A Covid-19 patient in the Medical Intensive care unit (MICU) at St. Luke's Boise Medical Center in Boise, Idaho, is being treated for the coronavirus. Idaho public health leaders have activated "crisis standards of care" for the state's northern hospitals because there are more coronavirus patients than the institutions can handle. Since the Idaho's Department of Health and Welfare made the original announcement on September 7, the authorities extended the decision to include all hospitals in the state. (AP Photo/Kyle Green, File)

Idaho’s implementation of rules to help allocate care in hospitals that are overrun with Covid-19 patients started in rural North Idaho and spread to the entire state.

The Idaho Department of Health and Welfare (DHW) announced at the beginning of September that hospitals in two health districts covering the panhandle would use “crisis standards of care” due to shortages of staff and beds caused by a surge in Covid-19 hospitalizations.

Since then, the state expanded the crisis-care order to all hospitals in the state. Crisis Standards of Care are initiated under conditions set by the state that allow for delivery of care under extraordinary circumstances.

Brock Slabach, chief operations officer at the National Rural Health Association, said crisis standards of care are used only in extreme situations and helps hospitals ethically decide which patients to allocate their limited resources like beds, equipment, and supplies to.

“When supplies are limited, crisis standards of care is a mechanism states have to care for the most patients while making the most efficient use of its resources,” he said.

Slabach said it was the first time during the pandemic that any state had activated the crisis standards of care. The last time he remembers a hospital or a hospital system activating these standards was after Hurricane Katrina when hospitals along the Gulf Coast and in New Orleans initiated it.

In Idaho, officials said, the situation facing hospitals in the state is dire enough to activate the crisis standards.

“Crisis standards of care is a last resort. It means we have exhausted our resources to the point that our healthcare systems are unable to provide the treatment and care we expect,” DHW Director Dave Jeppesen said in a statement. “This is a decision I was fervently hoping to avoid. The best tools we have to turn this around is for more people to get vaccinated and to wear masks indoors and in outdoor crowded public places.”

Idaho ranks 49th out of all 50 states and the District of Columbia for vaccination rates, ahead of only Alabama. Only 41% of Idaho’s population has been fully vaccinated, according to the Centers for Disease Control and Prevention (CDC). More than 2 million doses of the vaccine have been distributed in the state, but only 1.58 million have been administered.

State data indicated that 486 people were hospitalized in 43 hospitals across the state, as of September 22, with 146 patients in Intensive Care Units. The state reported just 16 ICU beds available that day, up from a low of six on Sept. 10. 

As of September 22, the state has recorded 2,753 deaths attributed to Covid. 

With a population of 1.8 million people, Idaho has recorded more than 250,955 cases of Covid since March. On September 24, the state recorded 1,646 confirmed or probable Covid cases. On September 8 and 10, the state recorded more than 1,500 cases each day, the highest number of cases since a peak at 1,604 on September 2.  The previous peak was 2,298 in December 2020, which fell to as low as 22 in June 2021. 

In Clearwater County, population 8,756, more than 1,524 cases of Covid were either confirmed or probable on that day, leaving the county with a rate of 17,228 cases for every 100,000 people, the third highest in the state, behind Lewis County at 17,717, and Madison County at 19,983.6. 

“We have reached an unprecedented and unwanted point in the history of our state,” Idaho Governor Brad Little said. “We have taken so many steps to avoid getting here, but yet again we need to ask more Idahoans to choose to receive the Covid-19 vaccine. 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.”

Like for those Idaho hospitals activating the crisis standards, the biggest issue across rural hospitals, Slabach said, was a shortage of staff.

Additionally, the length of time Covid patients spend in the hospital adds to the problem. The normal course of treatment for a hospitalized Covid patient is two to three weeks, he said. A surge in patients who need longer treatment times puts stress on the system.

“It’s easy to set up beds,” Slabach said. “But the problem is hospitals don’t have the staff to take care of the patients in the extra beds.”

For rural residents, the best course of action, not just for themselves, but for their neighbors, Slabach said, was to take steps to avoid catching the disease. Masking, getting vaccinated can help keep the patient volumes down, he said.

Preventing hospitalization due to Covid can help others who may not have Covid, he said.  

Slabach said that while rates of transmission are declining in some areas of the country, like the South, rates are increasing in areas like the Northwest and Northeast.

Hospitals in Nebraska, Georgia, Idaho, Maine, South Carolina, North Carolina, and Indiana have shut down non-emergency surgeries during the month of September. In Kentucky, Governor Andy Beshear has activated more than 300 National Guard members to help with non-clinical duties at 21 hospitals throughout the state, including rural hospitals like St. Claire Regional Medical Center in Morehead, and Pikeville Medical Center.

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