As a result, hospital officials around the state say they are not expecting a huge surge in COVID-19 cases. Their various models predict either a slight decline, a slight increase, or an increase that will plateau over the next few weeks, but nothing resembling other surges before vaccines.
What happens next in Massachusetts and surrounding states, where vaccination rates are high, will hold lessons for the rest of the country, said Dr. David Rubin, director of the PolicyLab at Children’s Hospital of Philadelphia. “There’s a lot riding for the country on how Massachusetts does over the next two to three months,” he said.
“This is the first time we’re going to test in winter conditions how well vaccines are protecting the more highly vaccinated states,” Rubin said. “The hope is there will be some resilience in these areas, you’ll see a lot of transmission but not an exponential rise in the hospitalizations.”
Meanwhile, hospitals are already struggling with longer-term consequences of the pandemic — a crushing demand for care for other illnesses, along with severe staffing shortages. Virtually every hospital in the state is bursting at the seams.
Massachusetts General Hospital has been packed for weeks, not so much with COVID-19 patients but with people seeking all types of treatment, often care that had been deferred during the pandemic, said Dr. Erica Shenoy, associate chief of the Infection Control Unit at Mass. General, which had 35 COVID-19 patients on Monday.
“It’s been very challenging,” Shenoy said. “We just do not have enough beds.”
The COVID-Lab at Children’s of Philadelphia projects cases four weeks into the future in 820 counties, including in Massachusetts. Pretty much throughout the state, cases are expected to go up anywhere from 25 percent or so, to 70 percent, depending on the county, over the next four weeks. But, in one worrisome sign, the percentage of COVID-19 cases in ICUs, now at 14 percent, is also starting to inch up. It was 34 percent in January.
“When you still have 20 to 30 percent of the population that has not been vaccinated,” Rubin said, “there’s plenty of room for this virus to grow and even to transmit to some degree among the vaccinated.”
William Hanage, an epidemiologist at the Harvard T.H. Chan School of Public Health, said in an e-mail that the pandemic is expected to get worse in Massachusetts, but not as bad as in the early months of last winter.
The highly transmissible Delta variant “will find unvaccinated people and make them sick — sicker than they would have been with the previous virus,” Hanage said. “Delta is nasty enough that it doesn’t take a large number of infections in a vulnerable vaccinated cohort to make a big difference.”
Nationally, hints of optimism have emerged. A consortium of researchers advising the Centers for Disease Control and Prevention has projected that cases and deaths will taper through next spring, according to media reports.
As the virus has stormed across the nation, it has bounced inexplicably from region to region, said Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. He’s mystified why Southern California and the New York City metro area are seeing lower rates of infection than would be expected based on vaccination levels and behavior.
After peaking in the South, the virus is now heading toward the Northeast — but it’s not known whether it will cause a surge or peter out. Osterholm dismisses models that project months ahead; history has proven them flawed.
“We have had an epidemic of modeling in this country,” he said. “Right now we need a lot more humility. I have no idea whether there will be another surge in the Northeast or Southwest.”
Still, the University of Washington’s Institute for Health Metrics and Evaluation does venture to take the long view. It is projecting daily infections in Massachusetts to rise to almost 9,000 a day by Jan. 1, similar to the number in late December 2020. The institute estimates there were about 2,400 cases a day in mid-September.
The model projects that deaths will increase slightly, as will hospital use, but not to the levels seen last winter. ICU use is projected to ramp up more steeply — but those numbers take into account the likelihood of the seasonal flu.
Notably, the University of Washington projection holds that if 95 percent of people wore masks when outside the home, both deaths and infections would markedly decline.
But surveys show that only a third of Massachusetts residents are routinely masking, said Ali H. Mokdad, professor of health metrics sciences at the institute. Combined with increased mobility, schools opening, cooler weather, and waning immunity in those vaccinated earlier this year, the result will likely be a rise in cases, Mokdad said.
“We have enough people in Massachusetts that are still susceptible to COVID-19,” he said. “We’re expecting that cases will keep increasing, unfortunately.”
While hospitals won’t be hit as hard as in previous winters, Mokdad said, “If mask wearing does not become a habit, a combination of flu and COVID will put a stress on the hospitals. Hospitals are already at a breaking point.”
Indeed they are.
“We have been consistently very busy with large volumes of patients seeking care, large volumes of very sick patients,” said Therese Hudson-Jinks, chief nursing officer and chief patient experience officer at Tufts Medical Center. “We’re seeing just about everything — cardiac disease, neurological disease, pulmonary disease.”
Although it hasn’t been studied, hospital officials say that, anecdotally, people are catching up on care deferred during the pandemic, often coming in with more advanced conditions. Some of the increase in very sick patients may be attributable to pandemic-related stress, Jinks said.
And every hospital is experiencing a stark increase in patients needing mental health care, many of whom languish for days in the emergency department or end up occupying a bed in a medical-surgical unit while waiting for room in a psychiatric hospital.
This is happening at the same time that exhausted health care workers are asking for time off or leaving the profession, while contract nurses who can fill in are instead busy in states overwhelmed with COVID-19 cases.
Hospitals in each region of Massachusetts are meeting regularly to balance the patient distribution so no hospital is overloaded.
“You continue to have this smoldering pandemic in Massachusetts in the background to the demands on the health care facilities,” said Dr. Alastair Bell, chief operating officer at the Boston Medical Center Health System, where COVID-19 cases recently plateaued after rising steadily since July. Bell expects an uptick over the winter.
At the Springfield-based Baystate Health hospital group, whose president sounded the alarm about a crush of COVID-19 patients four weeks ago, the number of cases has declined. More people in the region have gotten vaccinated and several municipalities imposed indoor mask mandates.
Dr. Mark A. Keroack, president and CEO of Baystate Health, said the system’s hospitals have about 70 COVID-19 patients, down from 100 four weeks ago. (At the peak of the pandemic, Baystate had 180 COVID-19 patients, he said.) But he’s bracing for a bump in cases after thousands recently gathered in East Springfield for the Eastern States Exposition.
The hospitals remain strained, especially the Springfield hospital, which is licensed for 980 beds but is sometimes packed with 1,100 to 1,200 patients, many waiting in the hallway for a room, Keroack said.
“There are going to be ripple effects from COVID going on for a long, long time,” he said.
Felice J. Freyer can be reached at felice.freyer@globe.com. Follow her on Twitter @felicejfreyer.