Five years after the first case of what was then a novel coronavirus infection, health care professionals and state legislators worry Massachusetts isn’t ready if another pandemic were to happen.

Today, they say, public health and health care in Massachusetts is forever changed. Hospitals still have not recovered in terms of bed capacity and health care worker burnout.

And while the virus has not mutated since the Omicron variant emerged in November 2021 — and COVID-19 is now treated in a similar fashion to influenza — they worry that the state doesn’t have the public health resources to respond if a new pandemic emerged.

The first COVID-19 case was reported in Massachusetts on Feb. 1, 2020, involving a University of Massachusetts Boston student who had returned to Boston from Wuhan, China. Roughly six weeks later, on March 10, then-Gov. Charlie Baker declared a state of emergency to “prevent and mitigate the spread of COVID-19.”

The order stopped state-related work travel, canceled or moved conferences to virtual attendance, activated the Massachusetts Emergency Management Agency, instructed the MBTA to follow a new cleaning protocol, encouraged elderly people to stay out of large crowds and relaxed K-12 school attendance mandates.

Three days after Baker’s declaration, President Donald Trump declared a nationwide emergency. On March 27, Boston Mayor Marty Walsh and Boston Public Schools Superintendent Brenda Cassellius announced a district-wide school closure.

Amid widespread confusion about the nature and potency of the virus, exemplified by a “super spreader” outbreak at a biomedical conference at a Boston hotel, the commonwealth had to prepare to deal with the virus rather quickly.

On March 4, about three weeks after the first case reached Massachusetts, the Legislature’s Committee on Public Health held a hearing on “Coronavirus Preparedness and Response,” where medical professionals explained what the virus was and what implications it could have on Massachusetts residents.

One of the experts was Dr. David Hamer, an epidemiologist who specializes in infectious diseases. He remembered the chaos of that day, having to “hustle across town” from Beacon Hill to WBUR’s office in Allston to talk to reporters.

“People were already starting to get sick,” he said. “Everybody was in one big room. Nobody’s wearing masks yet, because this was prior to mask use. And basically I fielded a bunch of questions and tried my best to explain things to them.”

Hamer was busy during the first few months of the pandemic. That initial conversation led to a Monday morning radio show for over a year to give updates on the pandemic.

As a professor at Boston University’s School of Public Health, he also spent time researching the virus, looking into diagnostics, personal protection measures and treatment. He also worked with former BU President Robert Brown and other higher education leaders in Massachusetts to figure out a way to manage the pandemic while trying to keep students on campus. Ultimately remote learning became standard practice as the pandemic spread.

Hamer has high praise for the efforts by the state Department of Public Health during those turbulent days.

“They tried hard to work with us to do the best possible thing for the communities, but also to really listen to outside voices,” he said.

That was made possible through federal funding DPH had received to support preparedness planning from as early as 2001. Events like the outbreak of H1N1 swine flu, ice storms and terrorism incidents like 2013 Boston Marathon bombings had “tested our preparedness efforts and fortified our planning and response activities,” a DPH spokesperson said.

Lawmakers reflect on challenges

At the same time, the Legislature had to find a way to continue to conduct state business under the restrictions of the pandemic.

“It was extremely difficult for everyone in the Legislature, and just like literally everyone around the world, had to shift into remote mode on a moment’s notice, and that was challenging,” said Sen. Becca Rausch, D-Needham, who served on the Legislature’s Committee of Public Health from 2019-2022.

In the months between March and May, lawmakers passed statutes and took measures to be able to hold public hearings, votes and sessions virtually to keep public access to the government, according to Sen. Bill Driscoll, D-Milton, who chaired the Legislature’s Committee on Emergency Preparedness and Management from 2021 to 2024 while serving in the House.

Many of the rules surrounding legislative and attendance put in place five years ago are still around. Legislators have been able to virtually attend hearings and vote from their districts across the state.

A notable moment for the current Senate chair of the Legislature’s Committee on Public Health, was one of the public hearings after the state’s vaccination appointment system crashed when swamped with requests.

He said he believed “a lot of good outcomes in terms of course correction and working with the administration” came out of that hearing and the resulting statewide listening tour.

Throughout the pandemic, the committee worked to appropriate money for vaccines, testing, contact tracing.

According to Sen. Jo Comerford, D-Northampton, who was Senate chair of the committee from 2019 to 2022, the panel focused a great amount of attention on local and regional health because of the inequity of public health staffing across different communities around the state.

“Poor communities, communities of color, high immigrant communities, rural communities were all at a disadvantage,” she said. “And we had to pay attention to all of these.”

Looking back, Comerford wishes that the state had a stake in funding local and regional public health when the pandemic hit. It does now as a result of the pandemic, but it “would have been much better if we had a local response.”

“The COVID pandemic was backed by a lot by a statewide response, but statewide efforts have a hard time reaching the hardest to reach,” she said.

Coping on the front lines

The pandemic hit frontline workers who worked in hospitals the hardest. They put their lives on the line to take care of people with the virus at a time when no one knew the extent of the disease.

Katie Murphy, an intensive care unit nurse and president of the Massachusetts Nurses Association, said that even though doctors and nurses were aware that the virus was coming, things got “really bad” and “escalated very fast.”

“Not only was it incredibly stressful having these incredibly sick patients at work, but you couldn’t even get kind of a respite at home because you couldn’t see your family or your children,” she said. “I think we were going so fast, we weren’t even processing it.”

Health care professionals quickly ran out of personal protection equipment and did not have the resources to get more due to supply shortages. Murphy recounted the extreme measures people took when working because “there were so many things we didn’t have.”

“We were running out of PPE,” Murphy said. “There were some hospitals around Massachusetts and in New York where people were wearing plastic bags. They were wearing veterinary gloves. People were going to Home Depot and buying goggles. I was one of them, buying a crate of goggles because we just didn’t have anything.”

As an intensive care unit nurse, Murphy said her job didn’t change much. She said Brigham & Women’s Hospital became a giant ICU once elective surgeries stopped because they were “all just racing and working to keep these patients alive.”

“Nobody was getting elective procedures like a colonoscopy in special suites, so all of those nurses and physicians were sent to be intensive care unit nurses,” she said. “And trust me, this isn’t something that you just remember after being out of it for 15 years. I was doing a lot of teaching.”

Crowded hospitals forced beds into the hallways, and according to Murphy and state data, they have never left.

Dealing with the aftermath

In the wake of the Steward Health Care crisis and the shortage of community-based care, additional strain has been put on emergency departments in the state.

According to the Massachusetts Health and Hospital Association, there are up to 2,000 “stuck patients” in hospitals at any given time because they cannot access the next level of care they need. This has caused longer emergency room wait times and a lack of available hospital beds.

Hospital emergency departments are fuller than ever, and Driscoll, the state senator, said he worries what would happen if another event sends dozens to the hospital.

“The state of hospital and health care is greatly diminished from where it was even in 2020,” Driscoll said. “We’re hearing from health care professionals that our ability today as a commonwealth to absorb a sudden surge of patients, whether it’s from a mass casualty incident or from a public health emergency like an illness or respiratory illness that the system itself has not recovered.”

Others worry that the state doesn’t have the resources to handle another COVID-like event.

“My worry is that [the Department of Public Health] doesn’t have the money and the resources because a lot of that has been cut back,” Hamer said. “If we were to have a major problem right now, I’m not sure they’d be ready for it.”

Maya Mitchell writes for the Gazette from the Boston University Statehouse Program.