Mass site closing, but virus fight continues

They’ve been in the trenches together for the past several years and soon would move on. The war might not be over, but this phase was.

“It’s bittersweet,” Dr. Mindy Kantsiper said Friday as she surveyed the state’s largely empty COVID testing, treatment and vaccination site in Baltimore.

She and Dr. Charles “Chuck” Callahan, who together led the site, visited and reminisced with staff in advance of its closing Saturday. There were hugs and reflections of a time when supplies were limited and long lines of people circled the temporary facility on a parking lot at the State Center complex in Midtown Baltimore.

But having largely served its purpose of handling massive numbers of people during peak periods of the coronavirus pandemic, the site is shutting down. With home tests and vaccines more readily available, and COVID cases declining, health officials say it’s time for the battle against COVID to be waged within the regular, community-level health care system — doctor’s offices, clinics, hospitals and neighborhood pharmacies.

Testing at the State Center site has declined by 40% since December, from about 40 people per day to about 24 per day, according to the Maryland Department of Health. Vaccinations dropped dramatically, as well, from about 47 a day in October to eight a day now.

Such numbers drove the decision to close the state site, which most recently was housed in a big white tent that will be dismantled in the coming days.

There were more staff members than patients in the bare-bones facility Friday afternoon.

It might have seemed like a place where people anonymously filed through as quickly as they could for a test or jab in the arm. But relationships developed, the doctors said, and staff sought to treat the whole patient: Did they need help with other issues, be it diabetes, opioid use or housing?

“What I’m going to miss is the patients and the staff I had the honor of working with,” Callahan said. “There’s a piece of grieving.”

He remembers a woman who would come every Wednesday with her dog. Kantsiper remains touched by a woman who learned of their work and would periodically drop off paintings of staff. Several small ones are studies of the eyes of various staff members above their masks, and yet they are readily identifiable — of Kantsiper, of Jose Aguiluz, a nurse who does a lot of outreach to Spanish-speakers, in the same headgear he is wearing on this particular day.

One canvas depicts news coverage of a record-high number of COVID cases; another envisions a day when the pandemic passes and everyone can throw their masks in the air like Naval Academy middies tossing their caps at graduation.

“It’s been a life-changing experience to be part of it,” Kantsiper said.

These days, when many people have returned to their schools and offices, indoor dining and other pre-COVID routines, it can be hard to remember a time when there was little but masking, social distancing and hand-washing to offer the public in the face of the new and frightening coronavirus.

Health officials expressed pride in how they mobilized normally separate and even competing entities to distribute tests, treatments and vaccines as they became available. The State Center site, for example, was managed by the Maryland Department of Health, with Callahan of the University of Maryland Medical System as director, and Kantsiper of Johns Hopkins Medicine as deputy director.

For Dr. David Marcozzi, who served as a top adviser to then-Gov. Larry Hogan on the pandemic, that kind of coming together provides a model for how to respond to a crisis — and beyond.

“We’re moving from a crisis operation to a stability operation,” said the professor of emergency medicine at the University of Maryland School of Medicine.

Marcozzi said the state’s “playbook” had to constantly change in response to the ever-fluctuating threat posed by the virus. And indeed, the site itself went through multiple iterations, and even locations, adding offerings as they became available.

It began as a MASH-like field hospital in the cavernous Baltimore Convention Center downtown, set up by about 100 Maryland National Guard soldiers clad in camouflage and seemingly ready for battle — albeit one led by medical rather than military professionals.

The field hospital opened April 27, 2020, to treat COVID patients and help relieve an expected surge that might overwhelm area hospitals. But its 250 beds were barely used — by June 2020, just over 100 patients had been transferred there, staying for an average of five days.

On June 17, 2020, the convention center facility began offering free COVID tests and eventually became the most heavily used of the state’s mass testing sites. Shortly after the U.S. Food and Drug Administration gave emergency approval to a monoclonal antibody treatment for COVID on Nov. 9, 2020, the convention center site began offering it. And on Feb. 5, 2021, the site began offering vaccines.

On Nov. 13, 2021, as the convention center prepared to return to its regular operations, the site moved to the State Center complex.

Its closure comes amid a steady decline in COVID hospitalizations in Maryland since early January, when about 900 people were being treated for the virus. As of Friday, according to state data, 371 people were hospitalized with COVID, a nearly 60% drop.

Still, the virus continues to take its toll: The state reported eight deaths Friday, for a total so far of 16,172.

Federal officials plan to end the public health emergency in May — a “huge public health success story,” said Jennifer Martin, deputy commissioner of population health and disease prevention at the Baltimore City Health Department.

“We have really high vaccination rates in the state of Maryland,” she said. “In Baltimore City, we have more than 81% of our residents aged 12 and older who are vaccinated.”

Still, Martin and other health officials said, the work against COVID will continue.

The city agency still will offer vaccines and PCR tests at multiple locations and partner with community organizations to distribute at-home test kits, she said.

“We continue to look at testing volume, test positivity, looking at the number of cases, outbreaks in congregate settings, number of individuals who are hospitalized,” she said, “and take all of that COVID data into consideration in making our decisions.”

The overall picture masks disparities among neighborhoods, some community organizers say. They say the winding down of efforts and temporary safety nets, from rent relief to extra food resources, ignores the continuing harm COVID wreaks, particularly in disadvantaged neighborhoods.

Fanon Hill and his wife, Navasha Daya, run the Youth Resiliency Institute in the South Baltimore neighborhood of Cherry Hill in South Baltimore. They continue to check in with elderly community members — as they have since the start of the pandemic — bringing them food, hand sanitizer and masks.

“The crucial matter is, despite the belief that the pandemic is over, disruption continues,” Hill said.

Yvonne Bronner, a professor in Morgan State University’s School of Community Health & Policy, said community groups have become even more important as the fight against COVID transitions away from larger efforts such as the State Center site.

She has worked with the city health department and neighborhood groups in identifying “ambassadors” who can spread the word on where people can find tests, vaccines and other assistance within their communities.

“Our goal is to continually educate people so they can make the best decisions and connect to services in their neighborhoods,” Bronner said. “We’re trying to help our communities to develop behaviors that are sustainable.”

Dr. Jonathan Thierman, chief medical and integration officer of LifeBridge Health Partners, said he believes COVID’s path is starting to resemble that of the flu — something that can be managed without a massive state effort.

“Between Walgreens and CVS and private companies, and also the pretty robust and large health systems in Maryland, the flu is not something that the state feels like they need to open up these massive flu testing or flu vaccination clinics,” he said. “We’re at the point now where our ability to handle COVID testing and vaccination is pretty equivalent and pretty much in place and will probably be there for a very long time because this isn’t going away.”

It’s been about a year since LifeBridge scaled down its large-scale COVID vaccination and testing efforts, Thierman said. Since then, the health system’s urgent care centers have been able to meet the demand once handled by larger sites.

It’s likely that the state will be similarly successful at dialing back or shutting down its once-essential vaccination and testing services, Thierman said.

However, he added, it’s important that the state remain prepared to scale up, if needed. Many Marylanders likely will feel apprehensive as the state and federal government prepare to end big COVID efforts, he said. It’s important to transmit the message that, “We’re still here.”

“There’s probably going to be some nerves about all of this being, quote unquote, ‘Declared over,’ ” he said. “Because it’s not over.”

Doctors say they believe the lessons learned by the massive state effort will continue to inform the management of COVID.

To date, the state has since administered more than 160,000 COVID tests and more than 137,000 COVID vaccinations, and prescribed Paxlovid to more than 1,700 patients.

“In a nutshell, what has happened is exactly what you want to happen in a pandemic,” Callahan said. “The health care system and the public health system have stepped up.”

And now, the work continues, but in a different way.

“Just because a tent may get folded up,” Kantsiper said, “the skills are still there and growing.”