With Maine breaking records for COVID-19 hospitalizations and cases this fall, the state’s hospitals are activating strategies to expand capacity to meet the demand of surging patients.

Steven Michaud, president of the Maine Hospital Association, said the increasing numbers of patients hospitalized with COVID-19 is “extremely concerning.”

The state reported 323 patients were hospitalized with COVID-19 on Saturday, the latest data available, including 104 in critical care and 40 on a ventilator.  On Nov. 18, Maine had 271 patients hospitalized with COVID-19.

Michaud said the hospitals are getting filled up with COVID-19 patients.

“We think we are getting close to having a major problem,” Michaud said, although it’s impossible to say exactly when capacity could be reached. “You can’t put a number on it.”

That’s because hospitals are using some of their tools to increase capacity, such as delaying elective surgeries, using rural hospitals to care for COVID-19 patients and bringing in temporary workers, such as recent retirees, to volunteer or for paid work. The temporary workers could work in other areas of health care, such as vaccine clinics, to free up the permanent employees to care for COVID-19 patients.

The Mills administration has encouraged rural hospitals to support the regional medical centers and has begun encouraging volunteers or temporary health care workers to help with the pandemic.

Michaud said there’s still more give in the system, because hospitals can increase usage of the tools. For instance, regarding delaying elective surgeries, such as hip and knee replacements, hospitals can “tap the brakes” by delaying some surgeries or “push hard on the brakes” and delay most elective surgeries. Michaud said most hospitals in Maine can do more to delay additional surgeries if needed.

“Clearly, we are going to have to manage elective procedures even more than we do right now,” Michaud said.

 

The Mills administration recently eased some regulatory rules that now permit smaller, rural hospitals to care for COVID-19 patients. So, for instance, hospitals in Machias, Millinocket, Farmington, Calais and other rural hospitals are now permitted to care for COVID-19 patients, although severe cases are always transferred to major hospitals such as Maine Medical Center in Portland and Eastern Maine Medical Center in Bangor.

John Porter, a spokesman for MaineHealth, a health network that includes Maine Med and seven other Maine hospitals, said rural hospitals in the MaineHealth system now being able to care for COVID-19 patients means their capacity to care for pandemic patients has increased.

“With these high numbers of COVID patients, it allows us to make better use of our beds throughout the system,” Porter said.

On Friday, the MaineHealth system was caring for 88 COVID-19 patients, including 29 at Maine Med. Rural hospitals pitched in, such as Franklin Memorial Hospital in Farmington with six COVID-19 patients, Stephens Memorial Hospital in Norway caring for eight COVID-19 patients and Waldo County General Hospital in Belfast with five patients.

One specific area of concern is the capacity of the state’s intensive care units, where the most severely ill patients are cared for. The state CDC said Maine hospitals had about 55 available ICU beds as of Thursday, including those for adults and for youth.

Michaud said hospitals can convert non-ICU beds to intensive care beds. But a bigger issue is a limited number of nurses and other workers to staff the beds.

Yet another challenge that the health care system is trying to address is a lack of capacity in nursing homes and other skilled care facilities, which is making it difficult to discharge patients and make room for new admissions. Opening up beds in nursing facilities would mean that patients who need to be discharged into skilled care don’t spend more time than is necessary at the hospital, Michaud said.

Meanwhile, hospitals and state health officials continue to urge more residents to get vaccinated as the best way to contain the surge and save hospital capacity.

About two-thirds of all hospitalized COVID-19 patients are unvaccinated, although the percentage varies from week to week,  according to the Maine CDC. And the unvaccinated are far more likely to become severely ill and require intensive care.

It’s unknown when or how high the peak of the surge will be, but public health experts say increasing vaccinations in recent weeks should help keep cases in check. Vaccination rates have increased recently  by about 30 percent to about 9,200 shots per day, with ages 5 through 11 becoming eligible in early November, and all Mainers age 18 and older becoming eligible for booster shots last week.

Since 5- to 11-year-olds became eligible, 26.95 percent of Maine’s schoolchildren have gotten their shots, with 25,999 shots given in about three weeks. Cumberland County has vaccinated the highest percentage of its 5- to 11-year-olds, with 46.2 percent getting their shots, compared to less than 10 percent of that age group in Somerset and Piscataquis counties.

In all age brackets, 68 percent of Maine’s 1.3 million population have received their final dose. The state reported on Saturday that 280,626 booster doses have been administered.

Cases are rising again nationwide as people spend more times indoors in cool weather. But Maine’s surge remains among the worst in the nation, with the 11th-highest cases per capita of COVID-19 as of Friday, according to the Harvard Global Health Institute.

Maine has an average of 47 cases daily per 100,000 population compared to the national average of 26 per 100,000. Michigan, Minnesota and Wisconsin are currently the hardest-hit with COVID-19, with Michigan leading the country at 84.7 average daily cases per 100,000. Florida is currently the lowest at 5.1 cases per 100,000, down from a peak of more than 100 cases per 100,000 population in mid- to late-August.

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