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Upper Valley hospitals prepare for surge in COVID-19 cases

Valley News Staff Writer
Published: 10/20/2020 9:48:25 PM
Modified: 10/20/2020 9:48:20 PM

LEBANON — With COVID-19 cases surging in other parts of the country and rising in the Twin States, Upper Valley hospitals are keeping a close eye on the trend but have yet to see a spike in patients.

“We are beginning to be concerned about the numbers,” said Dr. Michael Calderwood, an infectious disease specialist and associate chief quality officer at Dartmouth-Hitchcock Medical Center in Lebanon.

New Hampshire, which has seen a fivefold increase in cases since the end of August, is “now seeing numbers matching in the community what we saw in May,” Calderwood said in a phone interview on Monday.

The surge in the region is evident both in a rise in case numbers in each of the Twin States and in rates of death due to COVID-19 in New Hampshire. This surge is different than the one that hit the Northeast in the spring in that the uptick in cases has not resulted, as yet, in an influx of patients in Upper Valley hospitals. Springfield (Vt.) Hospital recently increased its restrictions on visitors, but most in the region continue to operate in what has become normal.

To help mitigate the effects of this phase of the pandemic, which has strained the resources of hospitals in the Midwest, Calderwood said it’s “critical” for New Hampshire to enact a “more broad mandatory mask policy.”

He said he was hopeful that mask-wearing, in addition to reducing the spread of COVID-19, will also reduce the number of cases of flu this year. Though some communities in New Hampshire, including Enfield, Hanover, Lebanon and Plainfield in the Upper Valley, have adopted mask ordinances, the state has not. Vermont’s statewide mask mandate went into effect on Aug. 1.

Calderwood also urged caution with travel and sports, and suggested that people ought to have smaller Thanksgiving gatherings than in years past, noting that “smaller is better” in terms of reducing the risk of spreading the virus, as is reducing travel. He encouraged families to talk about quarantining before they gather and traveling via car rather than plane.

“People need to take this seriously,” he said. “This is not going away.”

Cases on the rise

Through much of August, New Hampshire reported fewer than 20 new cases per day. In September, as schools reopened, case numbers increased to include several days with more than 30 cases. This month, however, has included days in which more than 60 cases have been reported. There are currently 1,020 cases in New Hampshire, out of a total of 9,746 since the pandemic began. Most cases are in the southern part of the state.

Vermont also has seen an increase in cases in recent weeks, in part driven by outbreaks tied to migrant workers at an Addison County apple orchard and to hockey in Central Vermont. At a Tuesday press conference, Vermont officials said the past three weeks have seen the highest case count since April. They predict the average number of new cases per day will continue to climb to more than 20 in the coming weeks. That rate has recently been at about 10 cases per day, after having many days in September with fewer than five new cases reported.

At a Tuesday’s news conference in Montpelier on COVID-19, Vermont Health Commissioner Mark Levine said residents need to resist “pandemic fatigue” and stay focused on health precautions.

“We just need to double down on prevention, and not roll the dice on risk,” Levine said. “Because one thing we do know is that when gambling with health the virus might really win. We have been a model for the nation ... and we can keep it that way.”

Deaths also are on the rise of late in New Hampshire. The state saw one death every 10 days in September, but that has recently climbed to an average of two deaths per day, Calderwood said. New Hampshire has seen a total of 468 deaths due to COVID-19 since the pandemic began. Vermont, which has reported a total of 58 such deaths, has not seen any since July.

In the Upper Valley since the pandemic began, Windsor County has seen two COVID-19 deaths, while Grafton and Sullivan counties have each had one such death. Orange County has not reported a death due to COVID-19.

The number of patients with COVID-19 in the Twin State’s hospitals has lagged behind increases in cases and deaths, although about a week ago hospitals also began seeing an increase, Calderwood said.

That increase is modest, however. There were still just a couple of inpatient COVID-19 cases in the entire D-H health system as of Tuesday, according to Dr. Joseph Perras, CEO of Mt. Ascutney Hospital and Health Center, which is a member of the D-H system.

As of Monday, there were 16 patients in New Hampshire hospitalized with COVID-19, according to state data. There were no patients hospitalized with COVID-19 in Vermont on Tuesday.

“Right now, the news is still good,” Perras said Tuesday. He described the low numbers of hospitalized patients as an “encouraging sign.”

He said the uptick in cases in the community is “really due to not following the rules,” such as failing to wear masks or social distance; or traveling to places or hosting visitors from outside of the green zone on Vermont’s travel map without a quarantine.

Vermont on Tuesday updated its travel map, which as it did last week indicates that nonessential travel between Vermont and Grafton County requires a quarantine. As of Monday, there were 29 active cases of COVID-19 in Grafton County. There were just five cases in Sullivan County, which remains green on Vermont’s travel map. There have been 16 new cases identified in Windsor County in the past two weeks and six in Orange County during that same time frame. Vermont does not restrict travel between counties within the state.

Hospitals prepare

Though COVID-19 cases in the hospitals remain low, officials are still prepared to care for an increase in cases should it come, both Perras and Calderwood said.

They have the necessary personal protective equipment and ventilators on hand, as well as the ability to treat patients with COVID-19 in a separate part of the hospital. DHMC currently has one critical care unit designated for that purpose, Calderwood said. Should cases tick upward, more space could be made available both at the hospital and at surge sites at Dartmouth College, if necessary, he said.

“We have a really robust plan,” he said.

Unlike in the spring, Calderwood said, “The plan would not be to shut everything down.”

Hospitals could implement a range of changes as cases increase, such as restricting visitors and postponing elective procedures, he said.

While supplies necessary for treating patients with COVID-19 are available, testing materials are in short supply nationally and the same machines are used to test for both COVID-19 and the flu, Calderwood said. He anticipated that flu testing might be reduced to allow labs to run all the necessary COVID-19 tests.

On Tuesday, Perras said hospitals in the D-H system were “busy,” with DHMC and Mt. Ascutney both full of non-COVID-19 patients.

“Right now, we remain reassured,” Perras said. The “Upper Valley has had a really nice response to the virus. Mitigation efforts that everyone has engaged in have protected us to some extent.”

Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.




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