Mass. Curbing Some Elective Inpatient Procedures, Expanding Test Sites

With Thanksgiving celebrations being blamed for the "rapid increase" in COVID-19 infections over the past week, Gov. Charlie Baker on Monday announced an expansion of free testing and said hospitals beginning Friday would "curtail" inpatient elective procedures that can be safely postponed to free up bed space and staff.

Baker also said his administration was studying the post-holiday data to determine whether additional restrictions were necessary to stop the spread of the virus and take some of the pressure off hospitals. Baker said "every option is on the table" if infections and hospitalizations continue to rise, but said he'd have more to say on further restrictions "soon."

As of Sunday, 1,416 people were hospitalized with COVID-19, including 298 in intensive care units. Statewide, hospitals were operating at 68% of capacity, with 39% of all ICU beds still available.

"Massachusetts is now experiencing a rapid increase in new positive cases in the wake of Thanksgiving, and in turn the number of people becoming ill and needing hospitalization is also increasing," Baker said.

Baker last week visited the DCU Center in Worcester where a field hospital has been set up for the second time this pandemic, and the state working to establish a second field hospital in Lowell, and possibly a third on the South Coast.

"Even with these additional resources, we can't afford to continue to strain the hospital system at this rate," Baker said. He explained that the problem of increasing admissions has been compounded by staff testing positive or having to quarantine.

Health and Human Services Secretary Marylou Sudders said the curtailment of elective procedures will be limited to inpatient treatments and procedures, and not outpatient surgeries or appointments for preventative services like mammograms, colonoscopies or regular pediatric checkups.

"Let me be clear. This is a limited curtailment of elective procedures to promote the redeployment of staff that perform non-essential elective procedures to support the essential emerging inpatient care," Sudders said. "It is not the blanket across the board curtailment that we implemented in the first surge."

Sudders told the Massachusetts Association of Health Plans in early November that the administration was working with hospitals, providers and insurers to "engage in more nuanced planning in order to maintain access throughout the fall and winter" and avoid a situation like the spring when the state mandated that Massachusetts hospitals cancel non-essential elective procedures.

"We also saw some of the consequences of shutting things down in terms of people delaying treatment, and then when they were hospitalized it was for very, very serious conditions, so we're trying to find the balance here," she said on that Nov. 6 call.

Massachusetts Health and Hospital Association President Steve Walsh said hospitals had become "stretched yet again by an influx of COVID-positive patients," but have worked to make sure a widespread closure won't be necessary as it was in the spring.

"As each hospital makes its own adjustments based on bed capacity and care demand, we urge every patient to remain engaged with their care team, to seek care when they need it, and to help our system by following public health measures. Hospitals are here for you, as they have been throughout this crisis," Walsh said in a statement.

Baker, who said he planned to address the media five times this week, including on Wednesday about vaccine distribution, expressed frustration that the warnings from public health officials over the dangers of gathering for Thanksgiving were not heeded.

He said he spoke over the weekend with several mayors who are frustrated with him for not taking more aggressive action to curtail activities, but he said all of them also admitted to seeing people in their communities engaging in the risky behavior he has been warning about, including neighbors hosting informal gatherings.

Some mayors told the Boston Globe over the weekend that they were reluctant to act alone to shut down businesses in isolation, but were considering regional action if the state doesn't take more uniform steps to control the spread.

In addition to making sure hospitals have the space and staff to treat COVID-19 patients, Baker announced an expansion of testing that includes three new free express testing sites in Framingham, New Bedford and Lynn. Those express sites will be operated by Project Beacon, the vendor running the express testing site in Revere, and will be able to test 1,000 people a day. The Framingham site was expected to open Monday, and the others by the end of the month.

Baker said free "Stop the Spread" testing sites set up by the state for people with or without symptoms will also be opened in Barnstable, Berkshire, Franklin, and Hampshire counties, with a capacity to test 110,000 people a week.

"All of these sites will be able to deal with the fact that it's getting colder and winter is coming," Baker said.

Public health officials and lawmakers from Cape Cod have been urging the administration to set up a "Stop the Spread" site on the Cape, describing the region as a "testing desert." With money from a July COVID-19 budget bill, the county will now be running a drive-thru site in Falmouth.

Baker also said new testing sites will be established in Amherst, Great Barrington, Greenfield, North Adams and Pittsfield, and up to 150,000 Abbott BinaxNOW tests will be distributed to community hospitals and health centers for rapid testing.

"We're in the holiday season and I know that folks, for the most part, are tired of dealing with all this, but the disease is highly contagious and will continue to be dangerous for quite some time," Baker said, urging the public to stay vigilant.

Before the governor's Monday press conference, New York Gov. Andrew Cuomo announced that in his state if hospital admission rates do not stabilize over a five-day period indoor dinning would either be shut down in New York City or cut back to 25% capacity in other regions of the state.

Baker, however, defended restaurants against being scapegoated as the driving force behind the increased rate of infection.

"There are many things that spread COVID and restaurants certainly play a role along with many others," Baker said. "But honestly if you were to say to me the thing I worry about the most is still the informal gatherings, because there are no masks, there are no rules, there are no guidance, there are no time limits. It's a completely different problem."

Baker said the restaurants in Massachusetts operate under some of the strictest guidelines in the country, and do not present the same risk as gathering at a table in someone's home with a large group for dinner, as occurred on Thanksgiving.

Over the week that ended Thursday, the Department of Public Health's data shows that restaurants and food courts accounted for 24 clusters of COVID-19 and 103 confirmed cases, compared with the 21 clusters and 130 cases traced back to social social gatherings.

The biggest source of transmission - 9,393 clusters and 23,756 - continues to be within households where the source of the original infection cannot be traced.

Baker was also asked about social clubs, which have been linked to several outbreaks.

"Stay tuned," he said.