A6 EZ RE THE WASHINGTON POST.SATURDAY, DECEMBER 25 , 2021
BY JOANNA SLATER
On a recent morning, Neil
Meehan opened a spreadsheet he
has come to dread.
It showed the number of inten-
sive-care beds available in an area
of New Hampshire that is home
to 350,000 people: two.
A day earlier, there was just
one. Very often there are none.
Meehan, the chief physician
executive at Exeter Hospital, has
worked in emergency medicine
for nearly three decades. He has
lost track of the number of un-
precedented things he has wit-
nessed during this second pan-
demic winter as virus cases and
hospitalizations in the state hit
record highs.
His hospital has canceled elec-
tive surgeries and placed adult
patients in pediatric wards. There
are members of the National
Guard carrying out support tasks.
One seriously ill patient had to
wait a week for a transfer to a
larger hospital that could treat
his condition, a move that nor-
mally would have taken hours.
“You have duress in the system
that I have never seen before,”
said Meehan, 56.
Across New England and the
northeastern United States, hos-
pitals are struggling with an over-
whelming burden of patients
amid a covid-19 surge that has
struck harder and faster than
experts expected, even in some of
the most highly vaccinated states
in the country.
The infections — nearly all
driven by the delta variant, not its
new cousin omicron — have led to
record covid hospitalizations in
Vermont, New Hampshire and
Maine. All three states have expe-
rienced their biggest surges in
cases since the pandemic began
and asked for federal help, an-
other first. President Biden an-
nounced Tuesday that the gov-
ernment will send emergency
medical teams to Vermont and
New Hampshire and ambulance
crews to Maine.
In Massachusetts, Rhode Is-
land and Connecticut, covid hos-
pitalizations have soared in re-
cent weeks, although they remain
below previous peaks. Yet the
winter surge comes at a time
when hospitals were already
grappling with a staffing short-
age combined with an influx of
people who had delayed care and
an increase in patients battling
mental illness. Doctors fear that a
large wave of omicron cases could
increase the burden even further.
“It’s definitely as bad as it’s
ever been,” said Eric Dickson,
chief executive of UMass Memo-
rial Health in Worcester, Mass. “I
can use a New England analogy.
Snowstorms, right? You get a bad
snowstorm and oh, you deal with
it. But you get one on top of that,
and now you’ve got all that snow
from before that you have to
manage. And that’s really what
it’s feeling like now — it’s just
piling up.”
Interviews with 10 hospital
leaders across the region revealed
a grave picture. Executives at
smaller and midsize hospitals
said that it has become exceed-
ingly difficult to secure care at
higher-level facilities in the re-
gion, and they worry that delays
in transferring patients could
have life-threatening conse-
quences. Several said they were
discussing whether they might
need to implement standards for
rationing care.
In Rhode Island, the president
of an association of emergency
doctors warned in a letter to the
governor last week that the situa-
tion had become “acutely unten-
able” and “any added strain right
now will lead to the collapse of
the healthcare system.”
The emergence of the omicron
variant represents a major un-
known. The variant is already
present across New England, and
doctors said they expected it to
become the dominant strain
shortly. They vacillated between
optimism that the variant ap-
pears to cause milder illness and
pessimism that the sheer number
of infections could overwhelm
hospitals.
Doctors in the region all said
that a substantial majority of the
patients currently hospitalized
with covid — between 60 percent
and 80 percent — were unvacci-
nated. The breakthrough cases
that end up in the hospital tend to
be milder and are concentrated
among older patients and people
with other health conditions,
they said.
Most state leaders in New Eng-
land have been reluctant to reim-
pose mask mandates, but several
have announced plans to distrib-
ute millions of free tests. On
Tuesday, Massachusetts Gov.
Charlie Baker (R) said he was
activating up to 500 members ofthe National Guard to assist
stretched hospitals.
The recent experience of states
in New England is especially
dispiriting given their vaccina-
tion rates. In Vermont, long laud-
ed for its handling of the pandem-
ic, 77 percent of the population is
fully vaccinated, compared with
nearly 62 percent nationwide. In
Maine, it’s 75 percent. In Massa-
chusetts, it’s 74 percent.
This fall, as colder weather
pushed people indoors and chil-
dren returned to school, trans-
mission began to accelerate. In
places such as Vermont, New
Hampshire and Maine, which
were relatively unscathed by pre-
vious surges, there was also a
lower level of prior exposure to
the virus. Meanwhile, vaccine-in-
duced immunity was waning in
those who had flocked to get their
shots early in 2021.
Matthew Fox, an epidemiolo-
gist at Boston University, empha-
sized that vaccines are “still very
effective” at preventing serious
illness and death. But when it
comes to vaccines preventing in-
fections, “we thought it would be
a greater benefit than we’re ob-
serving.”
Fox said that difference could
be attributed to waning immuni-
ty, or to the delta variant itself,
which emerged after vaccines
were developed. “If you put it all
together, it’s just more transmis-
sion than we would have liked,”
he said. The highly contagious
omicron variant, meanwhile, can
spread among people who are
fully vaccinated and boosted.The high vaccination rates in
places such as Vermont and
Maine masked considerable vari-
ations at the county level, experts
said. “People say, ‘Oh, Maine’s
doing really well,’ but when you
peel the onion layers, what you
see is two states,” said Dora Anne
Mills, chief health improvement
officer at MaineHealth. While
83 percent of the population in
Cumberland county — home to
the city of Portland — is fully
vaccinated, that figure slides to
below or near 60 percent in sev-
eral predominantly rural coun-
ties.
Mills said her group of hospi-
tals had scrambled to find more
space — canceling elective sur-
geries, treating patients in recov-
ery rooms for the first time — but
she was anxious about the com-
ing weeks because “we could very
well be finding out what the limit
of that capacity is.”
Nirav Shah, director of the
Maine Center for Disease Control
and Prevention, echoed that sen-
timent. “It is not out of the realm
of possibility that we will ap-
proach a time where ICU beds
will not be available,” Shah re-
cently told the Portland Press
Herald. “Not just for covid pa-
tients but for any patient.” He said
the state is making plans to avoid
that situation, which he likened
to a “big pileup on the highway.”
In neighboring New Hamp-
shire, where vaccination rates are
lower, hospitals have been flood-
ed with covid patients. Jocelyn
Caple is chief medical officer of
Valley Regional Hospital, a 21-bedfacility in Claremont. She said
that 50 percent or more of her
beds on any given day are now
taken up by patients with covid.
Her greatest concern is finding
spots for critically ill patients of
all kinds at higher-level hospitals.
“The sense that the entire system
is frozen with an inability to
transfer patients around is the
most worrisome aspect,” Caple
said.
In New Hampshire, Maine and
Vermont, covid hospitalizations
have touched their highest point
in the pandemic in December. For
New Hampshire, they peaked at
478, according to state figures. In
Vermont, they hit 94. That figure
may not sound large to other
parts of the country, said Trey
Dobson, chief medical officer at
Southwestern Vermont Medical
Center. But in a low-population
state like Vermont — home to just
600,000 people in total — it is
considerable, he said.
“What we have going right now
is what I would call a triple
whammy,” Dobson said. There is
an influx of patients coming into
hospitals, both with covid and
other ailments; hospitals are hav-
ing difficulty discharging pa-
tients to rehabilitation facilities
and nursing homes, which are
also strapped for staff; and hospi-
tals can’t find beds for patients at
larger, more specialized facilities.
Dobson said his hospital has
called as far away as Philadelphia
to find appropriate beds, and
there have been days “where
we’ve made 20 calls and not
found someone who could take a
patient.”
In Massachusetts, the number
of patients hospitalized with
covid has swelled over the past
month, to more than 1,600 as of
Monday, compared with 700 a
month earlier. Hospitals are
struggling to cope with the added
burden. Ron Walls, chief operat-
ing officer of Mass General
Brigham, the state’s largest hospi-
tal system, said that starting in
the late summer, hospitals saw
patients returning “in absolutely
unprecedented numbers” as the
pandemic appeared to recede.
The surge in covid cases is “stress-
ing an already stressed system,”
Walls said.
Mark Keroack, the chief execu-
tive of Baystate Health, the main
hospital system in the western
part of Massachusetts, said his
facilities are licensed to treat 998patients at a time. During the
past month, however, the number
of patients admitted jumped to as
high as 1,200. The hospitals are
now 10 percentage points over
capacity on a regular basis —
something he has never seen
before.
Baystate is the only health-care
provider in its part of the state
that offers the highest level of
trauma services. “By God, if we
get jammed up to the point where
we can’t take any more, it’s seri-
ous,” Keroack said. “Where can
people go? All the big systems in
Massachusetts are fighting the
same battle we are.” Keroack said
that one patient elsewhere in the
state who required an advanced
life support treatment — pump-
ing and oxygenating a patient’s
blood outside the body — had
been transferred from Massachu-
setts to Virginia this month.
Meanwhile, Keroack’s hospital
has begun reviewing its policies
on how to ration medical care in
an ethical way, also known as
crisis standards of care, should
that become necessary. “I’m sit-
ting here, staring at the barrel of
this gun,” he said, referring to the
rationing policy. He worries that
his hospital might “actually be
putting it into use before January
is out.”
Under such standards, doctors
make decisions about how to
prioritize resources, including
whether to treat someone based
on age and severity of illness. No
one wants to take that step, said
Dickson, the hospital executive in
Worcester. But “effectively that’s
what happens when you run out
of space,” he said.
His hospital has stopped tak-
ing patient transfers except for
the most serious trauma cases —
people suffering from strokes,
heart attacks and brain hemor-
rhages — and it’s become “really
hard even to take those,” Dickson
said. That leaves smaller commu-
nity hospitals trying to care for
patients with other potentially
life-threatening surgical emer-
gencies, he said.
Doctors say they feel like
they’re shouting into a void, de-
livering news that a pandemic-
weary population no longer
wants to hear. “You come into
work and say, ‘This is the worst
it’s ever been,’ ” Dickson said.
“And then you come in the next
day and it’s even worse.”
[email protected]In highly vaccinated New England, hospitals are under unprecedented strain
ROBERT F. BUKATY/ASSOCIATED PRESS
Members of the National Guard arrive for orientation in an empty
wing at Central Maine Medical Center on Dec. 16 in Lewiston.PHOTOS BY AUSTIN ANTHONY FOR THE WASHINGTON POSTAmid the rubble,
a holiday spark
CLOCKWISE FROM TOP: A “Hope” sign
in Mayfield, Ky., on Friday. A tornado hit
the town Dec. 10, killing dozens. Juan
Perez, 10, plays with a dart gun he got for
Christmas. Mary Ellen Mathews hugs a
fellow congregant during a service for
displaced members of two area churches.