As patient volumes surge at Maryland hospitals amid soaring COVID-19 infections statewide, Gov. Larry Hogan implemented a temporary state of emergency Tuesday as well as other executive orders designed to give the state government more powers and tools to combat the health crisis.
The Republican governor, however, did not implement statewide indoor mask or vaccination mandates, steps that public health experts and medical professionals say would curb the spread of the coronavirus in a state where more than 1 out of every 25 Marylanders has been infected since the beginning of December.
“While we are hoping for the best, we are actively preparing for the worst,” said Hogan, adding that the latest projections show state COVID hospitalizations could reach more than 5,000, well above Tuesday’s pandemic high of just over 3,000.
Hogan’s new initiatives, announced at a news conference in Annapolis, give state Health Secretary Dennis R. Schrader broad powers to assist hospitals with soaring bed occupancy numbers and staff shortages; expand the emergency medical services workforce; mobilize 1,000 members of the Maryland National Guard to assist with COVID-19 testing sites and some patient transport operations; open 20 new coronavirus testing sites adjacent to hospitals, which have reported high numbers of emergency department walk-ins seeking testing; and begin providing booster shots for 12- to 15-year-old kids in the state.
Without requirements on masking and vaccinations, though, the state’s hospitals will not be able to recover lost footing as quickly, said Dr. Eric Toner, a senior scholar with the Johns Hopkins Center for Health Security.
“We have learned over the last year and a half that mask mandates work but voluntary masking recommendations do not,” said Toner, also an internist and emergency physician. “Masking is the least restrictive intervention we can employ to slow down transmission before our hospitals are completely overwhelmed. High-quality N95 masks should be worn by everyone while indoors in public spaces until the current surge has passed.”
Hogan directed the state’s employers to incentivize masks in workplaces, as well as encourage vaccinations and boosters among employees. He said “we don’t have the means to enforce” a statewide mask mandate, and that people who choose not to wear masks won’t change their minds under threat of a government requirement.
But early on in the pandemic, the governor issued a mask mandate for public transit, indoor businesses, stores, pharmacies and other retail establishments. That mandate expired in May. He kept a partial mask mandate in place until July, and reinstituted a face coverings requirement Monday for inside state buildings and offices.
Hogan’s decision to not require masks statewide is a political calculation that assesses what damage a mandate could have on his standing with constituents, as well as what the public will reasonably tolerate, said Dr. Chris Beyrer, an epidemiologist and the Desmond M. Tutu professor of public health and human rights at the Johns Hopkins Bloomberg School of Public Health.
Mandates work, Beyrer said, but they may be unpopular among the Republican governor’s supporters, as well as those he might court in the future.
“He’s leaving it more to the counties to make decisions about other kinds of mandates, but this virus does not respect county boundaries or state boundaries,” Beyrer said. “From a public health perspective, to let that be at the county level is easy for a governor, but not as effective.”
Some local entities, such as Baltimore, Howard and Anne Arundel counties, have reinstated indoor mask requirements within the past month.
In addition to a mask mandate, Hogan should require state employees to be fully vaccinated, said Dr. Leana Wen, an emergency medicine physician and former Baltimore health commissioner. This requirement should include booster shots, which are helping reduce transmission and severe illness, she said.
If Hogan won’t touch mandates, local executives and jurisdiction leaders can step in, Wen said, by implementing vaccination requirements to enter businesses, attend concerts and athletic events, eat in restaurants and work out in gyms. Other places such as New York, Los Angeles and Philadelphia have implemented this step successfully, Wen said.
“It’s the unvaccinated who make up the majority of people being hospitalized, and every step needs to be taken to stop transmission in this population so as to reduce the strain on the health care system,” Wen said.
Baltimore Mayor Brandon Scott said in a Tuesday interview that he would meet Wednesday with other regional leaders to discuss such a regional “vaccine passport” requirement.
“We have to be thinking about this in lieu of the governor,” Scott said. “I tell folks, look, he’s not going to do anything, so we should assume he’s not going to do anything.
“He’s going to punt to us and when it goes wrong, he’ll blame us. When it goes right and we’re in the national media as one of the cities dealing with COVID the best, he’ll take the credit. That’s just the way he is. Just take him as is and operate in our best interest.”
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Meanwhile, the state’s hospitals are overwhelmed, said Dr. Ted Delbridge, executive director of the Maryland Institute of Emergency Medical Systems, which transports and matches patients to the right providers during emergencies.
The 3,057 COVID-19 patients hospitalized Tuesday occupy 37% of the staffed acute care hospital beds and 45% of the staffed intensive care beds statewide. Meanwhile, flu and other seasonal illnesses also are bringing people into hospitals, Delbridge said.
“Our hospitals are struggling to deal with the number of sick people coming to them,” Delbridge said. “It’s just plain sad. For our health care heroes, it takes a toll.”
Emergency departments at hospitals throughout the state are as busy as they ever have been, Delbridge said, while emergency medicine first responders are reporting delays in tending to calls due to resource limitations.
He said patients experiencing heart attack and stroke symptoms should continue to go to hospital emergency departments, while people with less urgent needs, such as minor illnesses or injuries, should seek care elsewhere.
Above all, he said, patients who are seeking COVID-19 testing should make use of state and local clinics, not hospitals.
Several hospitals statewide have adjusted protocols and internal standards to meet the demands of the moment, including University of Maryland St. Joseph Medical Center in Towson, which announced its shift to made crisis-mode Monday. Such changes give hospitals greater authority to delay some surgical procedures to conserve providers and bed space; allows them to cut back on certain responsibilities, such as documentation, for the time being; and enables them to shift workers more readily between departments based on needs.
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Under Hogan’s executive order, inactive health care practitioners will be able to work without reinstating their licenses, while licensed providers can practice outside the scope of their licenses and those who have completed nursing school can work at “any health care facility.” Providers licensed in other states also will be able to work in Maryland, according to the order.
The governor’s other executive order will authorize steps to beef up the emergency medical services workforce, allowing those who are licensed outside of Maryland to work here and expediting the licensing process in the state.
Hogan also called on the federal government to increase its supplies of monoclonal antibody treatments, rapid tests and COVID-19 antiviral pills, all of which have been depleted during the latest wave of the virus. The state health department instructed providers last month to conserve monoclonal antibody therapies for certain patients based on need after the federal government found two of the three treatments to be ineffective against the new omicron variant, which became the dominant strain in the U.S. in less than a month.
Hopkins’ Beyrer said such steps should provide some relief to hospitals.
“It’s important to say that he talked about the things he can do, and what the fed needs to be doing, and that’s appropriate,” he said. “The focus of what he’s trying to do is reduce hospitalizations and deaths, and clearly he’s doing so without stepping in the politically divisive issue of mandates.”
Hogan called vaccines the “single most important” tool to combat the virus. He said 84% of last year’s COVID hospitalizations and an even greater share of the deaths were not fully vaccinated. Some people were hospitalized who were partially vaccinated, he said, which makes getting booster doses all the more important.
The governor, who recently recovered from COVID-19, said his case felt like “a pretty bad cold.”
“That’s because I was fully vaccinated and boosted,” he said. “So, I didn’t end up in the hospital or dead like so many other folks.”
Hogan said he also received monoclonal antibody treatment during his illness, which he believes prevented his condition from worsening.
Baltimore Sun reporters Meredith Cohn and Emily Opilo contributed to this article.
