On a recent morning, Neil Meehan opened a spreadsheet he has come to dread.
It showed the number of intensive-care beds available in an area of New Hampshire that is home to 350,000 people: two.
A day earlier, there was just one. Very often there are none.
Meehan, the chief physician executive at Exeter Hospital, has worked in emergency medicine for nearly three decades. He has lost track of the number of unprecedented things he has witnessed during this second pandemic winter as virus cases and hospitalizations in the state hit record highs.
His hospital has canceled elective surgeries and placed adult patients in pediatric wards. There are members of the National Guard carrying out support tasks. One seriously ill patient had to wait a week for a transfer to a larger hospital that could treat his condition, a move that normally would have taken hours.
“You have duress in the system that I have never seen before,” said Meehan, 56.
Across New England and the northeastern United States, hospitals are struggling with an overwhelming burden of patients amid a COVID-19 surge that has struck harder and faster than experts expected, even in some of the most highly vaccinated states in the country.
The infections — nearly all driven by the delta variant, not its new cousin omicron — have led to record COVID hospitalizations in Vermont, New Hampshire and Maine. All three states have experienced their biggest surges in cases since the pandemic began and asked for federal help, another first. President Joe Biden announced Tuesday that the government will send emergency medical teams to Vermont and New Hampshire and ambulance crews to Maine.
In Massachusetts, Rhode Island and Connecticut, COVID hospitalizations have soared in recent weeks, although they remain below previous peaks. Yet the winter surge comes at a time when hospitals were already grappling with a staffing shortage combined with an influx of people who had delayed care and an increase in patients battling mental illness. Doctors fear that a large wave of omicron cases could increase the burden even further.
“It’s definitely as bad as it’s ever been,” said Eric Dickson, chief executive of UMass Memorial Health in Worcester. “I can use a New England analogy. Snowstorms, right? You get a bad snowstorm and oh, you deal with it. But you get one on top of that, and now you’ve got all that snow from before that you have to manage. And that’s really what it’s feeling like now — it’s just piling up.”
Interviews with 10 hospital leaders across the region revealed a grave picture. Executives at smaller and midsized hospitals said that it has become exceedingly difficult to secure care at higher-level facilities in the region and they worry that delays in transferring patients could have life-threatening consequences. Several said they were discussing whether they might need to implement standards for rationing care.
In Rhode Island, the president of an association of emergency doctors warned in a letter to the governor last week that the situation had become “acutely untenable” and “any added strain right now will lead to the collapse of the healthcare system.”
The emergence of the omicron variant represents a major unknown. The variant is already present across New England and doctors said they expected it to become the dominant strain shortly. They oscillated between optimism that the variant appears to cause milder illness and pessimism that the sheer number of infections could overwhelm hospitals.
Doctors in the region all said that a substantial majority of the patients currently hospitalized with COVID — between 60 percent and 80 percent — were unvaccinated. The breakthrough cases that end up in the hospital tend to be milder and are concentrated among older patients and people with other health conditions, they said.
Most state leaders in New England have been reluctant to reimpose mask mandates, but several have announced plans to distribute millions of free tests. On Tuesday, Massachusetts Gov. Charlie Baker said he was activating up to 500 members of the National Guard to assist stretched hospitals.
The recent experience of states in New England is especially dispiriting given their vaccination rates. In Vermont, long lauded for its handling of the pandemic, 77 percent of the population is fully vaccinated, compared with nearly 62 percent nationwide. In Maine, the same figure is 75 percent. In Massachusetts, it’s 74 percent.
This fall, as colder weather pushed people indoors and children returned to school, transmission began to accelerate. In places such as Vermont, New Hampshire and Maine, which were relatively unscathed by previous surges, there was also a lower level of prior exposure to the virus. Meanwhile, vaccine-induced immunity was waning in those who had flocked to get their shots early in 2021.
Matthew Fox, an epidemiologist at Boston University, emphasized that vaccines are “still very effective” at preventing serious illness and death. But when it comes to vaccines preventing infections, “we thought it would be a greater benefit than we’re observing.”
Fox said that difference could be due to waning immunity, or to the delta variant itself, which emerged after vaccines were developed. “If you put it all together, it’s just more transmission than we would have liked,” he said. The highly contagious omicron variant, meanwhile, can spread among people who are fully vaccinated and boosted.
The high vaccination rates in places such as Vermont and Maine masked considerable variations at the county level, experts said. “People say, ‘Oh, Maine’s doing really well,’ but when you peel the onion layers, what you see is two states,” said Dora Anne Mills, chief health improvement officer at MaineHealth. While 83 percent of the population in Cumberland County — home to the city of Portland — is fully vaccinated, that same figure slides to below or near 60 percent in several predominantly rural counties.
Mills said her group of hospitals had scrambled to find more space — canceling elective surgeries, treating patients in recovery rooms for the first time — but she was anxious about the coming weeks because “we could very well be finding out what the limit of that capacity is.”
Nirav Shah, director of the Maine Center for Disease Control and Prevention, echoed that sentiment. “It is not out of the realm of possibility that we will approach a time where ICU beds will not be available,” Shah recently told the Portland Press Herald. “Not just for COVID patients but for any patient.” He said the state is making plans to avoid that situation, which he likened to a “big pileup on the highway.”
In neighboring New Hampshire, where vaccination rates are lower, hospitals have been flooded with COVID patients. Jocelyn Caple is chief medical officer of Valley Regional Hospital, a 21-bed facility in Claremont. She said that 50 percent or more of her beds on any given day are now taken up by patients with COVID. Her greatest concern is finding spots for critically ill patients of all kinds at higher-level hospitals. “The sense that the entire system is frozen with an inability to transfer patients around is the most worrisome aspect,” Caple said.
In New Hampshire, Maine and Vermont, COVID hospitalizations have touched their highest point in the pandemic in December. For New Hampshire, they peaked at 478 according to state figures. In Vermont, they hit 94. That figure may not sound large to other parts of the country, said Trey Dobson, chief medical officer at Southwestern Vermont Medical Center. But in a low-population state like Vermont — home to just 600,000 people in total — it is considerable, he said.
“What we have going right now is what I would call a triple whammy,” Dobson said. There is an influx of patients coming into hospitals, both with COVID and other ailments; hospitals are having difficulty discharging patients to rehabilitation facilities and nursing homes, which are also strapped for staff; and hospitals can’t find beds for patients at larger, more specialized facilities.
Dobson said his hospital has called as far away as Philadelphia to find appropriate beds, and there have been days “where we’ve made 20 calls and not found someone who could take a patient.”
In Massachusetts, the number of patients hospitalized with COVID has swelled over the past month, to more than 1,600 as of Monday, compared with 700 a month earlier. Hospitals are struggling to cope with the added burden. Ron Walls, chief operating officer of Mass General Brigham, the state’s largest hospital system, said that starting in the late summer, hospitals saw patients returning “in absolutely unprecedented numbers” as the pandemic appeared to recede. The surge in COVID cases is “stressing an already stressed system,” Walls said.
Mark Keroack, the chief executive of Baystate Health, the main hospital system in the western part of Massachusetts, said his facilities are licensed to treat 998 patients at a time. During the past month, however, the number of patients admitted jumped to as high as 1,200. The hospitals are now 10 percentage points over capacity on a regular basis — something he has never seen before.
Baystate is the only health-care provider in its part of the state that offers the highest level of trauma services. “By God, if we get jammed up to the point where we can’t take any more, it’s serious,” said Keroack. “Where can people go? All the big systems in Massachusetts are fighting the same battle we are.” Keroack said that one patient elsewhere in the state who required an advanced life support treatment — pumping and oxygenating a patient’s blood outside the body — had been transferred from Massachusetts to Virginia this month.
Meanwhile, Keroack’s hospital has begun reviewing its policies on how to ration medical care in an ethical way, also known as crisis standards of care, should that become necessary. “I’m sitting here, staring at the barrel of this gun,” he said, referring to the rationing policy. He worries that his hospital might “actually be putting it into use before January is out.”
Under such standards, doctors make decisions about how to prioritize resources, including whether to treat someone based on age and severity of illness. No one wants to take that step, said Dickson, the hospital executive in Worcester. But “effectively that’s what happens when you run out of space,” he said.
His hospital has stopped taking patient transfers except for the most serious trauma cases — people suffering from strokes, heart attacks and brain hemorrhages — and it’s become “really hard even to take those,” said Dickson. That leaves smaller community hospitals trying to care for patients with other potentially life-threatening surgical emergencies, he said.
Doctors say they feel like they’re shouting into a void, delivering news that a pandemic-weary population no longer wants to hear. “You come into work and say, ‘This is the worst it’s ever been,’ “ said Dickson. “And then you come in the next day and it’s even worse.”
COVID-19 indicators for New Hampshire have fallen over the past week, but the number of new cases per day has remained above the highest levels seen during the first wave at the end of 2020.
According to data from the state’s official COVID response dashboard, New Hampshire averaged 1,054 new cases per day for the week ending Monday, down 17 percent from a week earlier. The seven-day average share of antigen and PCR tests coming back positive was 12.1 percent, down slightly from 12.7 percent a week ago. Hospitalizations for the disease also dipped, with 399 inpatients as of Tuesday, down from 475 the previous week.
Like all N.H. counties, though, Cheshire is still seeing substantial levels of community transition, the highest of three tiers designated by the state health department. As of Thursday, the latest available data, Cheshire County had a 14-day average of nearly 1,421 new cases per 100,000 people. The local test positivity rate over the previous seven days stood at 10.8 percent, according to the state health department.
Dr. Jose Mercado, Dartmouth-Hitchcock’s COVID-19 Response Leader, said that the ongoing surge is being driven mostly by infections among the unvaccinated. This is true even though everyone’s risk levels are higher due to the colder weather, which increases the risk of spread of infection as more activities move indoors.
Martha Wassell, director of infection prevention at Dover’s Wentworth-Douglass Hospital, added that the state’s numbers are even higher than the predicted winter surge because of the omicron variant, which is now moving “in a tsunami-like fashion around the globe and across the country.”
Three research studies published earlier this week suggest that serious omicron infections are less common than serious infections from other variants. But Wassell warned that even with this positive news, the coming weeks are likely to be grim.
“While early studies indicate the omicron variant typically has caused less severe symptoms,” she said, “the sheer number of infections is likely to cause an overwhelming increase in patients requiring medical care.”
Mercado also encouraged people to be wary. “We should also remain vigilant and monitor for symptoms after seeing family over the holidays,” he said.
The seven-day moving average for new daily cases in New Hampshire had fallen in the first half of the year, bottoming out at just 16 at the end of June, but has quickly risen since then. That number peaked at 1,397 on Dec. 5. The average has fallen in the last week and a half, but the state is still averaging roughly 200 cases per day more than it was at the height of the first wave in December 2020.
Hospitals are also under slightly less strain this week than last. Even though the number of daily hospitalizations has more than doubled in the last five weeks, up from just 186 on Nov. 2, more staffed adult ICU beds have become available in the last week. As of Tuesday, 6.7 percent of the state’s supply was still available, up from less than 1 percent a week ago.
But in Keene, COVID-19 hospitalizations have continued to climb, also largely driven by unvaccinated patients, according to the latest available data from the Dartmouth-Hitchcock affiliate. There were 28 new coronavirus inpatients from Dec. 13 to 19, up from 22 the week before.
New Hampshire’s per-capita case count of 88 per 100,000 has dropped to the seventh-highest in the nation, according to data from The New York Times. The highest numbers are now coming from Rhode Island and New York, at 124 and 112, respectively.
The number of daily deaths in New Hampshire has steadily climbed since mid-July. As of last Friday, an average of 5.6 people were dying of COVID each day, down from a high of eight on Dec. 9. This is fewer than the peak of 12 deaths per day during the first wave.
As of Wednesday, there were 8,495 known active cases. There have been more than 188,000 confirmed cases and 1,800 COVID-related deaths in New Hampshire since the pandemic began.
Vaccination rates continue to rise, though state and federal vaccination data for New Hampshire remain out of sync. Data from DHHS show that 62 percent of Granite Staters have received at least one dose, while the number from the CDC is much higher, at 95 percent. Similarly, DHHS reports that 55.7 percent of Granite Staters are fully vaccinated, while the CDC’s number is 11 points higher, at 67 percent. The discrepancy between DHHS and the CDC in terms of total doses administered is more than half a million.
Some early data show that both the Moderna and Pfizer vaccines offer significant increases in protection against the omicron variant. Another early study suggests that Johnson and Johnson’s vaccine does not offer increased protection against omicron, but none of these studies have been peer reviewed, which means that researchers are still deciding how confident we can be in the studies’ claims.
The Centers for Disease Control and Prevention says that all three vaccines are highly effective in protecting people against COVID-19, and they may also make the illness milder in those who do get sick.
“If you are eligible, you should get the booster,” said Mercado, citing his own observations of his hospital’s patients with severe infection, the majority of whom are unvaccinated.
“Getting vaccinated and boosted and encouraging your friends and family to do the same is a step you can take right now,” Wassell added. “These conversations are difficult, uncomfortable, and yet central to reaching the essential community vaccination rates and protecting one another.”
Heather and Matthew Badore loved traveling, demolition derbies, and their dog Mackenzie Jane (who loved them just as much), friends said.
Heather, 50, and Matthew, 42, and the family dog died late on Dec. 8 in a head-on collision on Route 9 in Keene, leaving behind loved ones and colleagues who remember the Swanzey residents for their warmth, positivity and energy.
Stephanie Shulda and her husband Paul Wood of Bernardston, Mass., have known Matthew Badore for more than 25 years. Wood and Matthew met at age 8 while growing up in Greenfield Mass., Shulda said, and she first met Matthew as a teenager. The three have remained close friends ever since, and Wood is the godfather of Matt’s 16-year-old son Ayden Badore.
When Heather started dating Matt about 15 years ago, she found a natural place in the friend group.
“She fit in right from day one,” Shulda said. “She was fun and exciting, always had a smile on her face.”
In addition to being a stepmom to Ayden, Heather was the mother of Kyle, 22, and Cole Sweet, 20.
Heather worked as a purchasing and administrative services manager at Main Street America Insurance in Keene, according to a company spokesperson. She joined the business in 2014, and colleagues say they will remember her for her positivity and drive.
“I have had the privilege of working alongside Heather for many years,” Daniel Fitzpatrick, an administrative operations supervisor at the company, said in a written statement. “We actually grew up in the same small community and it was a ‘small world’ occurrence when we first met and realized this. Over the years, we shared many laughs, meetings, projects, and even a couple of business trips. I always had the utmost respect for her. Heather will always be loved, missed, and will ALWAYS be our family.”
Jessica Eastman, an administrative technical specialist at the company’s Keene office, said Heather “persevered life’s trials and tribulations with a fierce force,” adding that she felt honored to have known and worked with her.
Diana Dillion, a receptionist at Main Street America, echoed those sentiments.
“Heather was the hardest working person I know. I respected and admired her strong leadership and willingness to teach or consult,” she said in a written statement. “I will miss her kind support and fun stories. My prayers go out to her family and friends.”
Matthew was a “gearhead,” according to Shulda, and spent several years taking on automotive work while also caring for Heather as she battled breast cancer. The couple moved to Swanzey in the summer of 2020, just as Heather’s health improved, and Matthew began working for a local concrete company.
Previously, the Badores lived in Matthew’s childhood home in Greenfield, according to Shulda. And while moving to the Monadnock Region wasn’t initially an easy experience, she said it was ultimately right for the Badores.
“I don’t think [Matt] could picture himself being anywhere else,” Shulda said, and Heather was finally much closer to her workplace.
The Badores enjoyed traveling together, and about two years ago took a road trip through the southern United States before swinging up to Lambeau Field in Green Bay, Wis. (Matt was a die-hard Packers fan, according to Shulda.) And when they weren’t exploring the rest of the lower 48 states, they traveled around the Northeast, fueled by their love for motorsports and a devotion to watching demolition derbies as often as possible, Shulda said.
Though they enjoyed getting out and seeing new places, it was the special personal connections the Badores had at home that truly brought the couple joy, Shulda said. In the summer, they loved having people over.
“Every Sunday, Matty was firing up the grill,” Shulda said. And during the week, Shulda and her husband would stop by the Badores’ on their lunch break, always finding the door open and friends ready for a visit.
The couple’s hospitality extended beyond just helping those they were close with, Shulda said. Heather and Matthew were always quick to extend a helping hand, opening their home to anyone who fell on hard times and needed a place to stay.
Around seven years ago, Heather was diagnosed with breast cancer. With resilience and strength, she faced the disease and other health complications, while Matthew supported her as he could, Shulda said. He began cooking and baking — a notable achievement for him, according to Shulda, and a definitive sign of love.
“I never have known Matt to cook anything but ramen noodles before he met her,” Shulda said. And as his skills improved, friends began calling him “Matty Crocker,” a play on the Betty Crocker brand.
Though challenging, Heather’s health issues didn’t bar her from living her life. While homebound, she doubled down on her love for knitting, often donating her skillful creations, Shulda said. In Massachusetts, she was also involved in Franklin County’s Relay for Life event, which raises money for the American Cancer Society.
“They were really some amazing people,” Shulda said. “And they’re definitely missed.”