ICU COVID admissions hit their lowest point during the spring wave

“The good news is that we are seeing fewer patients with critical COVID-19 conditions,” said Dr. Paul Biddinger, Chief Preparedness and Continuity Officer at Mass General Brigham.

This week’s rates are a few notches higher than April 24, when ICU admission rates bottomed out at 6.3 percent of the 396 COVID-positive patients in hospital.

Several factors contribute to the lower rates and are helping to decouple cases from serious illness, including rising vaccination rates in Massachusetts, the use of booster shots, and the number and greater availability of therapies. Some seasonal trends may also play a role.

“It’s a much more complex conversation than it used to be, where more cases predictably led to more hospitalizations and more serious illnesses,” Biddinger said. “We are seeing a changing relationship between the number of cases and the number of hospitalizations of COVID.”

As of Thursday, Massachusetts reported 3,485 new confirmed coronavirus cases. The seven-day average of daily new cases was 2,975, compared to a recent peak of 4,062 on May 17. Levels of coronavirus detected in eastern Massachusetts sewage, which is an early indicator of the spread of the virus, have also fallen in recent days, raising the possibility that our current wave is peaking.

Overall, fewer people who contracted COVID this spring were seriously ill compared to last winter. State data shows that since mid-April, about a third of COVID-positive patients have been hospitalized primarily for COVID, compared with 40 to 50 percent in January and February, when the state began providing a breakdown of the causes of COVID-related hospitalizations publish.

One of the reasons for the decline in serious illnesses was the state’s robust immunization and booster programs. As of May 26, 5.38 million Massachusetts residents were fully vaccinated — over 290,000 more than in early January. Of these, 3.05 million had received a booster shot – almost a million more than in January. In March, the FDA approved a second booster shot for older adults, and by the end of May approximately 463,000 people had received one.

“The good news is that we’re almost 80 percent fully vaccinated in Massachusetts,” Biddinger said. “We have pretty good rates of boosters. Vaccination and booster shots are by far the most important strategy we have to limit serious illness and death.”

Hospital systems also have more tools to combat serious illnesses. Although the FDA approved Paxlovid to prevent serious diseases in December 2021, supply was initially limited. Now more of the drug is being produced, and hospitals have stepped up efforts to provide access.

Mass General Brigham prescribes 400 to 600 cycles of Paxlovid each day and communicates with GPs and patients to optimize access. As of January 8, the healthcare system has issued more than 15,000 prescriptions for oral therapies including Paxlovid.

The healthcare system also uses remdesivir, monoclonal antibodies, and Evusheld for high-risk, immunocompromised individuals.

Even with reports of some patients recovering and becoming infectious again after Paxlovid treatments, the data shows that the treatment saves many people from getting seriously ill.

“It’s a multifaceted strategy — get vaccinated, get boosted, get tested, get treated early,” Biddinger said. “This is our best strategy for protecting the healthcare system and the ability to take care of all other patients.”

UMass Memorial Health has conducted about 8,000 courses with either Paxlovid or the monoclonal antibody therapy bebtelovimab since last July — nearly 2,000 of them since April 10. It also hosts Evusheld clinics for patients on Saturdays.

dr UMass Memorial Health CEO Eric Dickson said the health system has expanded the number of monoclonal antibody treatments it can perform in a day to 45 to 48 appointments. The center was operating at maximum capacity for the last five weeks when the latest surge began.

Other factors have also made this rise less steep than last winter. In January, the highly infectious Omicron variant raced through the community, reinfecting people who had previously had COVID infection and causing communicable diseases even in vaccinated individuals. Community dissemination was likely enhanced by the cold weather and holidays.

Biddinger pointed out that as of Jan. 8, the seven-day average of new COVID cases was over 23,000 — more than six times higher than in mid-May. Such rapid community spread naturally led to greater numbers of hospitalizations, even as the rate of hospitalizations due to COVID declined.

“Now we have a significant number of people who contracted Omicron over the winter, better immunizations and boosters, and warmer weather, all of which play a role in reduced community spread,” Biddinger said. “It’s incredibly difficult to think about how to quantify the relative contributions of each factor, but the sum resulted in a much lower peak.”

Despite less severe illness, the rising number of COVID patients this spring is still straining hospital resources. Mass General Brigham’s ongoing staffing problems from a dwindling healthcare workforce nationwide were compounded by staff out of work due to COVID-19 infections, Biddinger said.

Dickson said UMass still needs to isolate patients with COVID in negative pressure rooms, which filter the air and help keep contagious diseases from spreading down hallways and corridors, even if they came to the hospital for another reason. Staff are also required to use the full spectrum of PPE when treating COVID patients, further adding to the sky-high costs of care.

Some surgeries have also been canceled as the hospital discovered COVID cases in asymptomatic patients. In view of the shortage of staff in nursing homes and rehabilitation centers, the health system is finding it difficult to dismiss patients in need of rehabilitation.

“This has had a negative impact on hospital operations,” Dickson said. “Regardless of whether a lot of people are dying from COVID or not, it has made running a hospital difficult in 2022.”

dr Richard Nesto, chief medical officer at Beth Israel Lahey Health, said that of the system’s 175 COVID-positive patients, only 10 to 15 are in intensive care. Similar to state trends, two-thirds of the system’s COVID-positive patients had been hospitalized for something else.

The system has filled at least 8,000 prescriptions for Paxlovid in recent months and administered monoclonal infusions to patients who were ineligible for Paxlovid, such as those who had passed the five-day window from the onset of their symptoms. However, demand for therapies has been less resilient than expected given the prevalence of COVID in the community, Nesto said.

Although the virus is not currently causing serious illness in the majority of infected patients, Nesto warned that people should still take protective measures, seek treatment and remain vigilant.

“The perception of some providers and patients out there is that this form of COVID isn’t that bad because it’s so prevalent in the community,” Nesto said. “But who knows if there will still be a variant in six months that will change the picture of what we are experiencing. We don’t want people to be lulled into feeling that COVID is here to stay and that it’s not that bad. Patients still need to be vaccinated and refreshed.”

Jessica Bartlett can be reached at [email protected]. Follow her on Twitter @ByJessBartlett.

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