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Blood Shortage Contributes to Enactment of Crisis Standards of Care
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Thursday, January 27, 2022
 

STORY AND PHOTO BY KAREN BOSSICK

A shortage of blood was one of the major factors that led the state to reactivate crisis standards of care among hospitals in southern Idaho earlier this week.

Some hospitals in the state say they have just one unit of blood in their inventory. And Saint Alphonsus, the state’s major trauma center, is fearful it may not have enough blood for potentially life-saving transfusions, said Dr. Steven Nemerson, chief clinical officer.

One major trauma can require an enormous amount of blood, and that could quickly trigger a blood crisis, Nemerson told reporters at this week’s COVID briefing hosted by the state.

A blood shortage affects not just trauma patients but some cancer patients who need blood product to stay alive and women who suffer complications delivering babies. The shortage will probably force hospitals to postpone surgeries and procedures requiring blood transfusions, Nemerson said.

A blood product conservation plan has been enacted to make sure blood product isn’t wasted or given unnecessarily. Doctors must consult with the hospital’s blood bank, to ensure each patient getting a transfusion meets stringent criteria.

The state hastily convened a critical blood supply task force on Friday to determine the causes of the shortages, share conservation strategies and figure out ways to solve the problem.

The blood supply shortage is a national issue caused by blood drives being cancelled by bad weather and staff shortages caused by COVID, as well as fears of COVID among blood donors. COVID-19-related illnesses is also impacting processing and transportation, said Elke Shaw-Tulloch, the state’s public health administrator.

Those who wish to donate can call up the American Red Cross Blood Donor app, visit https://www.redcrossblood.org or call 1-800-REDCROSS.

A “DIFFERENT, MORE DANGEROUS SURGE”

Nemerson said that the latest Omicron surge is different and more dangerous than previous surges. Not only is it rapidly infecting the community faster than hospitals have seen during the entire pandemic, but it’s infecting health care workers.

Staff shortages also played a major role in Saint Alphonsus asking the state to enact crisis standards. The hospital does not have the ability to stretch staff and move beds into conference rooms and other non-traditional facilities like it did with the Delta variant surge, Nemerson said.

Currently, Saint Alphonsus has between 117 and 169 employees out with COVID

“I lie awake trying to figure out how we’re going to take care of the next patient who comes through the door, whether COVID-related or not,” he said.

During the Delta surge, the concern was whether there would be enough ICU beds available. The Omicron variant is putting tremendous pressure on the entire healthcare system, said Dave Jeppesen, director of Idaho Health and Welfare.

Clinics are closing or shortening hours, long-term care facilities can’t take hospital discharges because of their own staff shortages and healthcare workers who have been infected or exposed to COVID are unable to come to work at the same time the number of COVID-19 patients are rapidly increasing, he said.

“If current trends continue, I expect crisis standards of care will be activated in the rest of the state,” he added, characterizing the state of Idaho hospitals as “fragile.”

Nemerson said 80 percent of COVID patients in his intensive care are unvaccinated; 10 percent are partially unvaccinated.

He told of one man who caught COVID from a younger member of his family after the older man declined to get vaccinated. The formerly healthy man ended up in the ICU with organ failure and was sent home this week with hospice care to spend his last days with his family.

“This situation would have been entirely different had he only been vaccinated,” said Nemerson. “This is not a single story. This is happening every week in our health system.

He said his colleagues are experiencing moral trauma attempting to save lives of patients who would not need hospital care if they had been vaccinated or if they’d protected themselves with masks and distancing.

“It's just not necessary," he said. “The vaccine protects and if everyone in Idaho was vaccinated, we wouldn’t be in this situation.”

TEST POSITIVITIES EXCEED 60 PERCENT

The state set a record 34.1 percent test positivity rate this week, and some hospitals and counties are reporting test positivities of 60 percent or more, meaning six of every 10 people getting tested are positive. Saint Alphonsus has a test positivity rate of 46 percent—well above the 5 percent rate that indicates a pandemic is under control.

The state has a backlog of 39,700 reports, Jeppesen said. While the state reports it’s averaging 94.1 cases per 100,000 people a day, officials estimate the real number is 258.7 cases per 100,000 Idaho residents. And that number does not include the results of at-home rapid test results or unreported cases.

“We estimate we would have had 29,800 new cases reported last week or just over 4,000 cases a day every day last week if all the cases were processed, he added.

ARE WE NEARING HERD IMMUNITY?

Dr. Kathryn Turner said between 60 percent and 70 percent of those donating blood have COVID  antibodies, but it’s hard to say what proportion of the population has immunity due to vaccinations or infection.

State Epidemiologist Christine Hahn said it’s difficult to know whether Omicron infections and vaccinations will lead to a herd immunity. And there’s no way to tell whether getting infected with Omicron will protect one against future variants. But it’s believed the high number of people with antibodies will slow down the spread of COVID at some point.

Nemerson said he’s been asked if someone should go out and get infected.

“Absolutely not. Vaccination is more protective. And infection could lead to severe illness, in addition to impacting the health system,” he said.

Modeling done by the Mayo Clinic predicts the Omicron surge will reach its peak nationwide by the first of February. On its heels is a new variant--Omicron BA.2, which has been detected in Washington, California, New Mexico and Texas.

But doctors believe it will not cause the degree of chaos, morbidity and mortality that the original Omicron did, Dr. Jacob Lemieux, an infectious disease specialist at Massachusetts General Hospital in Boston told USA Today.

FREE N-95 MASKS COMING TO A PHARMACY NEAR YOU

The State of Idaho is planning to distribute highly protective face masks, made free by the Biden Administration, to EMS agencies, public health districts and pharmacies across the state.

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