A wide variety of factors can trigger the shift to these protocols, according to David Marcozzi, chief clinical officer at the University of Maryland Medical Center and incident commander for COVID-19 response at the University of Maryland Medical System. These can include the number of beds available, the ratio of patients to nursing staff, and emergency care or acute care facilities reaching maximum capacity.

Staffing, especially, has become a central issue for most hospitals in Maryland, which have been struggling with nursing shortages and broader workforce shortages throughout the pandemic. That issue is only becoming starker, Marcozzi said, as hospitals begin to see increases in COVID-19 cases among staff members, who then have to quarantine and are unable to work.

At Anne Arundel Medical Center, one of two Luminis Health hospitals that moved to contingency standards of care on Monday the decision was made based on the high number of COVID-19 patients currently in the hospital as well as the shortage of staff. There are 370 patients currently in the hospital, over a quarter of whom are COVID-19 patients, and 15% of the hospital’s COVID-19 patients are in the intensive care unit.

The hospital is also seeing record numbers of emergency room patients and increases in positive COVID-19 cases among staff.

As of Monday, 1,826 Marylanders were hospitalized for COVID-19 across the state, according to the state’s COVID-19 dashboard, the highest hospitalization rates the state has seen since January 2021’s surge prior to the widespread rollout of vaccines.

Outside of the pandemic, crisis standards of care are typically deployed during emergencies like hurricanes, wildfires or other natural disasters that result in high demand for care. Atlas said he doesn’t know of a previous occasion in which Maryland hospitals had to turn to these protocols but noted that all hospitals must have emergency plans in place in order to be accredited.

Anne Arundel Medical Center President Sherry Perkins could recall only one time emergency protocols were ever implemented at the hospital prior to the pandemic; the hospital made the choice to alter the surgical schedule to accommodate the potential demand when the state was facing an oncoming hurricane.

“But now it’s routine,” she said.

On top of optimizing hospital procedures, moving to contingency or crisis standards of care also serves to communicate to the public and to emergency medical services that a hospital is overburdened, Atlas said. If it is safe to do so, EMS will take a patient to a hospital that hasn’t moved into crisis standards of care rather than one that has, for example.

When emergency measures are in place, hospitals within Maryland’s numerous health care systems, such as UMMS, can also coordinate within the system to transfer resources, staff and patients between locations as needed.

At UMMS, Marcozzi said, the system has been working as a whole to accommodate its three hospitals — UM Upper Chesapeake Medical Center, UM Harford Memorial Hospital and University of Maryland Baltimore Washington Medical Center — that are currently following emergency procedures.

“We continually monitor, across our system, bed availability, so we move patients or staff or supplies across our system to ensure, as optimally as we can, the right care is delivered to the right patients at the right time,” he said.

Although it has not moved to crisis standards of care, LifeBridge Health, another Baltimore-based health care system, told The Daily Record in a statement that its hospitals are already “implementing some contingency plans, such as redeploying staff.”

“Our leaders (are) working together to see how our system resources can be used to support our hospitals before making any decisions on implementing crisis standards,” the statement said.

Two other major hospital systems in Maryland, Johns Hopkins Medicine and MedStar Health, did not immediately respond to inquiries regarding whether they plan or expect to move to crisis standards of care during the current COVID-19 surge.

For the hospitals that have already implemented emergency protocols, the omicron surge is expected to get worse before it gets better. Atlas, Marcozzi and Perkins agreed that following COVID-19 safety guidelines, like masking, distancing and getting vaccinated, is the best way for the public to support hospitals as they struggle to accommodate demand.

“We don’t believe we’re at the peak. We expect it to rise,” Perkins said. “We do believe different practices over the next holiday could shift that … Decisions to avoid crowds, to really manage holiday celebrations differently around masking and washing and keeping distance could truly make a difference. It could shift this.”