STORY AND PHOTO BY KAREN BOSSICK

COVID GRAPH BY PAUL RIES

Monday night’s Facebook post by a respiratory therapist at St. Luke’s Hospital in Boise spread like wildfire.

“FYI. We just filled the last ‘clean ICU’ bed by 6pm today with an intubated patient from McCall. And we also just filled the last ‘covid ICU’ bed with a post heart attack patient. The rationing has started,” the therapist posted.

After weeks of warning that Idaho hospitals were about to burst, it seemed that the rationing was about to begin. Although, as Dr. Terry O’Connor of St. Luke’s Wood River pointed out earlier, the rationing of health care actually started when St. Luke’s hospitals began postponing and cancelling elective surgery and when St. Luke’s Magic Valley had to stop taking some patients and transferring others elsewhere.

St. Luke’s Boise did indeed fill its available beds Monday night. And it kept people needing intensive care beds in emergency department beds overnight waiting for ICU beds to open, Dr. Bart Hill, chief quality officer for St. Luke’s Health Systems, told reporters Tuesday.

But, he said, hospitals are holding their heads above water with the help of a big juggling act.

The emergency department can provide the same kind of care they would receive in ICU, he added. The downside of doing that is that those beds are full if additional patients show up needing them.

The ICU did keep a “code bed” open in case a patient suffered a heart attack and needed to be transferred to ICU, he added.

“If we don’t have an ICU bed, that’s a problem,” he added.

By Tuesday morning, the Boise hospital had four ICU beds become available but they were needed for four people coming out of emergency—not elective—surgeries, Hill said. Nampa had three available beds and Meridian, one, as of Tuesday morning.

The Nampa hospital on Monday had open beds but not enough staff to facilitate transfers on Monday, Hill added.

The good news is in Twin Falls where St. Luke’s Magic Valley has reduced its test positivity rate, thanks to increased social distancing and mask wearing in the community, Hill said.Its hospital, which was bulging at the seams, now has a capacity of 38 percent.

But, across the board, St. Luke’s hospitals continue to see a 30 percent positivity rate--way above the 5 percent positivity rate that gives them breathing room.

Hill said the hospital system has been taking steps to increase capacity. It has, for instance, postponed and cancelled joint replacement and other elective surgeries. But some necessary surgeries may become urgent if they’re put off too long.

The hospital also recently began monitoring patients’ blood pressure and other vital signs remotely. Currently 158 patients are being monitored—120 of them COVID-positive patients. But that is not an option for patients needing hospitalization, he said.

The hospital also has some other options, such as redeploying recovery room staff to critical care.

Hill said he would characterize hospital operations as “stressed but managing.”

Staff in the Wood River Valley and throughout St. Luke’s system are working long hours and picking up extended shifts. COVID patients are very sick patients so they require a lot of attention. Since family members can’t visit them, often the staff is with them at the end of life so that’s taking its toll, Hill said.

Magic Valley nurses are experiencing a level of deaths they never have.

And staff are getting sick, as well. A week ago, St. Luke’s Health Systems had an average 80 staff out a day with COVID.  This week that number is up to 120.

Staffing very definitely affects capacity of St. Luke’s Wood River, said Wood River’s public information officer Joy Prudek.

“In addition, we had staffing shortages prior to COVID, partially due to the lack of housing and affordability to live in the valley,” she added. “We are actively working to address that issue.  We have utilized travelers, as well. But, as you can imagine, they are in high demand across the nation.”

Prudek added that Wood River’s capacity is highly dependent on the hospitals it transfers patients to for COVID or specialized care.

“Anyway, 10, 12or 14 patients may actually be our cap given staffing and other resources.”

Hill said doctors are “very concerned” that they will see an increase in hospitalizations two weeks from now stemming from people getting together with family and friends outside their immediate household for Thanksgiving. Right now, he said, Boise and Meridian’s ICUs are between 82 percent and 94 percent capacity, which is “pretty tight.”

Given that it would not be surprising to see state crisis standards setting guidelines for who doctors should give care to kick in.

“Really, all the Treasure Valley hospitals are at full capacity,” he said. “That’s when we’re at risk for the crisis standards.”