Pandemic Surges and Baystate Health Response
After a relatively quiet summer in 2020, cases of COVID-19 began to spike upward once again in October 2020, corresponding to the third wave of the pandemic in the United States.
The number of hospitalized patients rose to levels that approximated the original surge, and inpatient numbers remained above 100 across the system for three months, from December through February. Due to low vaccination rates in Hampden County, Baystate Health (BH) bore a disproportionate burden of cases throughout this longer third phase: over 10% of the inpatients in the state were at BH despite its having only 5% of inpatient beds, a twofold greater load than would be expected by our size alone. The number of hospitalized patients fell gradually to less than 20 by June of 2021, only to rise again in later July with the appearance of the more contagious Delta variant of the virus. This again led to a surge of inpatients, with a slant toward younger, unvaccinated individuals, many of whom had prolonged stays in the Intensive Care Unit (ICU). This fourth wave peaked at over 100 inpatients in September and was half that level in October. During the fourth wave in August and September, BH again bore more than its share of the inpatient case burden, this time seeing three times the number of inpatients that would be predicted based on its size. From the beginning of the pandemic through near the end of 2021, BH had cared for over 4,200 patients within its hospitals with COVID-19, of whom 585 died. The system performed over 400,000 tests and administered nearly 100,000 doses of vaccine.
Over 10% of the inpatients in the state were at BH despite its having only 5% of inpatient beds, a twofold greater load than would be expected by our size alone.
The Incident Command Team, led by Chief Physician Executive Dr. Andrew Artenstein, continued its heroic work in managing the BH response to the crisis, meeting 500 times since the start of the pandemic. All major clinical and administrative areas were represented and held coordinating meetings of their own, including hospital operations, ambulatory operations, supply chain management, clinical planning & education, personnel & staffing, laboratory testing, informatics & technology, communications, and finance & administration. The group issued hundreds of updates to the entire organization, typically daily during times of high caseload. The level of teamwork, innovation, and commitment cannot be underestimated. The team modeled many of the positive aspects of the new BH culture, including a system focus, learning & improvement, ingenuity, mutual respect, accountability, transparency, and decisiveness.
Providers brought new tools to the fight against COVID-19 during 2021. In addition to the well-established approaches to non-invasive ventilation, the modest effects of the antiviral drug remdisivir, and the significant effects of dexamethasone for serious illness, physicians had at their disposal monoclonal antibody treatments that reduced the likelihood of admission by 80% in high risk individuals when treated early in the course of the disease. An infusion center was established at Baystate Noble Hospital (BNH) and was staffed by BNH nurses, nurses from the infusion center, and infectious disease specialists from Baystate Medical Center (BMC). By the end of 2021, over 800 patients had been treated, with the great majority able to avoid hospitalization. Additionally, a program for home treatment with high flow oxygen was set up in collaboration with Baystate Home Health (BHH) and the Infectious Disease Division. Over 90 patients have been able to leave the hospital early to continue their convalescence at home, with readmission rates below 10%, helping relieve strained inpatient capacity. Finally, a multidisciplinary clinic was established, including clinicians from infectious disease, pulmonology, cardiology, nephrology, psychiatry, allergy, geriatrics, and physical rehabilitation, to treat the fatigue, aches, and “brain fog” that goes on for months in 10-20% of cases and goes by the name of “long COVID.” Over 250 patients have been evaluated and treated by this unique program.
Over 250 patients have been evaluated and treated by this unique program.
By far the greatest weapons against COVID-19 are a trio of highly safe and effective vaccines. BH was one of the early hubs of vaccine distribution starting in December of 2020, with a high-volume center established at our facility in Holyoke, as well as allocations each week to our health centers in Springfield and distributed in Franklin County. As the vaccine became more plentiful in the spring of 2021, a mobile vaccine van began visiting neighborhood centers across our service area each day. At this same time, it also became clear that vaccine hesitancy was a phenomenon that would require an active response. Hampden County has remained 10-15 percentage points behind overall vaccination rates in the state, with lowest rates in the Black and Latino communities, in many of the evangelical churches, and among many self-identified conservatives. Our Marketing and Communications team partnered with providers, pharmacists, and public health officials from the various towns and municipalities to raise awareness of vaccine availability and launched a multimedia campaign to allow diverse and expert voices to convey the facts about the safety and efficacy of getting vaccinated. We also partnered with a variety of churches, colleges, and social networking groups to leverage their influence in countering misinformation and getting the word out to underrepresented populations. At the end of the fiscal year, the vaccine team had administered nearly 100,000 shots to BH employees, independent providers, patients and members of the general public, making BH the second largest source of vaccine in western Massachusetts.