Even as COVID hospitalizations jump in Maryland, doctors expect to avoid a ‘tripledemic’ this fall

The number of people hospitalized with COVID-19 has more than tripled since late June amid a small resurgence of the coronavirus as health officials prepare to push the latest version of the vaccine this fall.

Despite the summer jump in COVID cases, Baltimore doctors are optimistic the region will avoid a repeat of last year’s “tripledemic,” when an explosion of respiratory syncytial virus cases — combined with COVID, influenza and an ongoing youth mental health crisis — overwhelmed pediatric emergency departments and children’s hospitals.

State data on the Maryland Department of Health’s website updated Aug. 21 showed 189 people hospitalized with COVID-19. While that’s well below the 548 people hospitalized on Aug. 21 last year, it’s up from 50 people hospitalized June 28 and 129 on Aug. 11.

Deaths from the virus are also rising, from 14 deaths two weeks ago to 25 last week, according to state Health Department data.

These trends show that the coronavirus is spreading more freely now than it has in about four months, said Andrew Pekosz, a professor at Johns Hopkins University’s Bloomberg School of Public Health whose lab studies the way respiratory viruses change from year to year.

“We’re all a little concerned” about the rise in hospitalizations, especially as there’s a similar uptick in COVID cases among kids coming to the pediatric emergency department at Johns Hopkins Children’s Center, said Dr. Leticia Ryan, director of pediatric emergency medicine at Johns Hopkins Medicine.

State Health Department spokesman Chase Cook said in an email that it’s not unusual to see upticks in COVID-19 cases during the summer as people travel and take vacations. The department encourages Marylanders to stay up to date on vaccines, wash their hands, cover their coughs, wear a mask when appropriate, and stay home from work or school when they’re sick, he said.

Beyond summer travel, waning immunity is likely another reason for the spread, because it’s been a while since there’s been a big wave of infections or since a new booster was made available, Pekosz said.

The variants currently spreading the most in the U.S. weren’t covered by the most recent booster, he said. During a two-week stretch from Aug. 6 to Aug. 19, the EG.5 strain of the virus — nicknamed “Eris” — was responsible for about a fifth of American cases, according to data from the U.S. Centers for Disease Control and Prevention.

The newest variants are a “little bit” better at infecting people than previous versions of the virus, Pekosz said, but it doesn’t appear they will cause a massive boom in cases. He expects the U.S. will continue to see a slow and steady increase in infections throughout September, as children return to school and indoor activities become more common.

The good news is that the CDC expects the latest COVID vaccine will be available for most people during the third or fourth week of September. That vaccine is expected to be “well matched” with the strains causing most of the cases in the country right now, Pekosz said. He suspects it will mark the start of a more regular vaccination schedule for the virus.

“I know that people are confused in terms of when they should get boosters, who’s eligible, how long they have to wait,” he said. “I think this all will factor into a simplification of the COVID-19 vaccine program that follows what we do for influenza.”

However, after the federal public health emergency ended in May, these vaccines will no longer be free for everyone. Insurance companies will have to start paying for the vaccine, which is around $100 a dose, Pekosz said. Whether people will have a copay may depend on their health coverage, he said, though the government likely will roll out another program to help people pay for the vaccine.

Even when the vaccine was free, however, only about 17% of the country’s population got a dose of the bivalent booster shot, according to CDC data. About 81% of the population — and 95% of U.S. residents 65 and older — have received at least one dose of the vaccine.

A piece of bad news is that another strain of the Omicron variant, BA.2.86, which is highly mutated and resistant to vaccine and infection-induced immunity, is slowly spreading. While it has caused only about a dozen cases worldwide, including two in the U.S. as of Wednesday, experts are closely watching its transmission since it could “put a wrench in the whole system,” Pekosz said.

Pekosz recommended that people be proactive, and plan to get themselves and their children vaccinated. He also suggested that people stock up on home COVID-19 test kits. Free test kits still may be available. Cook, the state health department spokesman, suggested that people contact their local health departments to find out.

The state health department has launched a website, health.maryland.gov/vaccines, to provide updated listings of local health department vaccine clinics, Cook said.

Meanwhile, doctors at the Hopkins Children’s Center are seeing more patients with sore throats and ear infections — symptoms that could be from viral illnesses, said Dr. Eric Biondi, director of Hopkins’ Pediatric Hospital Medicine Division. But he suspects that represents a “flattening of the curve,” rather than a sign that a bad viral season is ahead.

“Last year, the big problem was, we just got hit with everything at the exact same time, over a two-week period,” Biondi said. “Hopefully, what we’re seeing now represents a more normal distribution of viral illness, rather than foretelling a big spike.”

In a typical year, respiratory syncytial virus — better known as RSV — starts spreading in the late fall or early winter and usually peaks around December or January. Last year, however, as children went back to school without masks or other guardrails against infectious diseases, RSV surged in September, peaking later that month and in early October.

Since the spread of RSV and the flu had been tamped down during the pandemic, many children hadn’t yet had the chance to build up immunity to the viruses, so they were especially vulnerable, said Dr. Theresa Nguyen, chair of the department of pediatrics at GBMC Healthcare.

That spelled disaster for pediatric emergency departments, like the one at Greater Baltimore Medical Center — the only pediatric emergency department in Baltimore County, Nguyen said.

As a shortage of pediatric intensive care unit beds in Maryland developed, physicians at GBMC intubated children and kept them on ventilators until they could be sent to a larger hospital in the area. At times, the wait at the hospital’s pediatric emergency department stretched to 10 hours, Nguyen said.

Doctors at Hopkins Children’s Center set up tents outside the medical center to accommodate new patients, and the hospital was frequently at more than 100% capacity, Biondi said. They converted an outpatient research clinic at the center into an inpatient unit. At Hopkins Bayview Medical Center, doctors converted conference rooms into surge units and saw patients in waiting rooms.

“We’re so much more nimble coming out of COVID,” Biondi said. “A couple of years ago, if you said, ‘I’m going to open an inpatient unit in this outpatient clinic,’ people would look at you like you were crazy, and it would have taken three years. I think we did it in about 48 hours last year.”

All signs point to a more normal flu and RSV season this year, doctors said, but they’re prepared for a similar surge of patients.

At the University of Maryland Children’s Hospital, the pediatric emergency department is already expanding its capabilities to test for various infectious diseases and has set up separate waiting areas for infectious and noninfectious patients, said Dr. Getachew Teshome, chief of the hospital’s pediatric emergency department.

“We would be ready this year,” GBMC’s Nguyen said. “And often when you’re ready, you don’t get what you were preparing for. It’s always when you’re caught off guard. And no one could have anticipated what happened last year.”