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Boise, Idaho – Idaho’s public health officials announced on Tuesday that they had activated “crisis care standards” allowing health care rationing for upstate hospitals because there are more than coronavirus patients that institutions cannot manage.
The Idaho Department of Health and Welfare quietly adopted the decision on Monday and announced it publicly in a statement Tuesday morning – warning residents they may not receive the care they would normally expect if they were to be hospitalized.
The move came as confirmed cases of the coronavirus in the state have skyrocketed in recent weeks. Idaho has one of the lowest vaccination rates in the United States
Kyle Green / AP
The state health agency cited “a severe shortage of staff and available beds in the upstate caused by a massive increase in the number of COVID-19 patients who require hospitalization.”
The designation includes 10 hospitals and health systems in the Idaho Panhandle and north-central Idaho. The agency said its goal was to expand care to as many patients as possible and save as many lives as possible.
The move allows hospitals to allocate scarce resources like intensive care unit rooms to patients most likely to survive and make other dramatic changes to the way they treat patients. Other patients will continue to receive care, but they may be placed in hospital classrooms or conference rooms rather than traditional hospital rooms or without vital medical equipment.
At Kootenai Health – the largest hospital in northern Idaho – some patients wait long periods of time for beds to open in the full intensive care unit, said chief of staff Dr. Robert Scoggins. Inside the ICU, an ICU nurse can supervise up to six patients with the help of two other ICU nurses. That’s a big deviation from the usual ratio of an intensive care nurse to an intensive care patient, he said.
On Monday, Coeur d’Alene Hospital began moving coronavirus patients to its neighboring conference center. A large classroom in the center has been converted to a COVID-19 room, with temporary dividers separating the beds. Some emergency room patients are treated in a converted part of the emergency room lobby, and the entire third floor of the hospital has also been designated for coronavirus patients.
Urgent and elective surgeries are on hold, Scoggins said, and Kootenai Health is struggling to accept one of the high-profile trauma patients who would normally be transferred from small hospitals in the area.
Other states are preparing to take similar action if necessary. Hawaii Governor David Ige quietly signed an order last week freeing hospitals and healthcare workers from liability if they have to ration healthcare.
The crushing of patients in Idaho hospitals was anticipated with dismay by health care providers across the state. Medical experts have said Idaho could have up to 30,000 new cases of coronavirus per week by mid-September if the current rate of infections persists.
“Standards of care in a crisis are a last resort. It means that we have exhausted our resources to the point that our health systems are unable to provide the treatment and care we expect,” said Dave Jeppesen, director of Idaho Department of Health and Welfare, in a statement.
Kyle Green / AP
He added: “It was a decision I very much hoped to avoid. The best tools we have to remedy the situation are for more people to get vaccinated and wear masks indoors and in crowded public places outdoors. Please choose to get vaccinated as soon as possible. as possible – it’s your best protection against hospitalization with COVID-19. “
The designation will remain in effect until there are sufficient resources – including hospital staff, beds and equipment, or a drop in patient numbers – to provide normal treatment levels for all.
More than 500 people were hospitalized statewide with COVID-19 on September 1, and more than a third of them were in intensive care unit beds.
Hospitals in Idaho have struggled to fill nursing, housekeeping and other health care vacancies, in part because some staff have left because they are exhausted from the pressure pandemic and because others have been quarantined because they have been exposed to COVID-19.
Late last month, Little called in 220 medical workers available under federal programs and mobilized 150 Idaho National Guard soldiers to help hospitals weather the tide.
Two hundred of federal workers are medical and administrative personnel available through contract with the US General Services Administration. The US Department of Defense has agreed to send a 20-person medical response team to northern Idaho. Idaho National Guard soldiers will provide logistical support such as screenings and lab work.
On Tuesday, the governor called the decision to limit care “an unprecedented and undesirable point in the history of our state” and urged residents to get vaccinated against the coronavirus.
Data from the United States Centers for Disease Control and Prevention shows that full vaccination with any of the currently available coronavirus vaccines significantly reduces the risk of requiring hospitalization for coronavirus infection.
“More Idahoans must choose to receive the vaccine so we can minimize the spread of the disease and reduce the number of hospitalizations related to COVID-19, many of which involve younger Idahoans and are preventable with safe and effective vaccines said Little, who is a Republican.
When the pandemic first arrived in Idaho in early 2020, Little ordered a partial state shutdown – ordering some businesses to temporarily shut down or switch to takeout-style services, banning some large ones. gatherings and asking residents to stay home as much as possible. possible.
The move was intended to ensure that hospitals would not be overwhelmed with patients. Idaho was on the verge of adopting crisis care standards during a major coronavirus surge last winter, but narrowly avoided doing so – making it the first time the state has taken the drastic measure.
Little reopened the state in stages over a period of months and did not reimpose restrictions limiting gatherings. Most businesses operate normally.
State crisis guidelines are complex and give hospitals a legal and ethical model to use while rationing care.
Under the guidelines, patients are given priority scores based on a number of factors that affect their likelihood of surviving a health crisis.
People considered to be most in need of care and most likely to benefit from it are put on priority lists for scarce resources like intensive care beds.
Others in need but less likely to survive will receive “comfort care” to help them stay pain free, whether they succumb to their illness or recover.
Other patients with serious but not life-threatening medical problems will experience delays in receiving care until resources are available.
“I hope what you get out of this is that the vaccines work. They are by far the best tool we have,” to prevent people from getting seriously ill from the coronavirus, said Jeppesen, the director of the health department. of State.
Demand on hospitals is likely to increase in the coming weeks as the number of cases continues to rise, Jeppesen said, so everyone should take steps to avoid needing emergency care if possible by wearing seat belts, taking prescribed medications, and reconsidering activities such as biking that can lead to accidents.
“Just be a little more careful,” he said.
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