‘I’m scared for all of us’: Idaho declares crisis standards for all hospitals as COVID-19 surges

Idaho’s largest healthcare provider is “overwhelmed with patient volumes,” its intensive care units are “overflowing” and the overall system is being “absolutely crushed by COVID,” said Chris Roth, president and CEO at St. Luke’s Health System in Boise.

After a request from St. Luke’s, the Idaho Department of Health and Welfare declared crisis standards of care statewide Thursday morning.

Crisis standards of care mean hospitals can operate outside of normal settings, with different staff ratios and, in the worst-case scenario, ration care to save the most lives.

North and Central Idaho have been in crisis standards of care since Sept. 6.

“Crisis standards of care are activated when the ability to provide a reasonable community standard of care is exhausted, and that’s the state that we find ourselves in right now,” said Dr. Steven Nemerson, chief clinical officer at Saint Alphonsus Health System in Boise.

The Idaho Crisis Standards of Care Activation Advisory Committee met Wednesday and determined the influx of COVID patients had severely impacted all of the state’s hospitals to the point of asking the director to expand crisis standards statewide.

The move comes as COVID cases and hospitalizations are at their highest point in the pandemic and show no signs of slowing.

“These are uncharted waters,” said Brian Whitlock, president and CEO of the Idaho Hospital Association. “We’ve never been in this situation before as a state.”

Roth said St. Luke’s has done everything possible over the past 20 months to avoid crisis standards of care.

“This is an incredibly sad day for St. Luke’s and for our community,” he said.

Roth said the overwhelming patient volumes are a result of COVID-19 patients and historic levels of traditional patient care, with the latter largely brought on by a pent-up demand from patients delaying care last year because of COVID-19.

“I’ve never seen any volumes even close to what we’re seeing in my history at St. Luke’s of 14 years,” Roth said.

He said St. Luke’s had a record 173 COVID-positive admissions to its hospital at the end of August, breaking the 172-admissions record back in the December surge. It recently broke the record again with 281 COVID-19 admissions.

“If we continue on this course over the next several weeks, St. Luke’s Health System will become a COVID health system,” said Roth, noting it will consume every resource and bed it has with coronavirus patients.

Roth said the vast majority of patients in St. Luke’s ICU are COVID positive, with 98% of them unvaccinated.

He said the health system has hired more staff and is doing everything it can to provide safe and effective care, “but the standard of care is being eroded.”

“We’ve now stopped surgical procedures that can be reasonably expected to be associated with a significant risk of permanent disability or pathology,” said Dr. Jim Souza, chief physician executive at St. Luke’s.

Souza said certain breast cancers, prostate cancers and bladder tumors, for examples, will be managed “medically” until doctors can get to them.

Sandee Gehrke, chief operating officer at St. Luke’s, said the hospital stretched its nurse-ICU patient ratios. She said a registered nurse in the ICU typically took care of one or two patients but is now tending to about three.

Gehrke said the combination of high patient volumes and 400 employees at home because of COVID-19-related illnesses is stretching St. Luke’s staff thin.

“The strain that we are experiencing from a team member standpoint is heartbreaking,” Gehrke said. “To hear our team talk about the stress that they see and experience, when they are working 10 shifts in a row and they don’t get to see their family and they are seeing the death and the despair that COVID is bringing to us, it’s really taking a toll across the board.”

Nemerson said Saint Alphonsus has 135 COVID-positive patients, which is 35% of its total inpatient volume.

He said Saint Alphonsus is experiencing record numbers of non-COVID and COVID inpatients. Nemerson said COVID inpatients could exceed 210 in the next three to four weeks, at the current rate.

“We, too, are at the maximum capability of providing care without stretching our teams further and further and further,” he said.

Nemerson said Saint Alphonsus is able to continue to deliver a reasonable standard of care, but that will decline simply because caregivers cannot care for patients fast enough.

“I’m scared for all of us,” he said.

Still, Nemerson said people should not avoid emergency care, and if they have medically necessary or time-sensitive procedures, Saint Alphonsus will always be there for them. He said, to his knowledge, no patient in Idaho has been taken off life-support therapy in order to provide that therapy to another patient who has a better prognosis.

“While that has yet to occur, if we continue on this path, it will,” Nemerson said.

As of Tuesday, there were more than 600 Idaho residents hospitalized with the virus as federal contract workers are being dispatched to support understaffed hospitals. There were 173 Idaho COVID patients in intensive care units statewide.

Last winter, hospitals statewide saw just more than 400 COVID patients at once before the surge quelled.

“Our hospitals and health care systems need our help. The best way to end crisis standards of care is for more people to get vaccinated. It dramatically reduces your chances of having to go to the hospital if you do get sick from COVID-19. In addition, please wear a mask indoors in public and outdoors when it’s crowded to help slow the spread,” Department of Health and Welfare director Dave Jeppesen said in a news release. “The situation is dire – we don’t have enough resources to adequately treat the patients in our hospitals, whether you are there for COVID-19 or a heart attack or because of a car accident.”

Not all hospitals will have to ration care under the declaration, as situations vary around the state and in different hospitals.

Kootenai Health has been operating in crisis standards of care for a little longer than a week, treating lower-level COVID patients in a former conference room and stretching staffing patterns to accommodate the surge.

There are 113 Panhandle residents hospitalized with the virus at Kootenai Health, and 34 of those COVID patients are in the ICU.

Staffing challenges have forced the Coeur d’Alene hospital to ask the state for resources. A medical team from the Department of Defense and contracted federal workers has arrived in the past week to help the hospital treat the surge of COVID patients.

The addition of 90 staff members is helping already exhausted nurses attend to the predominantly unvaccinated COVID patients who continue to come into the hospital seeking treatment, but additional staff will not be enough to keep the hospital out of crisis standards of care.

Hospital leaders have asked Idaho residents repeatedly to wear masks and get vaccinated to help stem the tide of COVID cases and hospitalizations that continues to rise statewide.

A look at local numbers

The Spokane Regional Health District reported 296 COVID-19 cases Thursday and one additional death.

There have been 795 deaths due to COVID-19 in Spokane County residents.

There are 231 COVID-19 patients in Spokane hospitals.

The Panhandle Health District had 183 new cases Thursday and reported 35 deaths over the course of recent days.

There have been 433 COVID deaths in Panhandle residents.

There are 113 Panhandle residents hospitalized with the virus.