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Idaho hospitals are rationing health care because of COVID-19. Is Utah next?

U.S. Army 1st Lt. Blaine Woodcock, a critical care nurse, provides care to a COVID-positive patient in Coeur d’Alene, Idaho. Utah hospitals continue to be overwhelmed with COVID-19 patients, but are still hoping to avoid reaching the point where treatment must be rationed even as Idaho has now had to extend “crisis of care standards” throughout the state.
U.S. Army 1st Lt. Blaine Woodcock, a critical care nurse, provides care to a COVID-positive patient during the COVID-19 response operations at Kootenai Health regional medical center in Coeur d’Alene, Idaho, on Sept. 6, 2021. Utah hospitals continue to be overwhelmed with COVID-19 patients, but are still hoping to avoid reaching the point where treatment must be rationed even as Idaho has now had to extend “crisis of care standards” throughout the state.
Sgt. Kaden D. Pitt, U.S. Army via Associated Press

Utah hospitals continue to be overwhelmed with COVID-19 patients, but are still hoping to avoid reaching the point where treatment must be rationed even as Idaho has now had to extend “crisis of care standards” throughout the state.

“We’re going to do just every heroic effort to forestall that,” Greg Bell, Utah Hospital Association president and CEO said, acknowledging, “absolutely we’re worried. People aren’t wearing masks and we’ve got 50% of our state that is not fully vaccinated. That’s where COVID is raging.”

It’s up to hospital officials to approach the state about invoking crisis care standards, updated last year to respond to the pandemic since the previous version was oriented to dealing with the aftermath of an earthquake. The standards now spell out how to allocate limited ventilators, including when to make that decision using a lottery.

Bell said he wanted to emphasize hospitals are not yet talking about moving to those standards.

Last fall, the need for crisis care standards seemed imminent but was able to be avoided, Utah Department of Public Safety spokesman Joe Dougherty said. Today, he said most of the state’s hospitals are a step away, using a “deep contingency” standard of care, postponing surgeries and adding to the staff’s workload.

There’s no specific thresholds — or timeline — for when the crisis care standards may be revisited, he said.

“We’ve not gone there yet, where it’s like, hey, we’re predicting in days or weeks. Those words have not been spoken yet, All of the other words apply. Troubling. Worrisome,” Dougherty said.

Utahns are already running into long waits for critical hospital care, he said, a situation that will be much more grim under rationed care.

“The reality of crisis standards of care is that people will not get life saving care in the hospital. Health care providers will try to do everything they possibly can but at some point, if that is invoked, people will die and they will continue to die unnecessarily,” Dougherty said.

Dr. Todd Vento, an infectious diseases physician with Intermountain Healthcare, the region’s largest health care provider, also painted a bleak picture of what happens when hospitals can no longer meet demand and must choose who gets treatment.

“You now shift your focus on, ‘I’m going to do the greatest good for the greatest number.’ To do that, you need to focus on which patients are most likely to survive and have a severe illness,” Vento said, citing as an example having to prioritize COVID-19 treatment for a 60-year-old over a 90-year-old who also has cancer.

“The hospital would be forced to then put as much of the resources to do the greatest good for the greatest number and save that person so both individuals wouldn’t necessarily die. I hate to have that sort of specific or graphic about it, but that’s the concept,” he said.

Vento said there is a direct correlation between a state’s rate of COVID-19 vaccinations and how many people end up hospitalized with the virus. Idaho has one of the lowest vaccination rates in the country, with just over 40% of residents fully vaccinated against the virus, meaning it’s been two weeks or more since their final dose.

“You see it in Mississippi, Florida, Texas, etc.,” Vento said, calling it “simple math. Vaccines prevent severe COVID, therefore they prevent ICU hospitalizations. That was sort of one of those things you probably could have predicted. That’s exactly what Idaho is seeing.”

A registered nurse holds the hand of a COVID-19 patient in the medical intensive care unit at St. Luke’s Boise Medical Center in Boise, Idaho, on Aug. 31, 2021.
Kyle Gree, Associated Press

Thursday’s decision to institute crisis care standards in hospitals throughout Idaho comes after they were put in place Sept. 6 in hospitals in the northern part of the state. Alaska’s largest hospital, located in Anchorage, announced Tuesday that it was operating under similar standards.

Idaho officials warned hospital patients that the care they receive may be different than expected, including hospital beds not being available or set up in conference rooms or other repurposed rooms. Some may be moved to another hospital, even one that’s out of state, and others may even end up not being prioritized for treatment.

“The situation is dire — we don’t have enough resources to adequately treat the patients in our hospitals, whether you are there for COVID-19 or a heart attack or because of a car accident,” Dave Jeppesen, Idaho Department of Health and Welfare director, said in a statement.

Bell said Utah hospitals have been able to accommodate most of the requests to take patients from all over the country since the delta variant began fueling the ongoing surge in cases months ago. Now, though, he said Utah facilities are focused on regional needs, mostly in Idaho, Nevada and Wyoming.

“We haven’t directly felt a lot of pressure from Idaho,” Bell said, noting many of that state’s overflow in COVID-19 patients have been sent to hospitals in the Seattle area. That’s led to some frustration since Washington state has an indoor mask mandate and other measures to slow the spread of the virus — and Idaho does not.

Vento said Idaho hospitals “needed a lot of help from the community” to reach a point where crisis care standards were necessary.

“If your community’s not vaccinated, if your community doesn’t distance, if your community doesn’t wear masks, there’s going to be more cases. It’s going to overload the hospital. Some folks don’t like hearing that, but that’s just the facts. That’s exactly what’s happened in Idaho,” the doctor said.

Utah isn’t there yet, he said, but hospitals are having to be creative, providing some care at home or via telehealth, and transferring patients to other facilities. Last week, Intermountain Healthcare announced surgeries are being postponed, including for conditions that are urgent but not life-threatening.

“We are in a crisis. We are overburdened as a health care system,” Vento said, with intensive care units operating beyond capacity as COVID-19 cases climb and staffing levels drop. Many health care workers are tired and demoralized as the pandemic drags on.

Bell said Utah’s hospitals are tapped out. Meanwhile, the former lieutenant governor said Utahns are living in separate worlds when it comes to COVID-19.

“There’s the world who thinks it’s not relevant to them and they’re not really paying attention,” he said, and not heeding advice to mask up, vaccinated or not. “The other part of the world is those who are paying attention who are nervous about it personally and nervous about it as a community and as a state.”

Utah Department of Health spokeswoman Charla Haley said the agency “continues to watch the critical situation facing Utah’s hospital systems and encourages everyone to do their part.” She said getting vaccinated against COVID-19 is the best protection against being hospitalized, since most patients with the virus did not get the shots.

“If more people are not protected against illness, the state may face implementation of crisis standards of care, which is a step of last resort,” she said. “It means we have exhausted our resources to the point that our healthcare systems are unable to provide the treatment and care we expect.”