As COVID-19 hospitalizations dip, some health care leaders worry worst is still to come

Idaho health care experts expect COVID-19 hospitalizations to tax hospital capacity well into the fall — but with different predictions for how that will play out.

Predictions range from a determination that the worst is in the rear-view mirror to the potential that the situation may still get more dire. And with some state data beginning to show light at the end of the tunnel for hospitals, a snarl in the state’s data collection is impeding officials’ ability to revise their models.

For at least two weeks, local public health districts have been behind on reporting COVID-19 data to the state due to the high volume of new cases. On Tuesday, the Idaho Department of Health and Welfare had around 7,800 outstanding COVID-19 cases. With Idaho reporting an average of over 1,000 new cases a day, the backlog is likely significantly distorting the actual number of new daily infections.

While new COVID-19 hospital admissions are not declining, the state’s data dashboard has shown declines in the total number of confirmed or suspected COVID-19 patients since the end of last month, and the state’s test positivity rate has fallen slightly for three straight weeks.

“We’re cautiously optimistic that (a decline) is what we’re seeing, but we also know that we still have that backlog of the lab reports that need to get caught up,” said Elke Shaw-Tulloch, administrator for the Division of Public Health, on Tuesday.

WHAT ARE HOSPITALS PREDICTING?

For health systems in the Treasure Valley whose facilities are full of patients, what happens later this fall could come to define the state’s COVID-19 experience.

At St. Luke’s Health System, the hospital is delaying lots of surgical procedures — including highly necessary ones, like some cancer surgeries — and is finding ways to keep treating patients in regular hospital beds who normally would be transferred to an intensive care unit, where there isn’t room for them. On some days, the situation “gets a little bit worse and gets closer to the line of having to consider some really difficult decisions,” said Dr. Frank Johnson, chief medical officer for St. Luke’s Health System hospitals in Boise, Elmore County and McCall, in an interview with the Idaho Statesman on Friday.

Although St. Luke’s has not yet had to do so, the state’s patient guidelines for crisis standards include methods of “scoring” patients based on their likelihood to survive and numbers of years of life left to live, a strategy designed to help doctors choose how to triage care if necessary. Johnson said his hospital is prepared to do that if necessary.

As the state’s largest health care network, St. Luke’s is expecting to see a peak number of patients in the next few weeks.

“Predictive models aren’t perfect,” Johnson said.

His hospitals are heartened by a recent dip in patients, but he said they’re preparing for numbers to swing back up again.

“None of us know for sure what to make of those two different situations,” he said, referring to the recent dip in patients and the predicted surge.

At Saint Alphonsus Health System, which is also operating under crisis standards of care, the hospital is predicting a patient peak of sometime in early November, according to Dr. Steven Nemerson, chief medical officer for the health system. He said his hospital was expecting to be “in a plateau phase” until then.

“Beyond that, it’s impossible to predict,” he said Tuesday.

At West Valley Medical Center, in Caldwell, Chief Medical Officer Dr. Richard Augustus said the hospital had its highest number of COVID-19 patients around Sept. 20, and that numbers have been declining since then.

The hospital peaked at around 30 COVID-19 patients in September, and on Oct. 5 had around 17.

“It seems to have declined a little bit, but it hasn’t actually eased — like, we’re still full,” Augustus said. “Every day we open up a little space and fill it by the next day.”

On Oct. 5, he said the hospital had a couple of free intensive care unit beds, but that all of its regular beds were full. West Valley is operating at contingency standards, which is a level below crisis standards.

Augustus said he routinely refers to projections from the University of Washington, which show the state just past its hospitalization peak.

WHEN WILL THE STATE KNOW IF THERE’S A TREND?

At the start of October, with hospitalizations at record levels, Health and Welfare predicted a peak number of COVID-19 hospitalizations in November that was much, much higher than current levels.

Since then, the changes in the test positivity rate and number of hospital patients may have changed the outlook. Statewide, hospitalizations, while still very high, have fallen in recent days. At this month’s press conferences, state health officials have said the decline may be due in part to a high number of recent deaths.

But without the missing case data, state officials have been unable to revise their model.

“It’s really hard when the data that’s going into the model is not what it should be,” said Dr. Kathryn Turner, deputy state epidemiologist, on Tuesday. With the case data still incomplete, she said she was looking to the next positivity rate update, which will be published on Thursday.

“I think if I see a decline in the percent positivity again this week, I think we’ll lean more towards, ‘we’re optimistic,’ ” she said. “I think four weeks of declines would indicate to us that we would be on the downslope.”

Even so, hospital modeling requires predicting future events, meaning there’s always some uncertainty.

But one thing is certain: with several hospitals already operating under crisis standards of care and on the brink of having to make difficult decisions about which patients will receive certain treatments, a continued, major surge would place an immense strain on hospitals.

“We will hit a limit,” Johnson said. “Our teams at St. Luke’s are preparing to provide care for as many patients as we can and are prepared for an increase in the number of patients who present to St. Luke’s or the other hospitals in our region. … I don’t know exactly what’s going to happen, so (we) just prepare as best we can.”