Is Massachusetts seeing the COVID-19 surge?

IS MASSACHUSETTS in the so-called surge?

It seemed like it on Sunday, when the number of new COVID-19 cases for the first time exceeded Gov. Charlie Baker’s daily metric for surge peak of 2,500. But then the number of new cases on Monday fell back to 1,392, suggesting there is still some time before the state hits the peak.

While the timing of the surge peak remains a bit unclear, Baker insisted the immediate forecast isn’t good. Deaths are rising, up 88 on Monday, and new cases continue to mount. “Today is the beginning of what we expect is going to be a very difficult period,” Baker said.

Marylou Sudders, the secretary of health and human services, said the number of new COVID-19 cases now will translate into hospitalizations 7 to 10 days from now. “So this is the eye of the storm,” she said.

Initially, Baker had used models to predict a surge in people needing medical care between April 7 and April 17, a time frame that then moved up to April 10-20. He said the state could move that up further if the situation changes. “The great thing about models is they are always subject to change,” Baker said.

Sudders said hospital capacity is generally unchanged from where it was Friday, when Baker said hospitals were operating at around 55 percent capacity – meaning they had plenty of beds available to deal with COVID-19 patients and others who need medical attention.

“What we’ve done for the most part is built capacity around the Commonwealth to make it possible for us to deal with a worst-case scenario, which we hope never happens,” Baker said.

Baker said there is no exact way to predict how long the surge of patients will continue. “If you’re going to say is this going to last 10 days or two weeks, I don’t know,” Baker said. “What I do know is we’ve done a ton of work to build capacity to deal with it as it goes.”

While “flattening the curve” of new cases – the objective of social distancing – may make the surge last longer, Baker said the goal is to reduce the number of cases at any one time to an amount the medical system can handle.

As the so-called surge begins, the state is ramping up its efforts to obtain and distribute personal protective equipment.

On Sunday, the Department of Public Health published for the first time a record of how much personal protective equipment it had distributed from a state stockpile, and to which regions of the state. The state has given out more than 704,000 masks, 160,000 gowns, and 1.9 million pairs of gloves. The equipment was distributed to a range of agencies – the biggest chunks went to nursing homes and senior living facilities, local public safety agencies, state agencies, and an “other” category that included home care and pediatric care agencies.  The equipment was geographically distributed throughout the state.

Baker said Massachusetts has obtained an additional 200 ventilators from the Federal Emergency Management Agency, which will be distributed to hospitals Monday or Tuesday.

Baker also highlighted a new Manufacturing Emergency Response Team, a group of academic and manufacturing industry representatives that formed April 2. The team will distribute $10.6 million in grants and provide technical assistance to companies that are changing their manufacturing capabilities to something helpful for combatting COVID-19. The group will help companies figure out what equipment is needed, how to comply with FDA requirements, and where to test their products. It will provide design specifications and pay to retrain workers.

A number of companies are already switching their manufacturing capabilities. For example, the Boston-based company Lovepop, which makes 3-D greeting cards, is now making masks and face shields.

The Lawrence-based activewear apparel company 99Degrees is now manufacturing isolation gowns for medical professionals. Founder and CEO Brenna Schneider said it typically takes six to 18 months to develop a new product, but the MERT team helped her company switch in three weeks, while retooling its processes to ensure that employees remain safe during the pandemic.

At Baker’s daily update on Monday, Sudders also addressed the ongoing controversy over new “Crisis Standards of Care,” which are guidelines the Department of Public Health put out to hospitals about how to ration scarce medical equipment, such as ventilators, if there is not enough for every patient.

The guidelines prioritize saving the most lives and saving the most life-years. So a patient with severe comorbidities – underlying health conditions that limit their life expectancy – would be a lower priority than an otherwise healthy patient. The guidelines state that factors that cannot be included in determining priority are things like race, disability, gender, immigration status, socioeconomic status, homelessness, or incarceration.

The Black and Latino Caucus, a group of black and Latino state legislators, has worried that the standards disadvantage minorities who have higher rates of underlying health conditions

“It is apparent that some severe diseases and conditions may warrant a standard of care protocol,” Caucus Chairman Rep. Carlos González, a Springfield Democrat, said in a statement. “However, utilizing points for conditions that we already know are rampant in low-income communities due to historic health disparities is unconscionable.”

Rep. Joe Kennedy, a Democrat running for the US Senate, and state Rep. Jon Santiago, a Boston Democrat and emergency room physician, in a statement called on the Baker administration to rewrite the guidelines, noting that inequities in health care, housing, incarceration and other socioeconomic factors mean blacks are more likely than whites to have complex health conditions and shorter lifespans. “While fundamentally these guidelines make sense, realistically they will prioritize white patients over patients of color, a constant theme we see in our health care system,” Kennedy and Santiago wrote.

Sudders stressed that the goal of having objective standards is to mitigate against unconscious bias in medical decisions and ensure that inequities do not occur. She said hospitals should adapt the guidelines using triage committees that include a diverse group of clinicians.

Sudders noted that even in New York, the epicenter of the outbreak in the United States, these standards have not been used yet, and she hopes they will not be necessary in Massachusetts. “We continue to plan for the worst scenario with the fervent hope the guidelines are never used,” Sudders said.