Hospitalizations directly and indirectly related to the coronavirus — are up across the region, especially in Virginia, stressing staffing and prompting some hospitals to pause elective surgeries for the first time since cases spiked last winter.

Ballad Health, which serves Southwest Virginia and northeast Tennessee, and two hospitals in Maryland have delayed elective surgeries because of the increased workload.

Other hospitals find themselves tackling myriad issues all at once: an increase in covid-19 patients, care for those who put off treatment or who developed new issues during the pandemic, and transfers from places with fewer clinical resources.

Hospitalizations have nearly doubled in Virginia in the past month, with the seven-day average increasing from 1,064 a month ago to 2,044 on Monday, which is not far from the peak of 2,205 on Jan. 17, federal data shows.

By comparison, Maryland’s hospitalizations are up about 50 percent in that same time, with the seven-day average increasing from 671 a month ago to 1,014 on Monday. The peak exceeded 2,100 in mid-January, according to federal numbers.

In the region, coronavirus infections have increased most dramatically in Virginia, a Dillon Rule state where cities and counties can’t require masking since it’s not a power given to them under state law. That’s not the case in Maryland, where Baltimore City and Montgomery and Prince George’s counties — the most populated parts of the state — reinstituted mask mandates as the latest surge in cases grew larger.

And the lowest-vaccinated areas in Maryland still have higher vaccination rates than the lowest-vaccinated places in Virginia.

“People in Maryland are doing more to slow transmission than people in Virginia are,” said Neil J. Sehgal, an assistant professor of health policy and management at the University of Maryland School of Public Health.

Sehgal noted that hospitalizations tend to increase after coronavirus cases rise. Cases rose toward the end of August and early September as the highly contagious delta variant spread, and as federal and local leaders relaxed certain protective measures such as mask-wearing.

“I think what we’re seeing, especially in D.C., is the shadow
of the surge of cases that we had at the end of August, beginning of September,” he said.

Hours before President Biden announced last week that businesses with more than 100 employees must mandate vaccinations or require weekly testing, the Virginia Hospital and Healthcare Association (VHHA) issued a rare joint statement with other health-care organizations in the state, calling on residents to get vaccinated as hospitalizations and cases surge.

“With hospital inpatient and ICU beds already filling ahead of a looming fall surge, it is imperative for unvaccinated Virginians to do their part to help save lives and slow the spread of this deadly virus by getting vaccinated,” the statement said.

VHHA spokesman Julian Walker said a confluence of events, coupled with the pandemic, is stressing hospitals — including the resettlement of Afghan refugees, who in some cases have been vaccinated, screened and treated for covid-19, as well as measles.

The closure of some state-run psychiatric hospitals to new admissions has contributed to a backup in emergency departments, he said.

All of this is exacerbated by staff shortages and clinical-care contracts that have recently expired or are about to, he said.

“You have this Catch-22 where demand has gone up,” Walker said, creating what he called “almost an arms race to try to bring on supplemental staff.”

Every region of the state has shown an uptick in cases, but they are most pronounced in Southside, Southwest, Hampton Roads and the northern Shenandoah Valley, he said. Ballad Health’s pause in elective surgeries has been in effect since late last month.

Across the state, Walker said, ICUs are around 80 percent capacity, compared with a pre-pandemic average occupancy of 67 percent, and currently only about one-third of occupancy is attributable to covid-19.

Steve Motew, a physician and chief of clinical enterprise for Inova Health System, which includes five hospitals in Northern Virginia, said the health system is “very busy,” but in recent days there have been between 70 to 80 covid-19 patients, up from 60 to 70 two weeks ago. They are mostly unvaccinated, he added.

“We’ve seen a very, very slow increase. If we can continue our acceleration of general vaccination, I’m hoping we can stay ahead of it,” he said.

Deferred care, behavioral-health needs and the pipeline of care — from a physical to a screening to a specialist visit — can take a long time, he said. The return to school and sports injuries are also adding to the demand, Motew said.

Inova has not considered pausing elective surgery, as two of Maryland’s largest hospitals did Monday, citing a rise in coronavirus hospitalization rates following a late-August increase in cases.

Anne Arundel Medical Center in Annapolis paused some elective surgeries starting Monday to free up beds as the delta variant spreads throughout the region. And TidalHealth Peninsula Regional, which is the Eastern Shore’s largest hospital, decided to pause elective surgeries that require an overnight stay for at least two weeks, starting Monday.

The majority of the people who are getting sick enough to be hospitalized at TidalHealth Peninsula Regional, which is also facing staffing challenges, are unvaccinated, Mark Edney, the hospital’s president of medical staff, said in a news release Thursday.

“The subject of COVID vaccination has unfortunately become politicized, but there are some truths based on available community data and on current medical science that are indisputable,” Edney said.

While the District’s vaccination rates are relatively high, hospitalizations have jumped 20 percent compared with last week, with 23 people currently hospitalized with covid-19 and four people in the ICU per 100,000 residents, according to The Washington Post’s tracker.

But unlike the two hospitals in Maryland, none of the hospitals in D.C. had plans to curtail elective surgeries, said Justin Palmer, the vice president of the D.C. Hospital Association.

“I don’t believe people should be concerned about where we are,” Palmer said. “We were down to fairly low double digits in the District before, so there is an increase of covid patients, but it’s within our ability to manage them.”

Holy Cross Health, one of the largest hospital systems in Montgomery County, saw a surge in hospitalizations in late August, but the numbers have since settled, said Yancy Phillips, the chief clinical officer at Holy Cross Health.

“Part of it is that we do have a very high vaccination rate,” Phillips said.

Around 40 patients are currently hospitalized for covid-19 at the system’s two locations in Silver Spring and Germantown, compared with 210 at the pandemic’s last peak. But he did note that while hospitalization rates are manageable, the hospitals are still strained.

“I do want to emphasize that it’s not just the numbers who are here now, it’s the cumulative stress over time,” Phillips said. “There is a cumulative impact on nurses and doctors, respiratory therapists, laboratory people — and we’re feeling it.”