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SPOKANE, Wash. – Surgeries to remove brain tumors have been postponed. Patients are saved in the emergency room. Nurses work rough shifts. But at Providence Sacred Heart Medical Center in Spokane, Wash., Calls keep coming: Can Idaho send another patient across the border?
Washington state is reeling from its own wave of coronavirus cases. But in neighboring Idaho, 20 miles downstream of Interstate 90 from Spokane, uncontrolled transmission of the virus has already pushed hospitals past their breaking point.
“As they have seen the volumes of Covid increase, we have seen more and more calls for help from across northern Idaho,” said Dr Daniel Getz, Chief Medical Officer of Providence Sacred Heart, in an interview. As he spoke, a medical helicopter came down with a new delivery.
At a time when Washington state hospitals are delaying procedures and struggling with their own high workloads, some state leaders see Idaho’s outsourcing of Covid patients as a disturbing example of how whose failure to tackle the virus aggressively in one state may exacerbate a crisis in another.
On the Washington side, residents are required to wear masks when gathering indoors, students exposed to Covid are subject to quarantine requirements, and many workers are on vaccination prescriptions. On the Idaho side, none of these precautions are in place.
“It’s ridiculous,” said Cassie Sauer, president of the Washington State Hospital Association. “If your health care system collapses, the idea that you wouldn’t immediately issue a mask warrant is just weird. They have to do whatever they can do.
Last week, Idaho took the extraordinary step of moving its upstate hospitals to crisis care standards – the threshold at which facilities facing an overwhelming caseload are allowed to ration their resources, may -be suspending or delaying optimal care for certain patients.
Idaho now has more than 600 hospital patients with Covid-19, about 20% more than a previous peak in December. Only 40% of the state’s residents are fully immunized, one of the lowest rates in the country, compared to 61% in Washington state, one of the highest.
The pressure on health facilities is particularly evident in northern Idaho, where the vaccination rate is even lower; the region just hosted the northern idaho state fair, and in a region of deep government mistrust, no mask order or other strategy has been adopted to stop the spread of the virus. At Kootenai Health in Coeur d’Alene, a conference room has been converted to accommodate surplus patients.
With the Delta strain of the coronavirus sweeping the country, Washington state has had to face its own challenges and record hospitalizations, especially in areas in the eastern part of the state where vaccination rates are lower . This week, that state also began to speak openly about the possibility that crisis care standards may become necessary.
But Washington is in better shape than Idaho, where hospitalizations as a share of population are 45% higher.
“We certainly need our friends in the Idaho government to do more to protect the health of their citizens because we know their crisis is becoming our problem,” Democratic Governor of Washington, Jay Inslee said last week. “I am asking the people of Idaho to adopt some of the security measures – like masking requirements – as we have in Washington so that we can help our two states reduce this horrific pandemic. “
In Idaho, Gov. Brad Little’s office said he was not available for an interview, but he has indicated in recent weeks that he has no plans to reinstate virus restrictions, even if hospitals entered dangerous territory, saying he wanted residents “to choose to do the right thing and get vaccinated.” He released a statement Friday saying he was exploring legal action to end a tenure for President Biden that will require millions of people to get vaccinated.
“President Biden is out of touch and his tenures only add to the division within our country,” Mr. Little said.
The governor urged personal accountability, and in northern Idaho, where schools do not require masks or do contact tracing, health officials have become enraged by statements from members of the community suggesting they don’t think the situation is as bad as doctors and hospital administrators describe.
“It is extremely disappointing,” said Dr Robert Scoggins, medical director of the intensive care unit at Kootenai Health, at a press conference on Wednesday. “In northern Idaho, we don’t have a lot of mitigation going on. As they take care of these critically ill intensive care patients, they regret that they did not take it very seriously.
Last week, a US Army medical team deployed to support healthcare workers at the hospital.
Dr Getz and other Spokane doctors couldn’t resist taking patients from Idaho. Providence Sacred Heart has long viewed the neighboring state as part of its larger community, and when there is space, the facility has opened. But the transfers have helped push the hospital towards its own capacity limits.
Last week, 29 of the facility’s inpatients were from Idaho. The number of patients sent to the emergency room by Kootenai Health alone rose 34% in August, officials said. MultiCare Health System, which also has a hospital in Spokane, has also seen a substantial increase in calls for support from Idaho – although, like Providence, capacity issues have forced them to decline some of the requests.
It is not uncommon for hospitals to divert patients during peak periods or transfer them to facilities where there may be specialists better suited to their needs. But the current virus spike in the region – and much of the country – has left hospitals scrambling to find options. In Spokane, Providence has responded to calls from hospitals as far away as Texas and Missouri, which are also experiencing major epidemics.
Hospitals are generally required by federal law to accept transfer requests when there is room to care for them. For closer cases, officials said, patients can cross state borders to hospitals where they think they can get more immediate care, and hospitals must attend to those who show up on their doorstep. . For patients without insurance, hospitals can stop providing free care.
With the influx of patients, both from the community and across state lines, Providence Sacred Heart has seen patients stranded in the emergency room for hours longer than normal, waiting for an open bed. Those with a bed may not have room in the intensive care unit, as they normally would. The hospital has started canceling elective procedures and only conducts urgent ones, Dr Getz said. Brain tumor excision procedures and orthopedic injury treatment are among those that have been postponed, he said.
“We are delaying care for people who are in dire need,” said Dr Getz. “It’s scary for these patients. This has real impacts on these people who are waiting.
The rationing of care according to crisis care standards would go even further. In Idaho, that means nurses have a higher patient load and are not allowed to check vital signs as often as usual. Should the situation deteriorate, with insufficient supplies or staff to handle workloads, health officials said, rationing of care could mean having to decide which patients have priority for oxygen or ventilators.
States across the country have discussed triage plans that could be used when admissions have reached a crisis level, but few have actually activated them. Arizona and New Mexico activated their crisis plans earlier in the pandemic, but Idaho appears to be the only state with those standards currently in effect.
Medical staff struggled to keep up in both states. Some quit smoking, unable to cope any further with a pandemic that has already consumed them for 18 months. Some are demoralized by what they see as the public’s inability to take the virus seriously. Nurses regularly work 16 hour shifts.
Mary Jo Moore, director of intensive care at Providence Sacred Heart, said healthcare workers often face the anger of people who are asked to wear masks or who are told they cannot have any. visitors. Some patients refuse to believe they are infected with the virus, and some are pushing for unapproved forms of treatment.
“There is a lot of verbal abuse that staff are going through right now,” said Ms Moore, as she walked through the Covid units, where nurses were caring for patients who had been placed on their stomachs in an attempt to help them breathe.
“And I have a staff like this who are as pleasant as they get,” she said. “And they come back to work every day and provide care to these patients. “
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