Well into a second coronavirus wave that shows little sign of abating, the region’s hospitals have been treating more COVID-19 patients than at any time since the pandemic began.

Nevertheless, doctors and administrators at Lawrence + Memorial Hospital in New London and Backus Hospital in Norwich say they’re confident their facilities have the capacity to deal with what lies ahead. While they say contingency plans are in place, they dismiss talk about potentially being overwhelmed, a seeming inevitability in some parts of the country. They’re “smarter” about the disease, they say, and have more tools at their disposal than they did in the spring.

“It’s different this time, we know more,” said Donna Handley, the Hartford HealthCare executive who presides over Backus and Windham Hospitals. “Our numbers started to climb in early October, and we’ve been between 15 and 21 (COVID-19 patients) every day. We did not reach those kinds of numbers in the first wave. Back then, we were in the low teens, single digits.”

Backus planned for the current surge, Handley said, and is prepared to handle a caseload she expects to continue growing until the second or third week of January. Backus has the beds, the critical care space, the staff and sufficient stores of personal protective equipment, or PPE, to accommodate the anticipated demand, she said.

L+M’s COVID-19 patient count reached 40 last week, an expected result of the soaring number of cases reported in southern New London County towns served by Ledge Light Health District. During the disease’s first wave, L+M’s count peaked at 31 patients. Similarly, Westerly Hospital, L+M's Yale New Haven Health co-affiliate, has experienced daily patient counts in the high teens in recent days and weeks, more than double its previous high. (On Friday, after discharging a number of patients, L+M reported it had 27 COVID-19 patients and Westerly, 10.)

Dr. Kevin Torres, L+M’s assistant chief medical officer, discounted the notion of a "field hospital" to accommodate an overflow of patients, saying such a facility would be difficult to staff. Patrick Green, the hospital's president and chief executive officer, predicted in April that L+M could have as many as 50 or 60 COVID-19 patients at one time during the pandemic, including 25 to 30 in intensive care.

Torres said the profile of the typical COVID-19 patient admitted to L+M hasn’t changed much since the first wave but a smaller percentage of them now require intensive care and fewer need to be put on a ventilator, trends that are crucial to preserving resources. Patients of all ages tend to be seeking treatment earlier, he said.

“Generally, we’re still seeing an older population — patients with comorbidities like diabetes, overweight, breathing issues, but we're doing some things differently that seem to work,” Torres said. “We’re using steroids (to reduce inflammation) and high-flow oxygen to help those who don’t need ventilators. It’s the way the oxygen is delivered — not through a tube in the lungs but from a piece of equipment over the face. It’s less complicated. When you intubate, you’re always concerned with the strain on the lungs and the body in general. The mask is an option for every patient; for many, it’s enough.”

At the start of the pandemic, hospitals were seeing COVID-19 patients with exceptionally low oxygen levels, which often led to intubations, Dr. Patrick Troy, a Hartford HealthCare pulmonologist, said last week during a live Facebook presentation.

“We would default to a ventilator over 50% of the time in the early days. Now, it’s about 20%,” Troy said. “We do everything we can to avoid ventilators. ... One critical care doctor can take care of 20, 30, 40 patients on masks.”

Handley said the high-flow oxygen therapy is being provided at Backus, which she said is seeing younger COVID-19 patients than before and that the younger patients tend to have shorter hospitalizations. But as before, most of those who are critically ill and who die of the disease are in their 70s, 80s and older, she said.

L+M doctors are making greater use of steroids like dexamethasone to settle down the inflammation that accompanies the COVID-19 infection, and they’re starting them earlier in the course of treatment, according to Torres, who said hospital stays for COVID-19 treatment continue to average about 10 days at L+M. Convalescent plasma transfusions for seriously ill patients and the antiviral drug remdesivir remain treatment options, he said.

Back in April, L+M and Westerly hospitals embraced convalescent plasma therapy, a treatment in which blood plasma from a COVID-19 survivor is injected into an infected patient, and reported having some successes during the therapy's early, experimental stages. Its effectiveness, however, has yet to be established.

New treatments associated with President Donald Trump’s bout with the coronavirus are offering promise.

In early November, the U.S. Food and Drug Administration approved emergency authorization for bamlanivimab, a monoclonal antibody authorized for adults and children at risk for severe COVID-19 and/or hospitalization. Weeks later, the FDA granted similar authorization for Regeneron, a mix of antibodies meant to treat high-risk patients with mild to moderate disease.

“These are going to be used for patients who test positive but are asymptomatic,” Torres said. “It may be for someone over 75, has diabetes maybe, and you want to protect them from getting worse. Maybe you give it to them as an outpatient. Can we give it to them in a nursing home? The planning is still in its infancy.”

The newly approved drugs are not yet available in large quantities. The entire Yale New Haven Health system initially got 200 doses of the monoclonal antibodies while Rhode Island got 300, Torres said, adding, "If we get 20 doses, it's not going to do a whole lot." 

Despite the improvements in COVID-19 treatments and protocols, the number of cases continues to climb, increasing the risks for health care workers.

“What’s new this time is the community transmission,” Handley said. “We’re very focused on keeping our staff safe. As there’s more COVID in the community, we’re constantly evaluating which staff have had prolonged exposure and making sure who can come to work and who has to quarantine.”

With rare exception, she said, the disease has not been transmitted in the hospital.

Such an exception occurred in late August, however, when a nursing home resident who had been transferred to Backus for treatment likely infected a member or members of the hospital staff. COVID-19 cases in the Norwich area surged at about the same time. In late October, L+M management confirmed that dozens of hospital employees had tested positive in recent weeks, just as infections were spiking in New London County.

Neither Backus nor L+M has recruited retired health care workers or otherwise sought to supplement their stretched staffs, though both reported pressing administrators with training as nurses into service as nurses.

“They might put me back to work,” quipped Handley, who has decades of nursing experience.

The expectation that COVID-19 vaccines will be available later this month is a morale booster for health care workers who figure to be among the first recipients. The general public can expect to receive the vaccine by summer, state officials have said.

In the meantime, “We’re fully prepared to expand to whatever capacity necessary,” Handley said.

b.hallenbeck@theday.com