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Chief medical officer wants a more resilient health care system


The latest surge in COVID-19 cases fueled by the omicron variant of the virus is rekindling a familiar concern. While there are indications that infections caused by the variant tend to be milder for many people, others are still hit hard by the virus and require medical care. So the fear once again is that health care facilities in hotspots around the country could become overwhelmed by a rapid increase in COVID patients. To discuss this and how hospital preparations have changed during the last two years of the pandemic, we reached out to Dr. David Marcozzi, chief clinical officer at the University of Maryland Medical Center where he has led the COVID response. He's also professor of emergency medicine at the University of Maryland.

Dr. Marcozzi, welcome.

DAVID MARCOZZI: Thanks very much, Adrian.

FLORIDO: First of all, you yourself are on the front lines of the pandemic, working in an emergency room. What do things look like at your hospital in Maryland as we speak?

MARCOZZI: Well, I think, you know, we're presently in a perfect storm. We have a workforce that is frustrated and tired and potentially - even some are leaving health care altogether. We have some of our workforce who are staying in the hospital, getting infected with COVID either in the community or with their family members and having to isolate. And then we have this surge of patients coupled on top of that.

FLORIDO: How sick are the COVID patients you're seeing in your hospital?

MARCOZZI: It varies anywhere from mildly ill to critically ill. And on top of that, we're having less staff to be able to mount an appropriate response to those surging patients. And, Adrian, a key piece of this conversation - this is no longer just a COVID conversation. This affects our ability to deliver care to people who have broken their arms or someone else who requires another emergent condition that is not COVID-related because now - because of so many patients coming through our doors and emergency departments across, certainly, our state and in our hospital, we're having to figure out and prioritize patients who are needing urgent and emergent care and directing our resources and personnel to those individuals.

FLORIDO: We're seeing data that shows this massive spike in infections but - an increase but not as big of an increase in hospitalizations. Does this mean that you aren't worried about hospitals running out of capacity during a surge like this? Or are you?

MARCOZZI: So I think that it's important to recognize that although there's some data that suggests that this will be a mild - that the omicron variant is a milder variant - in other words, doesn't cause as severe disease - it is transmitting with such force, it is moving between us so easily that it is infecting many more than potentially even the delta variant did, the previous variant did. And I think right now we've got a confluence of two variants on our hands. Because of those two things as I mentioned in the beginning, we are, no question about it, in a perfect storm.

FLORIDO: What is the best way, in your opinion, to gauge the severity of the pandemic during this phase that we're in right now? Is it counting the total number of cases that are being reported? Is it the number of hospitalizations? Is it something else?

MARCOZZI: The response that we're presently in, I think, is best looked at from the lens of hospitalizations because what we're finding is some individuals have no protection, no immunization. Some have one. Some have been infected. And then some have two. Some have been fully vaccinated - at least right now, we describe that as three vaccines if you've had the mRNA. And what the real fundamental question is - is how many people are becoming ill requiring hospitalization and dying as a result of these new variants and the different levels of protection. So those are the two best indicators that I look at right now as I'm managing the response.

FLORIDO: One of the things that many people learned during the pandemic - at least those of us who don't follow the world of hospitals very closely or didn't before the pandemic - is that the U.S. has a lower hospital bed capacity than most wealthy nations. Have we made up any ground in the last two years by that metric or really other metrics about - that determined hospital capacity?

MARCOZZI: There's a couple of factors with regard to making sure that we have the ability to care for the community of which hospitals serve. And number one certainly - you're mentioning capacity is one of those factors, but capacity and/or capability - in other words, the nurse, the IT infrastructure, the efficiency and the data to make sure that that person gets the right care that they need. Appropriately doing that not just for when we are not in crisis but for when we are in crisis, understanding that care delivery is a continuum. So today, right now, we are in crisis. But tomorrow, when we're not in crisis, we should not forget that we need to weave in concepts of resiliency and preparedness into daily delivery of care, so that we're better prepared when we do have crises like these. And that, I think, is still a divide we need to address.

FLORIDO: So what do you think it's going to take?

MARCOZZI: I hope that we are better after this. And we put together a group that looks at with great scrutiny and puts everything on the table of how to do exactly what I said - weave those tenets of better resilience, so we can care for more individuals because you know what that translates into? It saves lives. And that fundamentally should be how we're thinking about building in concepts of better disaster preparedness.

FLORIDO: That was Dr. David Marcozzi. He is the chief clinical officer at the University of Maryland Medical Center and professor of emergency medicine at the University of Maryland.

Dr. Marcozzi, thanks so much for speaking with us.

MARCOZZI: Adrian, thanks so much, and stay well.

FLORIDO: You, too. Happy New Year.

MARCOZZI: Happy New Year. Transcript provided by NPR, Copyright NPR.