Cheshire Medical Center has the most COVID inpatients it’s ever had at one time, leading the Keene hospital Tuesday to convert more standard rooms to those capable of providing intensive care.
Three COVID-19 patients were moved that afternoon from the Dartmouth-Hitchcock Health affiliate’s main ICU into three of the four rooms converted Tuesday, according to President and CEO Dr. Don Caruso.
This isn’t the first time the hospital has had to make temporary negative pressure rooms to provide a high level of care for COVID-19 patients. The hospital has converted four standard rooms since November; however, more beds were still needed to deal with the current influx.
“This is probably the highest number [of COVID-19 inpatients] ... and they are all really sick,” Caruso said.
He added that if the hospital’s main and overflow ICUs are full, Cheshire Medical will work with its partners across the state to find beds and will relook at its internal resources to help.
As of Tuesday morning, Cheshire Medical had 27 COVID-19 inpatients, with nine requiring ventilation, Caruso said. For the past few days, the hospital has hovered around that number. (There are no issues with having enough ventilators or other supplies, spokeswoman Heather Atwell said.)
Those who are unvaccinated continue to make up a majority of the inpatients, with about 67 percent of those in the ICU as of Tuesday not inoculated.
A majority of these cases continue to be the delta variant, according to Dr. Aalok Khole, an infectious disease expert at the hospital.
Breakthrough cases of the viral disease can and do occur in those who are vaccinated. However, those who are inoculated are likely to have a much milder form of COVID-19 than those who aren’t.
Those who are hospitalized and fully vaccinated are often seeking medical attention for a different complication but also test positive for COVID-19, Cheshire Medical officials have said, whereas unvaccinated patients are usually there for complications of the viral disease.
Caruso said with another surge in cases expected following the holidays and the associated traveling and gatherings, the hospital is transferring about 30 nurses who work in outpatient departments to the inpatient setting to prepare.
“There’s no doubt it’s going to get worse, and any surge on top of what we already have is going to be incredibly problematic because our ability to stretch any further is pretty limited at this point,” Caruso said.
The hospital saw a slight decrease in its percent positivity rate — the proportion of COVID-19 tests coming back positive — for the first time in weeks, hospital data show, but the number remains high.
During the week ending Dec. 23, Cheshire Medical reported a rate of 19.7 percent, compared to the prior week when it was 21.1 percent.
Khole said such a small dip doesn’t mean that cases are decreasing.
“In the first few days [of this week], it’s already higher than last week’s ...,” he said. “It’s a blip.”
Cheshire Medical continues to urge people to practice COVID-19 safety measures, such as wearing a mask in public, staying home when sick and washing hands frequently, especially as New Hampshire sees its highest case rates to date.
Those who haven’t done so are also encouraged to get a COVID-19 vaccine or booster shot.
Several COVID-19 vaccination clinics will be held in the Monadnock Region throughout January for both the initial doses of vaccines and booster shots.
At-home rapid tests can also be a tool for prevention. While they can be hard to find at local pharmacies and stores, New Hampshire residents are eligible for a free test through the state at sayyeshometest.org.
To schedule a COVID-19 vaccine or booster appointment, visit vaccines.nh.gov or call 2-1-1.
Monadnock Region communities got more than $2.2 million in additional revenue this year, compared to last, from a state tax on meals, hotel stays and vehicle rentals, lawmakers announced this week.
Those funds went into local coffers Monday, after New Hampshire lawmakers added a provision to the state budget over the summer designating 30 percent of Meals and Rooms tax revenue for municipalities. As a result, cities and towns received $100 million this week, according to a N.H. Senate news release — 45 percent more than they got in the last fiscal year.
Supporters of that move, including Gov. Chris Sununu, welcomed news of the additional revenue Monday, saying it will help communities keep property taxes in check.
But some local officials noted that New Hampshire has for years shirked an obligation under state law to give municipalities 40 percent of Meals and Rooms revenue. Keene Mayor George Hansel said that while the state continues to shortchange its cities and towns in other ways, the recent payout is a “step in the right direction.”
“I’m glad that the Legislature recognized this as a problem and has taken some action to resolve the issue,” he said.
Enacted in 1967, the state’s Meals and Rooms tax applies to purchases from a restaurant or other food-service establishment, hotel stays and vehicle rentals. Republican lawmakers reduced the tax rate by half a percent — to 8.5 percent — earlier this year, with the change going into effect this past October.
Despite a statutory requirement to share 40 percent of that revenue with cities and towns, New Hampshire has routinely failed to meet that obligation, with elected officials instead diverting the money for state programs in the past. Municipalities got just 20 percent of the Meals and Rooms revenue in the last state budget, according to the N.H. Senate news release Monday.
But a bill introduced earlier this year by state Sen. Denise Ricciardi — a Republican whose district includes Dublin, Fitzwilliam, Greenfield, Hancock, Jaffrey, Peterborough, Richmond and Troy — sought to change that practice, by disbursing the full amount owed to local communities.
Ricciardi noted in a N.H. Union Leader op-ed last January that the state had pledged in 1993 to help municipalities recover the lost revenue but suspended that effort over the past decade. In the op-ed, she called her proposal to restore revenue-sharing to 40 percent a “fiscally responsible way for the state to start keeping its promises to local taxpayers.”
Lawmakers incorporated Ricciardi’s bill into the state’s 2022-23 budget but dropped the Meals and Rooms allowance for cities and towns to 30 percent. Ricciardi nonetheless touted the measure Monday as a way to stem rising property taxes.
“I made it my goal this past session to protect local property taxpayers by making certain the state kept its promise to share more of the revenues that our M&R tax generates,” she said in the news release. “I am happy and extremely satisfied that today, our cities and towns will finally receive the amount they’ve been promised for so long.”
Under the new revenue-sharing scheme, municipalities across New Hampshire got a combined $32 million more this year than in fiscal year 2021, the N.H. Senate announced.
That included an additional $534,000 for the city of Keene, bringing its Meals and Rooms allowance to $1.7 million for the current fiscal year. Among local communities, Richmond saw the largest proportional bump, with a nearly 47 percent revenue increase to $88,000.
Sununu cheered those numbers in a statement Monday.
“We cut the rooms and meals tax to its lowest level in over a decade and yet we still sent even more money back to cities and towns,” he said. “Instead of downshifting costs, we downshifted cash, giving cities and towns extra flexibility — a win for our citizens.”
Despite the windfall for Monadnock Region communities, state Sen. Jay Kahn, D-Keene, took a more sober view, arguing that other policies — including some championed by conservative lawmakers — promise to further strain local resources.
Giving municipalities 40 percent of Meals and Rooms proceeds is a “good goal,” according to Kahn, who said he’s worried the state won’t have enough money in the future to pursue that change. He noted that some revenue streams are set to dry up because Republicans in the state Legislature voted this year to slash corporate tax rates and to gradually eliminate a tax on interest and dividends income.
Those moves, combined with lagging contributions by the state into the N.H. Retirement System and public education, will continue passing costs to municipalities, Kahn said. That will disproportionately hurt low-income communities, he added.
“Whenever the state reduces its revenue sources, it usually means that local property taxes are going to go up,” he said. “… We face a dilemma when we do things for short-term benefit without looking at the long-term impacts.”
The additional Meals and Rooms revenue will, however, offer some relief for local property owners, Hansel said Monday. Noting that Keene, as a hub for dining and lodging, is responsible for much of that spending in the region, he said city officials will continue to push for more state aid through other sources.
“Ultimately, this is a complex problem,” he said. “It’s going to require years of sustained advocacy and effort.”
That’s unlikely to include a proposal from earlier this year to have Keene either sue the state or share with it only 60 percent of the Meals and Rooms taxes collected by local businesses. (Municipalities typically send all the proceeds to the N.H. State Treasury, which then redistributes them across the state.)
Since the 30-percent allocation was made state law, At-Large City Councilor Randy Filiault, who presented those options to Hansel and the council in October, said they’re largely irrelevant now.
Estimates by the Keene Finance Department show the city would have gotten an additional $8.8 million over the past decade if it had been given the full 40 percent of Meals and Rooms revenue, according to Filiault. He called for that funding to be restored fully, comparing the larger payouts this year to a thief stealing $20, then returning half of the cash and “tell[ing] you to be happy.”
“How anybody can think that’s acceptable is beyond me,” he said Monday. “… It goes to show the abuse that towns and cities in the state have taken over the years.”
City and Cheshire County officials will meet next month to discuss how they can advocate for more state assistance, Filiault said. Without that relief, he said Keene will be forced to cut services or again raise property taxes, making housing even more expensive.
“The trend has to change,” he said. “We can’t go down this road anymore … Middle-income families can’t even afford homes.”
The state of child care in New Hampshire has always been a tenuous one. In many areas there just aren’t enough open spots for families that are looking for care.
A 2018 Center for American Progress analysis found that more than half of Americans live in a childcare desert. And now add a pandemic that has stretched almost two years to the scarcity of spaces and ever-rising cost, and the stress for both child care providers and those looking for a facility has increased exponentially.
In the Granite State, 54,000 children under 6 years old needed child care but there were only 33,000 licensed slots, according to the February 2021 study Constraints on New Hampshire’s Workforce Recovery by NH Department of Health and Human Services. That’s a 40 percent shortfall, and most certainly some centers have since closed making the gap even wider.
“I can’t tell you the frequency of calls I get (from parents on the waiting list) asking if there are any spaces yet,” said Wren Hayes, owner of Building Block Commons in Exeter, a private school that serves children from 2 years 9 months old to 8th grade, with the majority of its population in the prime child care time of 2 years 9 months to 5 years old. “There is a dire sense in their voice, saying they have to quit their job (if they don’t get care) or ‘we need help.’ The urgency in these calls is something I’ve never seen before.”
Hayes said that before the pandemic she had a waiting list of maybe 50 kids, though it was “flexible” as she was able to move things around to accommodate as many people as possible. Now that number has ballooned to 206 (for 86 available spots).
“We’ve even been offered more money, but of course, we have to say ‘no’,” she said. “That’s how desperate people are now.”
A Place to Grow in Brentwood is licensed to care for 52 kids, but owner Jennifer Legere says they usually have around 39 due to what they are comfortable with given space and staffing. She said her waiting list has grown to a three-year wait.
“If you live in New Hampshire you literally have to look for child care when you find out you are pregnant because there isn’t enough,” said Legere.
At the start of COVID, with so many Granite Staters losing jobs or working from home, A Place to Grow saw the number of its students cut in half. Legere was able to fill some of those spots with children of frontline and essential workers. She said she “rebounded” with full capacity two months later. But that hasn’t made the past 20 months a smooth ride.
“Every day (during the pandemic) has been a roller coaster,” said Leger. “We’ve had the highest of highs and lowest of lows. But, as my assistant director has said, “you gotta tuck and roll to get through it every day.”
“I walk in Monday morning and think the day is going to be great and then two hours later … you just don’t know. Managing (staffing and kids being sick) is the hardest part.”
In addition to the problem of more kids than spaces in New Hampshire child care, the issue of staffing is a major concern. Low wages, job instability and stressful working conditions have resulted in 80 percent of centers across the country claiming staffing shortages, according to the National Association for the Education of Young Children survey in the summer of 2021. Half of the 7,500 centers that took part in the survey said they have fewer spots and reduced hours because of it.
“It is very, very challenging to hire,” said Marianne Barter, executive director of Merrimack Valley Day Care Service, which has five centers in Concord and Boscawen. “I’ve had an ad for three preschool teachers for two months and (the response) has been just … crickets. (There are) very few applicants and ones that did apply did not have (the correct) qualifications.”
Legere, at A place to Grow, said she recently received 25 applications for open positions — a higher-than-usual number. But when she contacted them within a day, half didn’t even call back.
Legere and Hayes are doing their part to help lessen the child care shortfall. Legere is starting to franchise her business. She said they are close to the first new A Place to Grow to increase the number of locations to four. Hayes said she added a second session that opened 26 more spots.
Legere is taking it one step further as she is advocating for help from the state of New Hampshire if the Build Back Better Act ends up passing. She hopes some of the funds from the federal act, passed on Nov. 19, can be used to provide funding for new child care locations and help find locations, provide livable wages for workers, and provide assistance for families.
In addition, Legere has talked with the Department of Health and Human Services, other child care providers, and licensing boards to brainstorm on new ideas to solve some of the many child care issues.
“It’s a real complex situation in New Hampshire,” Legere said. “What has been amazing is our local early childhood community. It has done a really great job coming together to support the industry to fix this. There has been a lot of amazing groundwork being done inside the state.
“I feel like it was every man for himself before the pandemic. We all did a lot of stuff to stay in the loop but at this point, it’s a team. We are all working together to keep ourselves alive.”
There’s a new state bill that was introduced in July called the Workforce Behind the Workforce Act of 2022, which “establishes a child care workforce fund to provide grants to eligible child care programs for child care workforce recruitment and retention bonuses and benefits.” It has not been assigned a bill number and is expected to be presented in 2022. It, too, has the potential to cut down the number of children waiting for child care.
Health officials’ recommendation this week to shorten the isolation period for people with asymptomatic coronavirus infections to five days was driven largely by the concern that essential services might be hobbled amid one of the worst infection surges of the pandemic, said senior officials familiar with the discussions.
The administration’s top health officials met over Christmas weekend to discuss the trajectory of the U.S. outbreak, with several expressing fear about how high case levels might climb in the coming weeks, according to four senior officials briefed on the discussion. They worried the sheer volume of infections could mean that tens of thousands of police, firefighters, grocery workers and other essential employees would be out of work, making it challenging to keep society functioning, even though many of the infections would be mild or produce no symptoms, the officials said.
While omicron is the most transmissible variant yet, it appears to have less severe effects than the delta variant and, so far, a smaller percentage of those infected end up hospitalized, according to international studies and early data from U.S. hospitals. Those who are vaccinated, and especially those who are boosted, are likely to have mild or asymptomatic infections, early research shows — a finding that also helped drive the recent change in guidance.
The decision to cut the recommended isolation time in half, which was hailed by business groups and slammed by some union leaders and health experts, reflects the increasingly tough decisions health officials navigate as they seek to strike the right balance between vigilance and normalcy as the nation heads into the pandemic’s third year. Even with a surging variant, President Joe Biden has said he is not looking at lockdowns and stressed that people who are vaccinated and boosted do not need to fundamentally change their lives as they did at the start of the pandemic.
The guidance by the Centers for Disease Control and Prevention “was based on the anticipation of a large number of cases might impact societal function,” CDC Director Rochelle Walensky said in an interview. “There were starting to be limitations in society, not just in our health-care workforce but in other parts of society. We were seeing infections in many places that we realized this could be a harbinger of many other essential workers we needed.”
The decision comes as the omicron variant pushed the seven-day average of new daily cases in the United States to 266,889 on Tuesday, surpassing the previous high of 248,209 cases on Jan. 12. Those numbers do not include the results of thousands of at-home tests since many people do not report those results to their physicians.
Biden was briefed Monday by his COVID response team on the CDC’s decision to revise its guidance, according to a senior White House official. The White House stressed that the agency had reached its own conclusion. “We’re tracking it. We’re being kept abreast,” said Kevin Munoz, a White House spokesman. “We’re not making the decision.”
The guidance suggesting those with no symptoms or whose symptoms are resolving may cut their isolation time from 10 days to five and then mask for an additional five days has been criticized by some experts and union leaders, who say it is based more on economic, than health, considerations.
The president of the nation’s largest nursing union said Tuesday that the recommendation would lead to increased viral spread because many will resume activities — or be pressured by their employers to resume them — while they are still infectious.
“It’s only going to lead to more illness, more cases,” Jean Ross, president of National Nurses United, said.
Sara Nelson, president of the Association of Flight Attendants, said she is concerned the guidance is so closely aligned with the requests of business leaders.
“No worker should be forced to come to work when they’re still sick,” Nelson said on CNN. “We’re very concerned about that.”
The agency also cut the recommended quarantine time from 10 days to five days for those exposed to the virus who are not yet boosted and showing no symptoms, adding that they, too, should wear a mask for an additional five days.
Besides the concerns about keeping society functioning, the CDC’s decision was based on a growing body of scientific evidence, as well as internal agency modeling, showing that people are most infectious in the one to two days before they develop symptoms and the two to three days after, Walensky said. Most people will not get tested until they start developing symptoms, she added, meaning that by Day 5 of isolation, they will be far less likely to transmit the virus.
After the agency updated its quarantine and isolation guidance for health-care workers last week to stave off staff shortages, officials realized numerous industries would face the same challenges, Walensky said. After conversation through the Christmas weekend, they realized they would also have to put out guidance for others, Walensky said.
“We have had to be ... able to update our recommendations in real time for the moment,” Walensky said. “This guidance is only as good as society’s willingness to follow it.”
Experts criticizing the guidance particularly faulted the agency’s failure to require people to have a negative test result before they complete their isolation or quarantine. The agency said best practice would be for people to get a test on Day 5 of quarantine but did not strongly recommend that they do so.
“There are people who are infectious and can transmit after five days,” said Walid Gellad, professor of medicine at the University of Pittsburgh. “It’s probably not the majority, but there are people, so by doing this, you are in effect encouraging people to engage in activities that could increase transmission.”
Gellad recommended that individuals not use the CDC guidance to make their own personal decisions, “if they’re able to do something differently than what CDC says.”
The change “does not seem to be based on science and data and what’s best for the public unless they’re accounting for the complete breakdown of society,” he added.
Walensky said the agency decided not to require a negative test result after people had isolated for five days because the results are often inaccurate at that point in an infection. PCR tests — those typically performed in a lab which are around 98 percent effective — can show positive results long after a person is no longer infectious because of the presence of viral remnants, she said. It remains unclear how well rapid, at-home tests determine someone’s ability to transmit the virus in the latter part of their infection, she added.
Instead, agency officials determined that wearing a mask after the isolation or quarantine period would help protect against lingering transmissibility, she said.
Some health experts said they support the updated quarantine and isolation guidelines for health-care workers, but didn’t know if they make sense for the rest of society. Health-care workers have to mask and wear personal protective equipment in the workplace, but that’s not the case for millions of other Americans, said Lisa Maragakis, senior director of infection prevention for Johns Hopkins Health System.
The guidance “feels like it is too early and is coming at not a good time as we are still in the very sharp increase part of this surge,” Maragakis said. “It feels to me the wrong time to relax any guidance for the public.”
The guidelines could offer relief to airlines, which began preemptively canceling flights before Christmas as coronavirus cases spiked among their crews. Carriers had lobbied the CDC for changes last week, arguing that it would be impossible to keep planes in the air with so many employees out with infections.
The airline industry group Airlines for America hailed the decision. “The aviation workforce is essential to maintaining the operations of air travel and cargo supply chains,” the group said in a statement.
Holly Wade, executive director of the National Federation of Independent Business, also applauded the decision, saying it could help alleviate workforce disruptions affecting many companies.