Medical center prepares for September COVID surge

In June and early July, Anne Arundel Medical Center experienced days with zero hospitalized COVID-19 patients as thousands of county residents received vaccinations against the virus.

A weekly “incident command” meeting among senior leaders and emergency response staff was disbanded during that time. But not for long.

Keeping an eye on the coronavirus situation in the South, where a more contagious delta variant of the virus has severely sickened mostly unvaccinated communities and strained hospitals, the incident command team rebooted on Aug. 4. Since then, cases in Maryland have nearly doubled.

“Back in early July, when we all were sort of taking a big, deep sigh of relief, we were at a low of 97 (hospital admissions) across the whole state,” said Jennifer Harrington, chief operating officer for Luminis Health Anne Arundel Medical Center, and the emergency team leader.

“And already we’re up to 719,” she added, referencing a chart of statewide hospital admissions displayed during the weekly incident command meeting on Aug. 24.

In two months, Anne Arundel County went from a transmission rate of 1 case per 100,000 residents to 17.2 cases per 100,000 residents — pushing the county into a category as an area at high risk of transmission. The upward trajectory matches a statewide trend in transmission rates.

When COVID-19 first emerged in the United States, an infected person would likely infect three people with the virus. Now, the delta variant that was first identified in India is the predominant strain in the United States. A person with the delta variant will likely infect about seven unvaccinated people, explained Dr. Stephen Selinger, chief medical officer at AAMC. Vaccinated people can spread the delta variant, but appear to be infectious for a shorter period, according to the U.S. Center of Disease Control and Prevention.

The hospital is bracing for a peak of around 55 patients at one time who require COVID-19 care this fall. That’s a remarkably low rate compared to how highly contagious the delta variant is, and it’s thanks to the COVID-19 vaccines, Selinger said.

During the past two surges of the coronavirus pandemic, AAMC saw a peak of around 109 COVID-19 patients hospitalized at the same time in May 2020 and again in January 2021. The hospital has treated 5,700 admitted patients for COVID-19 since March 2020.

As vaccination efforts continue, county health officer Dr. Nilesh Kalyanaraman said in a weekly media call that hospital admissions are a significant indicator of how severely ill the delta variant is making people and where it’s circulating.

During the weekly incident command meetings, Selinger is joined by Harrington, chief nursing officer Barbara Jacobs, and hospital president Sherry Perkins to plan for the expected September surge. The hospital must manage care for an influx of COVID-19 patients in addition to 340 people currently hospitalized with non-COVID aliments and around 300 patients that visit the emergency room daily, increasingly for behavioral health crises.

“To take care of an extra 35 or 40 (COVID19 patients) is an entire nursing unit that now just has to take care of those patients,” Jacobs said. “From a staffing perspective, it’s a lot of physical space and clinical need for those patients.”

Hospitals also face staffing issues when clinicians get sick. In the past 18 months, two employees at AAMC required ICU care for COVID-19. They have since recovered.

Vaccines prevent severe disease, and if everyone was vaccinated hospitals would have far fewer COVID-19 patients, Selinger said. About 75% of patients currently hospitalized at AAMC for COVID-19 are unvaccinated.

Patients are younger than in previous waves of the pandemic, including a handful of children under 18 who have sought care at AAMC. The average age of hospitalized patients is in the 50s, but staff are also seeing people in their 30s and 20s who are seriously ill, Jacobs said.

In Maryland, 90% of people age 65 and older have received at least one dose of the vaccine, according to the state health department. Throughout the pandemic, adults older than 59 accounted for 87% of the state’s 9,700 deaths. The introduction of vaccines has significantly reduced the number of elderly residents seeking hospital care for COVID-19, Jacobs said.

“It is the younger, unvaccinated population that’s coming in,” she said.

As COVID-19 cases spike, medical professionals are better prepared to treat patients compared to its initial surge when much of the virus and the disease it causes were unknown.

Sherry Perkins, president of AAMC, said hospital staff are meeting with the county to discuss how to keep the hospital open to visitors during the anticipated surge. Maryland hospitals prohibited visitors at the beginning of the pandemic when the virus’ infectivity was uncertain and personal protective gear under a national shortage.

Currently, one visitor is allowed in AAMC’s emergency department and two visitors are allowed in inpatient units, including COVID-19 wards. And hospital leaders meticulously track the number of drugs, gear and equipment they have in stock.

Over the last month, AAMC has expanded its ability to treat patients with a monoclonal antibody therapy that blocks the virus’ entry into human cells and prevents serious illness for people at high risk of hospitalization or death. In August, 61 people received the therapy compared to 18 people in July.

The hospital’s vaccination efforts had slowed down from spring months when staff administered around 1,500 shots a day, about 40,000 doses in total. Medical staff continue to partner with the county to vaccinate residents with less access to health care by bringing mobile clinics to neighborhoods such as Allentown Apartments on Forest Drive and Admiral Farragut on Hilltop Lane.

But AAMC is preparing to ramp up its efforts again to accommodate a flood of businesses that recently announced employees must be vaccinated or receive a weekly COVID-19 test, including the hospital itself. Gov. Larry Hogan mandated on Aug. 18 that all hospital and nursing home workers must be vaccinated or be routinely tested by Sept. 1.