We asked hospitals if they’re prepared for another COVID-19 surge. Here’s what they said.

“This is a time for everyone to be more cautious than in the past.”

Boston, MA - 4/27/2020: Respiratory Therapist Angelika MacClellan, left, talks with nurse Natasha Cacciatore through a patients door in the Special Pathogens Unit ICU at Brigham and Women's Hospital in Boston, MA on April 27, 2020. The hospital has converted the cardiovascular center into a Covid-19 intensive care unit. (Craig F. Walker/Globe Staff)  section: Metro reporter:  Coronavirus Covid-19 STAT   ICU
Respiratory Therapist Angelika MacClellan, left, talks with nurse Natasha Cacciatore through a patient's door in the Special Pathogens Unit ICU at Brigham and Women's Hospital in April. –Craig F. Walker / Boston Globe

Health officials are sounding the alarm that a second surge of COVID-19 might soon arrive in Massachusetts, concerned that the rise of virus cases in the state combined with the weather turning colder and the approaching holiday season — when people might be tempted to hold indoor gatherings — could result in a wave of the virus overwhelming health care providers.

Citing the increases in the daily numbers of new COVID-19 cases being reported by the state, Gov. Charlie Baker and officials are pushing for residents to approach Thanksgiving gatherings differently. More than half of the state’s new infections, which daily have topped more than 1,000 in the last week, are attributable to household infections and social gatherings.

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Facing the potential of another COVID-19 surge, Boston.com asked local hospitals how they  are preparing for a possible influx of cases. 

Doctors representing the four institutions  — Mass. General Brigham, Tufts Medical Center, Cambridge Health Alliance, and UMass Memorial Medical Center — all emphasized in their answers to Boston.com the need for state residents to step up efforts to prevent the spread of the virus to help keep hospitals from being overwhelmed by cases. 

“This is a time for everyone to be more cautious than in the past,” Dr. Richard Ellison, the hospital epidemiologist at UMass Memorial Medical Center, said. 

Below, what the physicians at four local hospital systems had to say about preparations that have been underway, their concerns about what a second wave could bring, and how the public can help. 

The responses have been lightly edited for clarity and length.

Mass. General / Brigham and Women’s Hospital 

Boston.com: Is the hospital system concerned about seeing another wave of COVID?

Dr. Paul Biddinger, medical director for emergency preparedness for Mass. General Brigham: We’re absolutely concerned about another wave of COVID. It obviously threatens to displace necessary care and certainly will create more strain on our health care workforce, building on what happened in the spring. 

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Is the hospital prepared? What has been done already or is being done to be ready for a surge? What is the status of the hospital’s PPE supply?

We’ve done a lot to prepare for a second surge. We’ve done a lot of listening to staff about their experiences in the first surge and trying to figure out what we might do differently or even better. 

In the first surge, we were ordered to cancel all non-essential care. But we don’t think that will happen again. In the second surge, we are likely going to have to try and manage ongoing care needs — which is a good thing — so people can see their primary care doctors, have their necessary procedures — but also make sure that we’re able to care for COVID patients. 

We’ve been planning since the middle of July for the possibility of a surge. And that includes adjusting how we use our staff, how we use our space. We purchased additional ventilators, additional dialysis machines, so there’s been an awful lot of work. 

We’ve also been working very hard to bolster our PPE supplies. We went into the first wave with a cache stockpile of PPE that was big enough to be about two weeks of peak utilization before COVID happened. We thought that was a realistic assumption, and we’re now building that cache up to be four months worth of utilization. We’ve been aggressively expanding our stockpile, and we feel like we’re in a good place. 

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Do you have any predictions on the timing of when it might arrive? 

We’re watching the rising numbers of test positives in the state. We have seen a slight uptick in the number of hospitalizations with COVID across our system, but it’s nothing like the drastic rise we saw back in the spring. 

It’s hard for us to know if and when there would be another rise. We do modeling within our healthcare system based on the number of patients we’re seeing that gives us a fair amount of confidence about what the next two weeks will look like. So far, our modeling is not showing a dramatic rise for the next two weeks. 

But the holidays are coming and people may be mixing indoors more, especially without masks.  They may be traveling to other parts of the country where COVID prevalence is even higher, so there are a lot of factors that make us concerned about the possibility of a second surge.

If, somehow, we can get through January without seeing a major second surge in terms of hospitalizations, I’ll feel a little bit more optimistic. But right now, I’m very cautious.

Will the handling of another surge be different from the spring wave of cases? If so, how or why?

We will definitely have better plans to preserve access to ongoing care. We also are going to try very hard to minimize redeployments whenever possible of people from one part of the hospital to another to help out, though if the surge is large enough, some will still be necessary. We have tried to give our staff better guidance on what they might expect for surge planning based on all the lessons learned from the first wave. 

What are your biggest concerns in the face of another surge in cases?

The strain on the medical system. Both on our patients — surges in COVID patients displace necessary medical care — and I’m very worried about the stress on the health care workforce. 

Everyone who works in a hospital is under quite a bit of strain and has worked extraordinarily hard to get us to where we are, to deliver amazing care in the first wave. I know a lot of people are fearful of having to go through that again — to turn their personal lives upside down and see the strain that this puts on the patients they care for who often are alone in the hospital. We don’t want anyone to be sick of course — we don’t want our patients to get COVID and have to come in — but I worry about the toll that this also takes on health care workers. 

Is there anything the hospital wants to see officials do to prevent another surge? Does some of the state’s reopening need to be rolled back?

What I most wish for is that the population of the state understands how much our health is tied together. We need everyone to follow the public health guidance to keep transmission low to protect those who are vulnerable. Just because someone is young and maybe has less of a risk for hospitalization or death from COVID, doesn’t mean that their infection isn’t a problem. The more infections there are, the more people who have medical conditions or who are older are at risk because the circulating virus is more of a threat to them and the community. 

What’s your message to the public, given the rise in cases Massachusetts has seen in recent weeks?

This is something we need to fix ourselves by making sure we follow guidelines. I recognize that everyone is tired of these actions and everyone is under stress, but the threat just isn’t gone. We have to keep doing what has worked well so far. 

Tufts Medical Center 

Dr. Shira Doron, infectious disease physician and epidemiologist at Tufts Medical Center. —Jonathan Wiggs / Boston Globe

Boston.com: Is the hospital concerned about seeing another wave of COVID? 

Dr. Shira Doron, infectious disease physician and hospital epidemiologist: Yes. We have been anticipating and preparing for a second surge since the first one ended, and now see the signs of one developing.

Is the hospital prepared? What has been done already or is being done to be ready for a surge? What is the status of the hospital’s PPE supply? 

Yes. We learned a lot in the last surge about what does and doesn’t work. We know where we will put patients when we run out of space, and are able to do preemptive things to avoid this, such as placing younger adults in pediatric areas and transferring less sick patients to our community hospital affiliates. We have been amassing supplies. We have built a new med-surg unit. Our PPE supply is better, but still not ideal.

Do you have any predictions on the timing of when it might arrive? 

Models currently suggest the rise will be slower and not reach as high a peak as the first surge.

Will the handling of another surge be different from the spring wave of cases? If so, how or why? 

We very much hope not to close down surgical and ambulatory operations during the next surge, since those services are essential for our patients.

What are your biggest concerns in the face of another surge in cases? 

Maintaining levels of staffing and preventing staff burnout are our biggest concerns. Supply shortages, including medications, are also a major concern.

Is there anything the hospital wants to see officials do to prevent another surge? Does some of the state’s reopening need to be rolled back? 

It is not at all clear that rolling back reopening would stem this current rise in infections, since they are not clearly linked to transmission in business/commercial settings. Bigger factors appear to be pandemic fatigue and cold weather, leading to people letting their guard down during private gatherings. Public health messaging should focus on the importance of masks and distancing in those settings.

What’s your message to the public, given the rise in cases Massachusetts has seen in recent weeks? 

This is the time — today — to double down on efforts to prevent transmission. Follow the guidance that has been laid out, keep your gatherings small and outdoors as much as possible. Wear a mask when you cannot distance.

Cambridge Health Alliance

Medical workers take down personal information at a Cambridge Health Alliance COVID-19 testing site. —Erin Clark/Boston Globe

Boston.com: Is the hospital concerned about seeing another wave of COVID?

Dr. Lou Ann Bruno-Murtha, division chief of infectious diseases: CHA is greatly concerned about a second surge which currently appears to be evolving in Mass. As part of our ongoing hospital preparedness planning, we anticipated a surge in the fall and have planned for it to be further complicated by traditional illnesses (e.g., influenza and pneumonia) that we typically see during the colder months. Our staff and patient influenza programs have commenced, and our organization is also administering other immunizations at points of care to prevent other vaccine-preventable diseases. We are concerned about the potential for family gatherings during the upcoming holidays which could further amplify COVID-19 transmission. 

Is the hospital prepared? What has been done already or is being done to be ready for a surge? What is the status of the hospital’s PPE supply?

CHA has been planning for a second surge since the caseload waned in the spring. Personal protective equipment supplies have been restored. We have facilitated physical distancing throughout the organization, continue to provide robust testing with a favorable turnaround time of results and expanded opportunities for patient influenza vaccination with a drive-through program. CHA continues to limit visitors in the interest of patient and staff safety while accommodating virtual visitation. Masking and eye protection remain essential elements of our universal approach for all patient encounters.  

Do you have any predictions on the timing of when it might arrive? 

It appears we are entering our second wave in MA. The testing positivity rate has also increased as have hospitalizations in the state.

Will the handling of another surge be different from the spring wave of cases? If so, how or why?

Hospitals are better prepared now. We know how to protect staff and patients and have proven treatment options along with access to reliable testing with quicker turnaround of results. PPE supplies are far more robust now. 

What are your biggest concerns in the face of another surge in cases?

The health and well-being of staff caring for serious and critically ill COVID-19 patients during a second surge is our biggest concern. Staff have not had an ample opportunity to decompress after the first wave. 

Is there anything the hospital wants to see officials do to prevent another surge? Does some of the state’s reopening need to be rolled back?

The state has worked hard to manage the crisis and balance all the mitigating issues. At this juncture, I would recommend rolling back indoor dining and indoor fitness unless ventilation systems are vetted and verified. Remote working should continue, and residents should be educated on how to limit risk during small holiday gatherings.  

What’s your message to the public, given the rise in cases Massachusetts has seen in recent weeks?

Residents need to fight the urge to become complacent. Everyone must be respectful and accountable for masking, physical distancing and performing hand hygiene in order to prevent disease. We have an ethical obligation to protect older adults and individuals at greater risk for severe disease. If a household member is diagnosed with COVID-19, all others in the home must quarantine and call their health provider to arrange for testing. 

UMass Memorial Medical Center

The UMass Memorial Medical Center in Worcester. —John Blanding / Boston Globe, File

Boston.com: Is the hospital concerned about seeing another wave of COVID?

Dr. Richard Ellison, hospital epidemiologist: Yes. We are concerned about that. We actually created a second wave committee over the summer, which has been meeting since then to prepare. 

Is the hospital prepared? What has been done already or is being done to be ready for a surge? What is the status of the hospital’s PPE supply?

Yes, we are prepared for it.  We never stopped tracking our supplies of PPE. We have been tracking them and other relevant equipment, especially ventilators, since the first surge and we have been purchasing new equipment over the summer. We have a several-months supply on hand, in house. So that is the goal, to actually maintain a several-month supply.

Do you have any predictions on the timing of when it might arrive? 

We’re very worried that it will arrive in the next several weeks. In terms of what we know about other coronaviruses, they often will have an upswing in November. So we are tracking the cases both in the state and what we’re seeing within our own system continuously. We have an automated dashboard to track cases — the number of positive tests, the number of in-patients — in real time. 

Will the handling of another surge be different from the spring wave of cases? If so, how or why?

Yes, it will be different. We entered the spring surge with no idea of how many people were infected, and we now have that information from tracking the number of people who have been infected. This will allow the state and communities to make interventions such as going to virtual schooling, closing or limiting the hours of restaurants, and cutting back on indoor seating or the size of gatherings. Those public health measures will help.

What are your biggest concerns in the face of another surge in cases?

If we have another surge that fills all the ICUs, it will again put a major demand on hospital resources and may lead to shortages of the drugs, such as remdesivir, so that we won’t be able to provide the same level of care as we have done the last 5 months.

Is there anything the hospital wants to see officials do to prevent another surge? Does some of the state’s reopening need to be rolled back?

YES – public health measures are of major importance in preventing people from catching COVID or the flu, and taking action early if it looks like the number of cases is increasing rapidly will help hospitals and healthcare facilities be better able to care for the individuals who are really sick

What’s your message to the public, given the rise in cases Massachusetts has seen in recent weeks?

Everyone can help slow the spread of COVID by taking precautions including 1) wearing a mask, 2) social distancing when you’re outside of your home, 3) performing frequent hand hygiene, 4) quarantining if you’re exposed to someone who has COVID. Everyone should think about how they plan to spend the holidays, and think about having smaller gatherings and having family members even wear masks inside the house if the gathering includes family who normally live in different households.


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