Are Maryland hospitals overflowing? Official data and ground reports seem to differ.

All around the United States, hospitals are filling up quickly. According to numbers published by the US Department of Health and Human Services, around 78% of the staffed inpatient hospital beds and 81% of the ICU beds nationwide are occupied. While these are the highest hospital occupancy rates recorded at any time during the Covid-19 pandemic, they actually appear to be low-ball estimates. There seems to be a disconnect between the official data made available to the public and what’s happening on the ground.

The reason for this is unacceptable delays in reporting. HHS and other agencies have always acknowledged that public reports on hospital capacity—for Covid-19 and all other conditions—actually reflect data that are 1-2 weeks old. But until now, such lags rarely mattered because most hospitals haven't had to operate near or above 100% capacity routinely, even during the pandemic. Under normal circumstances, whether a hospital was 65% or 75% full does not make much of a difference, though as the numbers creep up, care can be compromised. And even in past moments when capacity was closer to 100%, a wave of Omicron-driven Covid-19 was not headed towards hospitals.

Many hospital systems are teetering on the edge, due to a combination of Covid and non-Covid care. As I told New York Magazine last week, I wish I could say I knew hospital capacity would not become a major catastrophe in the coming week or two. Unfortunately, as of now, I can’t be sure and so I can’t say that. That uncertainty—the notion that I do not actually know whether hospitals will truly be able to provide adequate care to everyone that needs it—is unprecedented and worrying.

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Let’s focus on Maryland, where the Governor declared a 30-day state of emergency last week. According to HHS, 87% of the state’s hospital beds are occupied. But my team’s Covid-19 Hospital Capacity Circuit Breaker Dashboard (which I first conceived of when writing an Inside Medicine entry just 3 weeks ago, and built out since with the help of Benjy Renton and Harvard epidemiologist Bill Hanage) shows that every single county in Maryland appears to be over 100% capacity. The reason we project that things are bad is that we monitor the change in Covid-19 cases over the last week or so to “nowcast” what we think has happened in any region since the last HHS update.

Our model shows Maryland ought to be in crisis mode.

Is it? Well, I’m not there. But there are two indicators that the scene is bad, more in line with our model than with HHS’s outdated data.

First, in the region of Maryland where, among others, Johns Hopkins Medical Center is, there have been red alerts issued in 21 of 23 facilities, indicating that beds full. "Red alerts" mean that beds are so full that even patients with heart conditions are unable to have real-time telemetry monitoring, which could be dangerous for some patients.

Second, healthcare workers have told me what they’re seeing. Some of these accounts are people that I personally know and trust, while others were responses to social media posts.

In response to my Twitter post yesterday, Dr. Geeta Soo, an infectious diseases specialist at Johns Hopkins University responded that things really were as bad as I fear. “Yes, it is that busy. Highest number of hospitalizations in the state and our health system ever. Several hospitals have moved to crisis standards of care.”

One physician in the northern part of Maryland reached out to me via email to say ICU beds had been completely full for around 3 weeks, with some patients boarding in the emergency room for over two days awaiting an actual ICU bed. “However, I could not possibly comment,” the doctor said to me, his email oozing with the snark of an exhausted warrior.

When I asked a physician colleague and friend there how things were, he didn’t hold back.

“I can attest the situation in Maryland is [expletive] horrendous. The state has been maxed out for about 2 weeks. Multiple hospitals are operating under crisis standard of care. EMS [i.e. ambulances] is now so taxed that Baltimore county started transporting people in fire trucks last week. This is absolutely unheard of and absurd. Reports of people waiting over 1-2 hours on scene with fire fighters before an EMS unit gets there. Then when they get to the hospital they wait literally hours for a bed. Transfer centers now just laugh when you call the system is so back logged. It’s mind boggling to me how none of this has been national news.”

As fast as the patients are coming, healthcare workers have been sidelined. Like in New York, and other places, Omicron infections have cut the number of available care providers substantially in Maryland. In early December, around 5% of hospitals reported staff shortages. Now it’s closing in on 20%.

Another physician tweeted a thread that described how stretched the healthcare workforce is. The scene sounds grievous and harrowing.

Scarier yet, there’s no place to send patients, in many cases. When one hospital is full, or lacks particular resources, transferring patients to an appropriate alternative site is routine—if something of a hassle. But with all of Maryland’s counties apparently on the edge, such options are apparently drying up.

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Clearly Maryland is not alone. People responded to my post from all over the country.

Indeed, our live dashboard shows that across the United States, we project that far more counties are nearing or are over capacity than HHS data would suggest.

Given what I’m hearing from my colleagues all over the country, I’m increasingly convinced that our dashboard is providing a better summary of what’s happening in the United States, than federal and state data indicates.

While we can’t eliminate coronavirus, we can slow it down enough to keep hospitals safe. While we’ve done many things wrong during the pandemic, we actually did flatten the curve early on. And yes, we’ve allowed this virus to trample us for almost two years. But most of the time, we’ve managed to put on the brakes just in time to keep hospitals safe. I hope that will continue. I’m concerned it won’t.

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