COVID has Southwest Idaho in crisis standards of care again. Is it different this time?

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Four months after the delta variant surge last fall launched Idaho into crisis standards of care, the designation has been reactivated in nearly all of the southern part of the state as hospitals deal with a rash of new COVID-19 patients.

But the crisis is different this time.

Hospitals are facing staffing shortages and dire blood supply problems, leaving the state’s entire health system in “very fragile” condition faster than expected, said Dave Jeppesen, Department of Health and Welfare director, at a Tuesday news briefing.

“For the delta surge, there was focused pressure on critical care capacity,” Jeppesen said. “With the omicron surge, there is tremendous pressure on the entire Idaho health care system.”

If trends continue, Jeppesen said he expects the rest of the state to enter crisis standards in the coming days or weeks. Right now the designation covers three of Idaho’s seven public health districts.

Hospitals around the state have implemented blood conservation strategies as supplies run low. This month, the American Red Cross declared its worst blood crisis in over a decade due to reductions in the number of people who’ve donated blood since the pandemic began.

Saint Alphonsus Health System requested that the state enter crisis standards of care on Friday, and Dr. Steven Nemerson, chief clinical officer, said the hospital is “quite concerned” about its blood-supply levels. Saint Al’s has one of the region’s leading trauma centers, and blood transfusions are needed in a variety of medical procedures.

“Our current allocation is less than our daily consumption,” Nemerson said at Tuesday’s briefing. The outlook is severe enough that the hospital system expects to soon “limit the amount of blood that’ll be available to patients based on condition and prognosis in the future,” he said.

Health and Welfare has convened a blood supply task force to better understand the shortage and help hospitals share resources, said Elke Shaw-Tulloch, administrator for the Division of Public Health.

Hospitals are also constrained by large numbers of medical professionals and staffers calling out sick, as the omicron variant persists at high levels in the state.

In recent days, between 117 and 169 Saint Al’s employees have been on COVID-19 leave, out of around 6,000 employees in Idaho and Oregon. And the rate at which hospitalizations are rising at Saint Al’s is almost twice as fast as during the delta surge. As of Sunday, the system’s seven-day positive test rate was 46%.

“This is a different and more dangerous surge,” Nemerson said. “It’s more rapid, and we have fewer people to be able to take care of the patients that are needing our care because they, too, are getting sick, and they’re also tired.

“Our physicians and our staff are completely exhausted ... We don’t have the ability any longer to expand into nontraditional spaces.”

On Friday, the state’s Crisis Standards of Care Activation Advisory Committee recommended that crisis standards be activated statewide. The guidelines allow hospitals to ration care as needed as a result of insufficient resources, and in dire circumstances could mean patients enter a “triage algorithm,” whereby the best care is focused on those most likely to survive. But hospitals maintain that all patients will receive care.

On Monday, Jeppesen activated the crisis standards for Central District Health, Southwest District Health and South Central Public Health. The area includes the Treasure Valley, the Wood River Valley and the Magic Valley — 18 counties in all and a majority of Idaho’s population.

“I spent most of my weekend agonizing over this decision,” Jeppesen said at Tuesday’s briefing. He added that hospitals in the rest of the state “were headed the wrong direction, but hadn’t quite gotten to crisis standards of care.”

A graph shows the 7-day average rate of new COVID-19 cases per 100,000 residents in Idaho along with the estimated rate. The estimated rate is much higher, as a backlog of more than 40,000 cases is skewing the data.
A graph shows the 7-day average rate of new COVID-19 cases per 100,000 residents in Idaho along with the estimated rate. The estimated rate is much higher, as a backlog of more than 40,000 cases is skewing the data.

Omicron’s spread

The omicron variant has torn through Idaho in recent weeks, adding record numbers of new cases and sending the state’s positivity rate sky-high.

Health and Welfare estimates that the seven-day incidence rate of new COVID-19 infections is close to 259 per 100,000 through Saturday, meaning the state added close to an estimated 30,000 new cases the week of Jan. 16.

The surge has overwhelmed local public health districts, which process each positive test result. Currently, 40,700 cases from recent weeks still need to be processed. (The week of Jan. 16, the state officially recorded only 16,422 new cases, which itself was the record for a weeklong period during the pandemic.)

The week of Jan. 9, the state’s test positivity rate rose to 34.1% — a record. Some health care providers have reported positivity rates higher than 60%, Jeppesen said.

As of Thursday, there were 492 patients with confirmed or suspected COVID-19 at Idaho hospitals, and there were 101 in intensive care units. Since vaccines have become available, hospitals have reported that the vast majority of COVID-19 patients are unvaccinated, and that has remained the case even though omicron has led to more breakthrough cases.

A graph shows the number of COVID-19 patients at Saint Alphonsus Health System since April 2020. “You can just look at the slope of the mountain and it’s almost twice as fast” during than omicron surge than it was during delta, said Dr. Steven Nemerson, chief clinical officer of Saint Al’s.
A graph shows the number of COVID-19 patients at Saint Alphonsus Health System since April 2020. “You can just look at the slope of the mountain and it’s almost twice as fast” during than omicron surge than it was during delta, said Dr. Steven Nemerson, chief clinical officer of Saint Al’s.

At Saint Al’s during the omicron surge, 80% of COVID-19 patients have been unvaccinated, about 10% partially vaccinated and 10% fully vaccinated, Nemerson said — “fully vaccinated” meaning a booster dose.

State health data also show that the vast majority of COVID-19 deaths have been among unvaccinated people.

The number of patients at Saint Al’s is “surging at a rate never before seen in the pandemic,” Nemerson said, but the hospital system is not yet rationing care.

“Do not neglect your health if you need us,” he said. “We will fit you in and we will prioritize patients that have the most emergent conditions.”

Nemerson added that 10% of Saint Al’s patients are awaiting discharge to nursing facilities and nursing homes, but that staffing shortages at the long-term care locations means the hospital is unable to move them.

At St. Luke’s Health System, the state’s largest provider, facilities are operating at contingency standards of care, a level below crisis levels, said a spokesperson, Christine Myron, by email.

“People needing health care should continue to seek it as needed,” she said.

Better masks and blood donations

Some research suggests the omicron variant is 2.7 to 3.7 times more infectious than delta. With that in mind, health officials have recommended that residents use high-quality medical-grade masks instead of cloth masks for increased protection.

On Tuesday, Shaw-Tulloch announced the state will be distributing free KN95 masks, which provide a high level of protection, in cooperation with the Idaho Office of Emergency Management.

Health officials also asked for the public to sign up to give blood in the coming days to combat the shortage and to take precautions against the coronavirus.

“I cannot emphasize how important it is right now to properly wear a high-quality mask,” Jeppesen said. “Avoid crowds, physically distance when in public, wash your hands often and stay home when you’re sick. ... If you haven’t been vaccinated or received your flu shot, please consider choosing to do so. And if you’ve been vaccinated, choose to get a booster.”

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