BY KAREN BOSSICK

You don’t often hear peanut butter lumped in with hospital care.

But Dr. Laura McGeorge did just that Thursday afternoon as she described health care under crisis standards of care.

“The care being provided is not the standard of care to which we have been accustomed,” St. Luke’s Health System medical director told reporters at a virtual press conference. “It’s like a peanut butter spread as we spread our resources more thinly.”

It’s been a week since Idaho became the first state in the nation to enact Crisis Standards of Care across the state to address hospitals that are bulging at the seams with COVID-19 and other patients.

A record 760 Idahoans were hospitalized for COVID-19 across the state on Monday—a record 202 of them in intensive care, according to the Idaho Department of Health and Welfare. The high during the previous surge was 496 on Dec. 10, 2020.

St. Luke’s hospitals on Thursday hit a record of 315 hospitalized COVID patients—tenfold the 30 patients on any given day during the end of July.

Crisis Standards provide guidelines doctors can use in triaging patients to save the most lives possible when they don’t have enough ventilators, ICU beds and other resources. They also limit the liability faced by medical providers as they make those tough decisions.

Doctors at St. Luke’s Magic Valley were nearly forced to ration care this past week when six of its patients suddenly deteriorated and there were no ICU beds available, according to Dr. Jim Souza, chief physician executive for St. Luke’s Health System. Doctors were eventually able to find beds for them in other hospitals.

Hospitals are stretching nurse-patient ratios, meaning patients don’t see nurses as often as they would under normal circumstances. They’re bringing in less experienced nurses from other areas to assist regular nursing staff. And they’re asking nurses to work extra shifts and to work longer and harder, said Dr. Frank Johnson, chief medical officer for St. Luke’s Boise, Elmore and McCall.

Doctors have had to delay cancer, pediatric and other surgeries to create additional capacity. And patients have received care in makeshift surge units opened in the ambulatory surgery center across the street from the hospital in Boise and in other non-traditional places, said Johnson. Some COVID patients who might be hospitalized under normal circumstances are being sent home with portable oxygen.

St. Luke’s had 24 of 101 ventilators available Thursday, but that can change on a dime, Johnson said. Hospitals have had to move around BiPap machines. And even the Boise hospital is reaching its limits regarding the amount of oxygen being pumped into rooms.

“The building itself isn’t designed to withstand all the oxygen coming through,” Johnson said.

ICU care is incredibly expensive and COVID hospitalizations may last longer than a month, Johnson noted. And COVID patients who are released don’t just jump back to their normal lives. Some may be disabled for life because of damage to their lungs, he added.

In addition, some hospitals have had to work with coroners to find places for those who have died.

“We’re running as hard as we can … and, at least so far, we’ve been able to spread our resources around so everyone who has come to our hospitals can get care,” Johnson said. “But we are spread pretty thin.”

BOOSTER VACCINES

St. Luke’s has been fielding a lot of questions about vaccine boosters, said McGeorge. The FDA approved a third shot a month ago for those who are immunocompromised, such as organ transplant recipients who didn’t get as much protection from the initial two-dose regimen of COVID vaccines as others. St. Luke’s is currently providing those shots.

The FDA just this week approved emergency use authorization for a third Pfizer vaccine dose for those who are at higher risk than most but are not immunocompromised. The new group includes those ages 65 and older, those who are even mildly obese and those who are diabetic. It also includes those working in an occupation that would put them at severe risk of getting COVID, such as health care workers, police and teachers.

“There is no emergency for people to run out and get the third dose,” said McGeorge, offering that people should contact their primary care physicians for questions about the third dose.

McGeorge added that she expects the FDA to make recommendations later regarding a third dose for Moderna and a second dose for Johnson & Johnson. More testing needs to be done on whether providers can mix and match the shots.

MONOCLONAL ANTIBODY THERAPY

These synthetic antibodies, given to those at the beginning of a COVID infection for those who are at moderate to severe risk, have proven very helpful in staunching COVID infection. However, McGeorge questioned why anyone would consider the treatment better than a vaccine since the antibodies are synthetic.

The antibody treatment, which is sometimes provided like an insulin injection, costs $2,100, according to some reports. And there is a limited supply. They are being advised for those who are mildly to severely overweight, have high blood pressure, are in their third trimester of pregnancy or are immunocompromised.

“If you catch it early and are at high risk, absolutely we want you to get the antibodies,” McGeorge said.

VACCINE MANDATES

St. Luke’s has not paused vaccine requirement for staff but, rather, delayed them because of the COVID surge, said Johnson.

“We’re looking at crisis standards of staffing,” Johnson said. “We need those staff right now so they’re continuing to work with additional safety measures.

All of St. Luke’s physicians are vaccinated. Most of the unvaccinated are in roles like housekeeping or reception, according to Souza.

PEDIATRIC CASES

Three of the 80-plus people who died of COVID-19 at St. Luke’s hospitals this month were in their 20s, according to Souza.

St. Luke’s Children’s Hospital had five children between the ages of 11 and 17 with COVID on Thursday. It is seeing surge in pediatric cases requiring hospitalization, including respiratory diseases, with 10 of them in intensive care unit.

HITTING HOME

Health and Welfare Director Dave Jeppesen told reporter during a COVID briefing last week that his mother got to experience what Crisis Standards of Care is like for herself when she had a stroke the day her son enacted them across the state. She had to wait in the ER longer than usual because of other patients receiving treatment and she received X-rays to assess whether she’d broken bones in a non-traditional area.  Instead of staying in the hospital overnight for observation, as she would have under normal circumstances, she was discharged that day.

WE’RE NO LONGER ALONE

Alaska became the second state to adopt crisis standards for its hospitals on Wednesday.

WHEN WILL IT END?

The Idaho Department of Health and Welfare reported 1,344 new cases of coronavirus and 32 COVID-related deaths on Thursday. But there’s been a slight decrease in the percentage of people testing positive for COVID this week over last, when it was extremely high with a third of those being tested testing positive, said McGeorge. The urgent care volume in southern Idaho is also down slightly.

The COVID detected in Boise’s wastewater treatment facility is also down slightly, indicating that new cases may be slowing as the vaccination rates creep up, Johnson added.

“We don’t know if that’s a blip or if we’re starting to see a change,” McGeorge said. “We won’t know for a couple weeks.”