COVID-19 outbreak forces health care rationing in parts of the West

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BOISE, Idaho (AP) – Another worrying sign of the spread of the delta variant, public health officials in Idaho on Thursday expanded rationing of statewide health care and individual hospital systems Alaska and Montana adopted similar crisis standards amid a spike in the number of unvaccinated COVID-19 patients requiring hospitalization.

The decisions marked an escalation of the pandemic in several Western states struggling to convince skeptics to get vaccinated.

The Idaho Department of Health and Welfare made the announcement after the St. Luke Health System, Idaho’s largest hospital system, asked state health officials to authorize “crisis care standards” because the increase in the number of COVID-19 patients has drained the state’s medical resources.

Idaho is one of the least vaccinated U.S. states, with only about 40% of its residents fully vaccinated against COVID-19.

Crisis care standards mean scarce resources such as intensive care beds will be allocated to patients most likely to survive. Other patients will be treated with less effective methods or, in extreme cases, will benefit from pain relief and other palliative care.

A hospital in Helena, MT has also been forced to implement crisis care standards amid an increase in the number of COVID-19 patients. Critical care resources are at full capacity at St. Peter’s Health Hospital, officials said Thursday.

And earlier this week, Providence Alaska Medical Center, Alaska’s largest hospital, also began prioritizing resources.

Thursday’s move to Idaho came a week after state officials began allowing health care rationing at hospitals upstate.

“The situation is dire – we do not have enough resources to adequately treat patients in our hospitals, whether you are there for COVID-19 or a heart attack or because of a car accident,” said Dave Jeppesen , director of the Idaho Department of Social Affairs. in the statement.

He urged people to get vaccinated and wear masks indoors and in crowded outdoor places.

“Our hospitals and health systems need our help,” Jeppesen said.

In the St. Luke Health System in Idaho, patients are ventilated by hand – with a nurse or doctor clutching a bag – for several hours at a time as hospital officials scramble to find a bed with a mechanical ventilator, said Chief Medical Officer Dr. Jim Souza.

Others are treated with high-flow oxygen in rooms without a monitoring system, which means a doctor or nurse might not hear an alarm if the patient has a medical emergency, he said. he declares. Some patients are treated for sepsis – a potentially fatal infection – in emergency department waiting rooms.

Normal standards of care act as a net that allows physicians to “perform the high-flying acts we do every day, such as open heart surgery and bone marrow transplants and neuro-interventional care for stroke. cerebral, ”said Souza. “The net is gone, and people are going to fall off the high wire.”

One in 201 Idaho residents tested positive for COVID-19 in the past week, according to a count from Johns Hopkins University. The predominantly rural state ranks 12th in the United States for new confirmed cases per capita.

Hospitalizations have exploded. The most recent data available from the state on Monday showed that 678 people have been hospitalized statewide with coronavirus.

Meanwhile, the number of COVID-19 patients in intensive care unit beds has remained essentially stable over the past two weeks at 170 people per day – suggesting the state may have reached the limit of its ability to treat intensive care patients.

While all hospitals in the state can now ration health care resources as needed, some may not need to take this step. Each hospital will decide how to implement the standards of crisis care in its own facility, public health officials said.

As of Wednesday, nearly 92% of all COVID-19 patients in St. Luke hospitals were unvaccinated. Sixty-one of the hospital’s 78 intensive care patients had COVID-19. Doctors in St. Luke have pleaded with Idaho residents for months to get vaccinated and take action to slow the spread of the coronavirus, warning hospital beds are quickly running out.

The healthcare crisis isn’t just impacting hospitals – primary care physicians and medical equipment suppliers are also struggling to cope with the crushing demand from coronaviruses.

A major medical supplier, Norco Medical, said demand for oxygen tanks and related equipment has increased, sometimes forcing the company to send patients home with fewer cylinders than they normally would. High-flow oxygen equipment – normally used in hospitals or hospices – is also more frequently in demand for home patients, said Norco president Elias Margonis.

“It appears they are aggressively unloading themselves to free up beds for new patients entering hospitals,” Margonis said.

Margonis has spent much of her morning on the phone with public health and hospital officials, trying to figure out how crisis care standards will change the way patients leave hospitals. Already, the company has seen an increase in the number of customers seeking specialized oxygen equipment that delivers at a rate of 8, 12 or 20 liters per minute rather than the standard 4 or 5 liters per minute, has t -he declares.

“When someone comes home, we bring their bed, we bring their wheelchair, we bring their cannula, their oxygen,” said Margonis. “This is where we say it’s important that you can’t just get rid of the problem, even if the patient is on the mend and on the way to being healthy. To recover, they need the right support.

Primary Health Medical Group, Idaho’s largest independent primary and emergency care system, was forced to shorten hours of operation as its waiting rooms were so crowded with patients that staff remained on call. hours after closing in order to see them all. Meanwhile, the company was facing a higher than normal number of staff members sick because they had been exposed to the coronavirus in the community or had symptoms and were awaiting tests.

Now the medical group is also preparing to monitor patients who are discharged from hospitals earlier than usual or who try to avoid emergency rooms altogether, CEO Dr David Peterman said and they will likely be more. sick and will need more care.

“It’s heartbreaking. I practiced medicine in southwest Idaho for 40 years and have never seen anything like it, ”he said.

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This story has been corrected to show that the average daily number of patients in intensive care unit beds statewide is around 170, not 70.

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Iris Samuels contributed to this report from Helena, MT. Samuels is a member of the Associated Press / Report for America Statehouse News Initiative corps. Report for America is a national, nonprofit service program that places reporters in local newsrooms to cover undercover issues.

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