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Crisis Standards of Care Deactivated for Most Idaho Hospitals
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The process to deactivate crisis standards of care began when healthcare systems in all but North Idaho began reporting that they had moved to contingency operations from Crisis Standards of Care conditions.
   
Tuesday, November 23, 2021
 

STORY AND PHOTO BY KAREN BOSSICK

Crisis Standards of Care ended Monday for hospitals in all regions of Idaho except North Idaho.

Crisis Standards remain in effect in the Panhandle Health District, which encompasses Boundary, Bonner, Kootenai, Benewah and Shoshone counties and the cities of Coeur d’Alene and Sandpoint.

Hospitals in northern Idaho began operating under Crisis Standards of Care a week before The Department of Health and Welfare enacted them for hospitals across the entire state on Sept. 16.

St. Luke’s is no longer in a crisis position. It has closed all of its surge units, now has room in the ICU, and has redeployed staff to home units, the hospital system’s chief medical officer Dr. Jim Souza told reporters in a virtual briefing Monday afternoon. Staff ratios and supply levels are adequate, and the hospital is even encouraging health care workers to take much needed time off—just in time for the holidays, he said.

Crisis Standards allow doctors to ration beds, ventilators and other types of treatment for those most likely to survive when staff and other hospital resources are stretched too thin to adequately treat everyone.

Idaho became the first state to enact them statewide in September as the number of new COVID-19 cases and hospitalizations spurred in part by the Delta variant forced hospitals to open COVID units in offices, classrooms and other non-traditional spaces and bring in federal workers and others to help provide care.

Only a few states have enacted Crisis Standards of Care since.

Health and Welfare Director Dave Jeppesen, who called Crisis Standards “a decision of the last resort,” told reporters that hospitals are still dealing with too-high numbers of COVID-19 patients. But caring for them and others, such as cardiac patients, is now more manageable.

All but the North Idaho hospitals are now operating under contingency operations, meaning they’re still stretched thin but not to the point of breaking. That said, numbers are improving in North Idaho, said Jeppesen.

Idaho had a high 793 hospitalized COVID-19 patients on Sept. 24. Since, hospitalizations have been decreasing—347 people were hospitalized with Covid on Nov. 17, according to the latest update on the state COVID-19 dashboard.

But Souza warned that the pandemic is not over and the number of patients being hospitalized for COVID could quickly rebound. In fact, COVID-19 patients still make up 21 percent of adult hospital admissions and 40 percent of ICU admissions at St. Luke’s, he said.

“We are not sharing a mission accomplished message,” he said. “We don’t believe this will be our last surge of COVID. I think all you need to do is look to North Idaho to see how volatile the situation remains. Or, look at what’s coming out of Western Europe. We are still in a contingency situation. We’re very busy.”

Dr. Patrice Burgess, executive medical director of Saint Alphonsus in Boise, concurred, saying Idaho probably wouldn’t have seen the surge if a significant portion of the population had been vaccinated.

“It is really a matter of our ability to get a significant portion of our population vaccinated and then also our ability to adhere to other precautions (such as wearing facemasks and washing hands),” she said. “That is what I see as our way out of this, and it is hard to watch the polarization around some of these measures that are really just basic science.”

Although Crisis Standards of Care have been lifted, it will be some time before healthcare systems return to full normal operations. The state is still providing such resources as healthcare personal from FEMA and other federal agencies.

But the respite gives St. Luke’s the ability to address a backlog of up to 8,000 non-emergency surgeries, such as open-heart surgeries, gallbladder surgeries, some cancer treatments and hip and knee replacements, that were postponed while the state was under Crisis Standards of Care.

St. Luke’s Wood River has been addressing some postponed surgeries in the past few weeks.

Even if St. Luke’s ran operating rooms at 120 percent, it would take six months to catch up on postponed procedures, Souza said, noting that his hospital system does about 50,000 surgical cases a year. The hospital has also seen an increase in substance abuse cases during the pandemic.

Souza praised healthcare workers, whom he said saved thousands of lives while coping with trauma, death and the unique stress of dealing with the COVID pandemic.

“The collective human effort that they pulled off in Idaho over the last five months is nothing short of remarkable,” he said.

Souza added that St. Luke’s will begin enforcing the employee vaccine mandate for influenza and COVID-19 now that the pressure on St. Luke’s hospitals is easing. Only 0.6 percent of St. Luke’s 17,000 employees—or 102 employees--have yet to get the vaccine or a medical or religious exemption. About  8 percent of employees received an exemption.

Employees will have a few weeks to get a vaccine or an exemption, Souza said.

In the two months Idaho was under Crisis Standards of Care, the state chalked up nearly 77,000 new cases of COVID.  More than 5,030 adults and at least 119 children were hospitalized with COVID. And more than 1,300 Idaho residents died of COVID.

About 25 percent of tests for COVID were positive at the peak.

To date, 3,846 Idahoans have lost their lives to COVID.

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