Baker Defers To Importance Of Local Decision-Making
Vaccines continue to be the “best defense” against COVID-19, but with the omicron variant threatening to drive cases, if not necessarily severe disease, to new heights, hospital and medical experts said Thursday that additional steps like mask-wearing may be necessary this winter to control spread and prevent hospital overcrowding.
“We’re at the point where we have to ask people to do more, again, because of the surge,” said Rep. William Driscoll, the co-chair of the Legislature’s Committee on COVID-19 and Emergency Preparedness and Management.
The collision of the holidays, cold weather and the new COVID-19 variant are raising fears about the ability of hospitals to meet the surging needs of patients, as well as questions about the efficacy of vaccines against the new strain of the virus spreading across the globe.
The Legislature convened an oversight hearing Thursday to probe the state of play with the coronavirus pandemic in Massachusetts and measures that could be taken to control the latest surge. The Department of Public Health on Wednesday reported 5,133 new cases, and 1,411 patients hospitalized with COVID-19 — levels not seen since last January and February.
Dr. Dan Barouch, director of Beth Israel Deaconess Medical Center’s Center for Virology & Vaccine Research, said there’s “no question” that Massachusetts will see an increase in breakthrough cases among the fully vaccinated if omicron becomes the dominant strain, but he said he “remains optimistic” that vaccines will continue to be highly effective in preventing severe disease.
Both Barouch and Dr. Nahid Bhadelia, founding director of Boston University’s Center for Emerging Infectious Diseases Policy & Research, said that while vaccines remain the best tool to fight the pandemic, masks and social distancing should be used to add a layer of protection.
“Is it really that hard to require someone to wear a piece of cloth or a good quality mask, at least in the short-term with a good solid off-ramp?” Bhadelia asked.
So far, Gov. Charlie Baker has resisted calls for a statewide mask mandate, preferring to let cities and towns impose their own rules. Sen. Jo Comerford, co-chair of the committee, said this has resulted in a “swiss-cheese looking map” of communities that do or don’t have an indoor public masking requirement. Comerford supports a return to a universal indoor public masking policy.
“At this point in time, I think it’s important for the locals to do what they think makes the most sense in their communities. But we have lots of mask mandates in places where we worry about vulnerability and spread all over the commonwealth,” Baker said Thursday when asked about the testimony, rattling off places like schools, doctor’s office and long-term care facilities where masks are mandated. Some schools have ditched masks after meeting required vaccination thresholds.
No one from the Baker administration testified at the Legislature’s hearing, despite Health and Human Services Secretary Marylou Sudders, Acting Public Health Commissioner Margret Cooke and Office of Preparedness and Emergency Management Director Kerin Milesky all being invited. The administration this week announced efforts to deliver 2.1 million at-home rapid tests to 102 cities and towns, and plans to open a booster clinic at Fenway Park next month.
Baker attributed his team’s absence to “calendar conflicts,” but acknowledged the chairs’ request for his team to appear before the committee in early January. “We’ll just make sure that fits,” he said.
The administration in recent weeks has taken steps to ease overcrowding concerns at hospitals by ordering the curtailment of non-essential procedures at some facilities, and allowing increased flexibility for hospitals to maximize their space to increase bed capacity.
Massachusetts Health and Hospital Association CEO Steve Walsh told the committee that as cases rise hospital capacity is “stretched more than it has ever been,” and he said anything the Legislature can do to address staffing shortages, such making it easier to transfer nursing licenses from other states, would have a positive impact.
“Every conversation with health care leaders begins and ends with staffing,” Walsh said, saying hospitals have lost 500 inpatient beds due to inadequate staffing.
Walsh also asked the Legislature to consider restoring liability protections for frontline health care workers that were in place early in the pandemic to protect doctors and nurses who may be asked to treat patients with conditions outside their areas of expertise.
“That is the biggest immediate piece that will allow our caregivers to go to work not worrying that they shouldn’t be trying to provide care and be the heroes that they are,” Walsh said.
Walsh said he supports mask mandates, and noted the mandate in health care settings across Massachusetts, but he said he doesn’t have to balance the economic, mental health and educational impacts of masking that Gov. Baker and legislators must weigh. The Retailers Association of Massachusetts, for instance, opposes a mask mandate, and says businesses should be able to decide for themselves.
“Nobody is saying don’t wear a mask,” Walsh said, adding, “People should be wearing a mask whether they’re told to or not.”
Walsh said hospitals are confronting a multitude of staffing issues that exacerbate their problems with capacity, including retirements and nurses either leaving the field or traveling to places that will pay them the highest wage. The surge in patients, he said, has been driven both by COVID-19, as well as people seeking care they deferred during the pandemic.
“After two years of fighting this virus, our caregivers are simply exhausted,” Walsh said.
Walsh said that the state’s efforts to expand scopes of practice and relax rules around hospital’s use of space to create more bed capacity have helped in the short term, but he said the health care industry must also create a new talent pipeline to bring people into the profession.
Expecting another 10 percent increase in patient demand by January, Walsh said hospitals are back to holding daily coordinating calls to identify available bed space within provider systems and across regions of the state that allow facilities to transfer patients, if needed.
Given the networks that exist, Walsh said he was hopeful the state’s hospitals would not get to a point where they simply run out of space and options for patients.
“We haven’t got there. I don’t think we will get there,” Walsh said.
Walsh also told Rep. Jon Santiago, a Boston Democrat and Boston Medical Center emergency room physician, that he did not think the situation would get so bad that hospitals would have to implement crisis standards of care, and begin rationing treatment to the sickest patients.
“We are not looking at implementing crisis standards of care and hoping that it never comes to that discussion,” Walsh said.
Barouch said vaccines continue to be “our best defense” against COVID-19, but he said the inability thus far for vaccines to control the pandemic has to do with a variety of factors, including inadequate supply in some parts of the world that has allowed variants like omicron to develop and spread. Barouch said the Pfizer and Moderna vaccines have also been shown to offer waning protection after six to eight months, making booster shots a critical part of the fight.
Though the research is still very preliminary, Barouch said the omicron variant may be better at evading existing vaccines than other strains of the virus, but vaccines still show promise at protecting people against severe disease.
“We should probably separate the concept of case rates and hospitalization and death rates because we might be in a situation where there’s discordance between those.” he said.
Barouch said wearing masks, social distancing whenever possible and developing new vaccines with better variant coverage and a strategy to make those available worldwide must be part of the strategy.
Bhadelia said she assumes the numbers of omicron infections nationally, and in New England, are higher than the totals that have been confirmed given the speed at which it spread in places like South Africa and the United Kingdom. Boston on Wednesday reported its first cases of omicron in three individuals over 18 who had not been vaccinated.
“I believe vaccines alone will not be enough given how fast this is moving,” Bhadelia said, suggesting a new statewide mask mandate and reducing capacity at large public venues, or requiring proof-of-vaccination for attendance.
“If you are listening to this and you are not boosted, you need to go out and get boosted,” she said.
