Colorado hospitals can turn away patients as state grapples with covid-19 surge

Colorado's governor said hospitals can turn away new admissions as they deal with a surge of covid-19 cases that has strained the state's hospitals.

Gov. Jared Polis, D, signed an executive order over the weekend authorizing the state's public health department to determine whether hospitals or emergency departments are at or will soon hit capacity. The department can order such facilities to halt admissions and redirect or transfer patients, according to the order, which will be in effect for 30 days starting Sunday.

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The move highlights the continued trouble parts of the country face, even as numbers at the national level suggest that the delta-variant-driven surge that swamped emergency rooms this summer and fall has started to ebb. Officials say the state's staffing shortages are also contributing to the burden from rising cases, and one bioethicist said the upward trend is particularly troubling without actions that can help bring numbers back down.

Right now there are "two Colorados," said Matthew Wynia, director of the Center for Bioethics and Humanities at the University of Colorado Anschutz Medical Campus.

"If you're in the health-care system, if you're a patient needing services in a hospital or if you're a medical practitioner, things are really bad," he said. "But if you're a regular citizen just walking around on the street, you wouldn't know it. People are behaving as though things are normal."

The governor said at a briefing last week that he was recently asked whether the pandemic is "over."

"When we have 1,100 people in the hospital, the answer is no, it's not," he said.

In a separate Sunday order, the governor said that "despite significant progress, there has been an increase in COVID-19 cases, largely due to the highly contagious Delta variant and the 20% of Coloradans who have yet to get the highly effective, safe vaccine."

He said the state's "severe staffing shortage," combined with the case surge, has forced officials to "undertake targeted efforts to respond and mitigate the effects of the pandemic, prevent further spread, preserve our health care resources, and provide needed flexibility to address the collateral consequences of the pandemic."

Officials said the way the pandemic peaks have fluctuated across the country may contribute to why Colorado is seeing an influx now. Wynia, who helped Colorado write its crisis standards of care early in the pandemic, said even as the state has done "fairly well" with vaccination rates, it may be seeing escalating numbers now because it hasn't experienced the major surges that beset other states.

"You might assume that what that means is that we have fewer people who are susceptible, which is true," Wynia said. "We have fewer people susceptible because of vaccination. But we have more people who are susceptible because we haven't had the major surges that they've seen in a number of other states."

There were more than 1,300 covid patients hospitalized in Colorado as of Monday, according to data tracked by The Washington Post, with nearly 400 of them occupying beds in intensive care units. The state's dashboard notes that 81% of the hospitalized are unvaccinated. Nearly 62% of the state's population is fully vaccinated, including 73% of adults ages 18 and older.

As of Monday, 88% of the state's hospital beds for acute care were in use, and across the state, 37% of facilities are anticipating staff shortages within the next week, according to the state's dashboard.

Wynia, referring to case counts that would have triggered mask mandates or business closures last year, said that "we're now hitting those numbers, but we're not doing those things to try and bring the numbers down."

Throughout the pandemic, the state's major health systems have worked together on "statewide load balancing" to make sure "one hospital didn't get swamped while another one still had beds available," Wynia said. While that's happened on a voluntary basis, the governor's new order allows the state public health department to "step in and literally transfer patients from one hospital to another without the hospital having to agree to that in advance or even without the patient agreeing to it in advance, if that's what was necessary," he said.

During last week's briefing, the governor said the state was ready to implement various measures - including crisis standards of care - if cases don't decline.

"Seeing the stress on hospital systems, certainly the staffing crisis standard of care is likely to be activated, and the hospital standard of care, where we look at principles by which hospitals can make decisions on triaging patients and using scarce resources, is another one that we'll consider," Eric France, chief medical officer of the Colorado Department of Public Health and Environment, said during Thursday's briefing.

The state has activated that resource before - crisis standards of care were implemented from April 5, 2020, until Feb. 11.

In September, as caseloads drove hospitals to a breaking point, some states and hospital systems activated those crisis standards, which allow hospitals to prioritize patients and ration scarce resources.

Polis also noted the regional nature of the pandemic's peaks and valleys across the country, with some states, including Colorado, experiencing a current surge.

"The same states including Colorado had a lower incidence over much of summer, which was wonderful. Our kids were able to enjoy summer activities and sports and not have to worry as much," he said. "But what happened in other states with a peak is happening here."

He said because of the state's vaccination rate, "the peak does not seem to be, nor do we expect it to be, as high as it was in states with lower vaccination rates with regards to hospitalizations. But nevertheless, the situation is dangerous and dire for those who are unvaccinated."

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María Luisa Paúl contributed to this report.

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