Maryland hospitals seeing post-holiday increase in COVID and flu cases

Hospitalizations from COVID-19 and the flu have surged in the past month, prompting the Maryland Department of Health to recommend that hospitals and doctor’s offices double down on efforts to suppress the spread of illness, including requiring masks in all patient care areas.

But even with the increased circulation of what pediatrician Dr. Monique Soileau-Burke called a “tossed salad” of respiratory viruses, doctors and hospital leaders said they aren’t being overwhelmed by sick patients in the same way they have been in recent years.

At emergency departments run by Adventist HealthCare, a nonprofit health system based in Montgomery and Prince George’s counties, the number of patients with respiratory illnesses has been climbing since shortly before Thanksgiving, said Dr. Patsy McNeil, senior vice president of Adventist and the system’s chief medical officer. However, she said, that trend is something she and her colleagues expected.

“It hasn’t been surprising to us,” said McNeil, who also is a certified emergency medicine physician. “We anticipated it. We knew that it was coming.”

Under guidance from the state department of health, health care settings should implement “broad facility-wide source control” when the statewide rate of weekly respiratory virus-associated hospitalizations meets or exceeds 10 hospitalizations per 100,000 residents. That rate was 16.7 hospitalizations per 100,000 residents during the week ending Dec. 23, and dropped to 8.1 during the week of Christmas — the most recently available data on the state’s website.

Hospitals can roll back the strengthened infection control measures — which, besides universal masking, also include optimizing facility ventilation and vaccinating eligible patients and health care workers against COVID, influenza and respiratory syncytial virus — when the weekly hospitalization rate stays below 10 for two consecutive weeks. Regular infection control measures should continue regardless, the health department’s Dec. 28 letter said.

Some hospitals in the state — like Luminis Health Anne Arundel Medical Center — are back to asking everyone to mask, including patients, visitors and employees. Others, like the University of Maryland Medical Center in Baltimore, are considering doing the same.

Hospitalizations for respiratory illness are being driven mostly by people infected with COVID and the flu now. Hospitalizations for respiratory syncytial virus appear to already have peaked for the season, according to state data. Early last month, there were 228 people hospitalized with the virus, which is particularly dangerous to babies and older adults. As of last week, however, that number had dropped to 104.

Dr. Gregory Schrank, an epidemiologist at the University of Maryland Medical Center, said he expects it will take an additional few weeks for the circulation of influenza and COVID to wane. In a normal respiratory season, kids tend to get sick before older adults, Schrank added, so there may be a decline in pediatric hospitalizations before there is one for adults.

“But that would be in a typical season,” said Schrank, who is also an assistant professor at the University of Maryland School of Medicine who specializes in infectious diseases. “Everything has been just a little bit different since the COVID-19 pandemic. Last year, we saw a very early influenza season that really started peaking in November. It remains to be seen exactly how this season will play out.”

As of Jan. 2 — the last date for which data was available — there were 545 hospital beds occupied by people sick with COVID, according to state data. That’s up by more than 100 from Christmas, when there were 425 people hospitalized with the virus. However, it’s much better than this time last year, when close to 800 beds were occupied by people sickened by COVID.

State data shows flu hospitalizations dipped at the end of last year, from 391 during the week before Christmas to 370 during the last week of the year.

At Luminis Health, there already has been a welcome decline in patients sick with respiratory illnesses. On Friday, there were about 26 patients at the Annapolis hospital with RSV, COVID or the flu, compared with about 35 following Thanksgiving, said Dr. Jean Murray, the system’s director of infection prevention and epidemiology.

What’s more good news, she said, is that the system is seeing fewer patients admitted to the intensive care unit or getting placed on ventilators.

A surefire way of avoiding the hospital, and especially the ICU, is to get vaccinated against the flu, COVID and — for older adults and babies — RSV. But as of Friday, only about a quarter of Marylanders had gotten their flu shot, according to state data.

Vaccine fatigue — and hesitancy — has ballooned during the past few years. The Centers for Disease Control and Prevention announced in November that a record number of parents had requested an exemption from their child’s school for getting them the shots that are typically required. The exemption rate rose from 0.4% to 3% nationwide and exceeded 5% in 10 states, the report said.

Soileau-Burke, a pediatrician in Columbia and president of the Maryland chapter of the American Academy of Pediatrics, said she has noticed that some parents happily get their children vaccinated against the flu, but are less excited to get them a COVID shot — which the CDC said also protects against the widely circulating JN.1 omicron subvariant.

“In the future,” she said, “we need to do a better job of reminding people that COVID, unfortunately, is not over.”