Idaho may see crisis standards of care again in the ‘near future.’ What would trigger it?

·4 min read

As Idaho’s health care system battles the omicron variant, health leaders fear that dizzying numbers of people testing positive in Idaho will “likely” necessitate a return to crisis standards of care.

In recent weeks, Idaho’s test positivity rate, which measures the number of tests that come back positive, has climbed precipitously, from a rate of 5.5% the week of Dec. 12 to 25.7% the week of Jan. 2, the most recent data available.

Case numbers have also risen quickly, with Tuesday’s tally of 3,555 marking the highest number recorded on any one day since the start of the pandemic, according to data from the Department of Health and Welfare. Tuesday’s tally topped Friday’s count, of 3,266 — which had also been a pandemic record — by nearly 300 cases. But even these numbers are likely less than the actual daily counts, as local public health districts are behind on recording around 28,200 cases over the last two weeks. That means a person who tests positive, and whose status is reported to the state, may not be added to the tally until days later.

At a press briefing on Tuesday, Health and Welfare Director Dave Jeppesen said that Idaho could reactivate crisis standards in the coming weeks “if the current trends continue.”

With crisis standards activated, hospitals are able to ration care if necessary, and to administer care in unorthodox settings when the need for medicine exceeds the resources available.

If “we continue to see this number of cases and this number of people going into the hospital, we would expect crisis standards of care” in a matter of weeks, Jeppesen said.

The possibility of crisis standards comes as hospitalizations are steadily rising. As of Jan. 12, there were 381 patients with confirmed or suspected COVID-19 at Idaho hospitals, up from 210 on Dec. 25, according to the dashboard. In intensive care units, there were 98 patients, up from 73. More recent hospitalization data has been delayed by the backlogs at overburdened local public health districts, said Dr. Kathryn Turner, deputy state epidemiologist, at Tuesday’s briefing.

State officials suspect the state’s seven-day incidence rate — the number of cases per 100,000 Idahoans — could be as high as 197 as of Saturday, Turner said.

Forty-three of Idaho’s 44 counties currently have high COVID-19 transmission, according to the Centers for Disease Control and Prevention.

At St. Luke’s Health System, there were 107 admitted patients with COVID-19 in isolation as of Tuesday, with COVID-19 patients making up 18% of all patients, according to the hospital system’s dashboard.

Why health experts say omicron rivals delta variant

COVID-19 patients made up 48% of all St. Luke’s admissions during the delta variant’s peak in late September.

While omicron appears to cause less severe disease in most people, it could be equally as dangerous because it’s highly contagious, said Dr. William Dittrich, a critical care physician at St. Luke’s Boise Medical Center who treats patients with respiratory issues.

Dittrich has been caring for COVID-19 patients in the ICU since the pandemic began.

“The numbers sort of balance each other out, unfortunately,” Dittrich told the Idaho Statesman. “So many more people are getting it, that even if a smaller percentage of them end up with more severe disease, that number that ends up in the hospital is still potentially a big number.”

Omicron still remains dangerous to many who ultimately end up in the hospital, he added.

“For those unfortunate few that end up in the ICU, it’s not any less severe,” Dittrich said. “It’s not any more mild.”

Crisis standards could be triggered with worse staffing shortages

At St. Luke’s, some critical care physicians have been pulled into the ICU on short notice, even on scheduled days off or at times they expected only to work with non-hospitalized patients — causing problems for patients with appointments, Dittrich said.

He said St. Luke’s has plans in place to cover the necessary last-minute changes, but “it still has impacts on patient care and patient flow, particularly in the outpatient setting.”

And at primary care providers in the Treasure Valley, the fast rise in testing demand and cases has already affected patient care.

Dittrich said that during this surge, large numbers of staff out sick have intensified the burden on hospitals by reducing the pool of resources available to them. Dittrich said it could mean that crisis standards would be triggered before the numbers of hospitalized patients reach the levels they did last fall.

“We only have so many ICU and hospital beds,” Dittrich said. “Those could fill up very quickly.”

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