Idaho begins rationing care as hospitals crumple under COVID load


Large tents set up outside a brick building.
Enlarge / Coronavirus preparedness tent set up outside hospital emergency room entrance at Gritman Medical Center in the northern Idaho city of Moscow in March 2020.

The Idaho Department of Health and Welfare on Monday activated its “crisis standards of care” in 10 northern hospitals hard-hit by staff shortages, hospital bed shortages, and a “massive increase in patients with COVID-19 who require hospitalization,” the department announced Tuesday.

The crisis standards mean that the quality of care in those hospitals will be reduced for all patients. Resources will be rationed, and patients with the best chances of survival may be prioritized.

In practice, that could mean that: emergency medical services may prioritize which 9-1-1 calls they respond to; some people who would normally be admitted to the hospital will instead be turned away; some admitted patients may be sent home earlier than typical or may find their hospital bed in a repurposed area of the hospital, like a conference room; and, in the worst cases, hospital staff might not be able to provide an intensive care unit bed or a ventilator to a patient that has a relatively low chance of survival.

“Crisis standards of care is a last resort. It means we have exhausted our resources to the point that our healthcare systems are unable to provide the treatment and care we expect,” Dave Jeppesen, director of Idaho’s Department of Health and Welfare, said in a statement. “This is a decision I was fervently hoping to avoid. The best tools we have to turn this around is for more people to get vaccinated and to wear masks indoors and in outdoor crowded public places. Please choose to get vaccinated as soon as possible—it is your very best protection against being hospitalized from COVID-19.”

Preventable

Idaho has one of the country’s lowest vaccination rates, with just 39 percent of the state fully vaccinated. With the rampant nationwide spread of the hypertransmissible delta variant, the Gem State has seen a surge in COVID-19 cases and hospitalizations since July. The northern district is seeing some of the worst of the surge. Hospitalizations in Idaho have exceeded all previous records in the state, hitting a seven-day rolling average of nearly 540 COVID-19 hospitalizations. The previous peak in late December was around 470. Statewide, around 89 percent of intensive care unit beds are occupied.

“We have reached an unprecedented and unwanted point in the history of our state,” Republican Gov. Brad Little said. “We have taken so many steps to avoid getting here, but yet again we need to ask more Idahoans to choose to receive the COVID-19 vaccine. More Idahoans need to choose to receive the vaccine so we can minimize the spread of the disease and reduce the number of COVID-19 hospitalizations, many of which involve younger Idahoans and are preventable with safe and effective vaccines.”

COVID-19 hospitalizations are up nationwide with the rise of delta, and several other states appear on the brink of rationing care as well. The Associated Press reported that Hawaii’s Democratic Gov. David Ige signed an order last week releasing hospitals and health care workers from liability if they have to ration care. NPR reported over the weekend that New Mexico has a waiting list of ICU beds while officials there warned that they may, too, need to enact crisis standards.

As of Tuesday, the US has recorded more than 40 million COVID-19 cases since the start of the pandemic and the death toll is poised to reach 650,000.



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