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North Idaho Hospitals Activate Crisis Standards of Care
Wednesday, September 8, 2021


The state of Idaho has activated crisis care standards at hospitals in North Idaho amidst a massive increase in COVID-19 hospitalizations there. The story was so noteworthy it attracted the attention of The Washington Post and other national media.

Hospital officials say a surge in COVID-19 cases fueled by the Delta variant and the area’s lowest vaccination rates in the state have left a shortage of hospital beds and medical personnel to take care of patients.

Hospitals in southern and eastern Idaho have not asked for crisis care standards yet, but Idaho Health and Welfare Director Dave Jeppesen warned that hospitals in the rest of Idaho are dangerously close to enacting crisis standards of care.

Hospitals caring for COVID patients saw a record high 496 COVID hospitalizations, 154 COVID patients in ICUs and 89 COVID patients on ventilators on Sept. 4, he said.

“And we expect these numbers to get worse,” he added. Jeppesen added that Spokane hospitals are too crowded to help and that any attempt by Treasure Valley hospitals to assist hospitals in northern Idaho could exacerbate the situation in the Treasure Valley.

Health and Welfare’s crisis care committee met late on Labor Day to vote on activating crisis standards of care at the request of Kootenai Health in Coeur d’Alene. The decision—considered a last resort--means that hospital beds, medicine and equipment like ventilators may be allocated to those deemed most likely to survive.

Designed to give doctors guidance on which patients to prioritize, it means that someone hurt in a car accident may have to be transferred to another hospital than the one he initially arrived at because there are no beds left in the first hospital. It means someone struggling to breathe because of COVID may not get a ventilator because someone else may have a better chance of survival. It means that those who go to the hospital for emergency care can expect a longer wait and they may be seen in a classroom or hallway. And it means that someone near death may receive only comfort care, rather than the life-saving equipment that might save them.

Dr. Robert Scoggins, chief of staff at Kootenai Health and a pulmonary and critical care physician, told reporters at a statewide COVID briefing Tuesday afternoon that his hospital has been doing things “way outside of normal” for some time.

His hospital had 25 COVID patients at the beginning of August. On Monday it had 113 COVID patients. Before the surge, the hospital had 190 beds, which were always more than 80 percent full of patient recovering from heart attacks, strokes, surgeries and respiratory issues.

It currently has 39 COVID patients in critical care—19 on ventilators and 20 on high-flow oxygen and, possibly, destined for ventilators. Normally the hospital has 26 ICU beds, but it has converted 32 medical-surgical beds into ICU beds to address the demand for COVID patients and an additional 11 non-COVID patients needing intensive care.

The hospital has converted a conference center to care for 22 patients, ripping up the carpet and installing portable wash stations and beds. It’s expanded its ER lobby to allow more capacity for ER patients, and it’s moved physicians and nurses into roles they don’t normally do. In some cases, one critical care nurse is caring for six patients with the help of two non-critical care nurses when the nurse would normally be caring for one ICU patient.

Its test positivity rate ranges between 25 percent and 30 percent—way above the 5 percent that means a community is , on the brink of community spread. The COVID patients range from 18 to 81, and the majority are under 65.

“It’s quite disturbing to see younger patients declining, and they’re what I would consider healthy,” Scoggins said. “They’re normal, everyday North Idaho people.”

“It’s hard to think about all the things we’ve done in last year and a half,” he added. “It’s definitely not something we train for. A lot of the nurses we have are in their 20s and 30s and they’ve never seen anything like this. To see the illness that goes along with COVID, how sick those patients are, now to see the young…we’re already seeing some nurses leave the profession. Many hospital workers are getting so frustrated with what’s going on outside the hospital. There’s definitely a lack of support for health care workers right now.”

Scoggins said he had just gotten off a week in the ICU taking car of some of the sickest patients he’s ever taken care of. They’re having cardiac arrests when they can’t get enough oxygen. Their only contact with family, unless they’re about to die, is through iPads

“I’ve had several young patients on ventilators… a couple have passed away. Those younger patients do affect the staff quite a bit,” he said. “It’s traumatic to see young people with many years of life in them passing away. And there’s concern we will see even younger patients as schools open.”

The crisis standards of care apply right now to Benewah Community Hospital, Bonner General Hospital, Boundary Community Hospital, Kootenai Health ad Shoshone Medical Center in the Panhandle Health District. North Central Health District hospitals in such towns as Lewiston are also affected, including Clearwater Valley Hospital, Gritman Medical Center, St. Joseph Regional Medical Center, St. Mary’s Hospitals and Syringa Hospital.

Gov. Brad Little called the activation of crisis care standards “an unprecedented and unwanted point in the history of our state.”

"More Idahoans need to choose to receive the vaccine so we can minimize the spread of the disease and reduce the number of COVID-19 hospitalizations, many of which involve younger Idahoans and are preventable with safe and effective vaccines,” he added.

Jeppesen added that Idahoans can stem the flow of COVID patients to hospitals by wearing a face mask when inside public places and outside where there’s a lot of people.

“Wear your seatbelt, take medications as prescribed, reconsider high-risk activities that could land you in the hospital,” he added.

Having students and staff wear masks is the best way to keep schools open and safe, said State Epidemiologist Christine Hahn, who added that she feels comfortable going to the grocery store as a vaccinated person wearing a mask.

“My mask protects you. Your’s protects me. If we all did that, we’d be okay,” said Dr. Kathryn Turner.

At least four Idaho schools, including schools in Idaho City, Payette and Bruneau/Grandview, have closed due to the increase number of positive COVID-19 cases and staff and students in quarantine. West Ada Schools which had allowed students and staff to opt out of wearing masks, announced this week that teachers will be required to mask given the spread of COVID in schools.

And the Nampa School District reported this week that 2,700 students were not in school on one day alone last week--more than the 2,579 students asked to quarantine during all of the 2020-21 school year.

Idaho ranks 42nd among the states in fully vaccinated adults with 49 percent of eligible residents vaccinated, according to the latest tallies provided by the Department of Health and Welfare. (Blaine County has 91 percent of its eligible residents vaccinated).

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