From the beginning, health care professionals everywhere feared not only a high death toll from COVID-19.
They dreaded the possibility of facing so many sick people at once that they couldn’t help them all. Even worse, they dreaded having to decide who gets an intensive care bed or ventilator or oxygen therapy — and who doesn’t.
Their nightmare has come to life in Idaho.
Last week, the governor authorized “crisis standards of care” in two regions in the northern part of the state where hospitals are being overwhelmed by COVID-19 patients. This week, the director of Idaho’s health department said three more regions would probably soon need the crisis standards.
The actions allow health care providers to assign “priority scores” to patients based on factors such as their likelihood of surviving if they receive the best care and equipment, and how many more years they would likely live. Some patients can be given only “comfort care.” The goal is to enable as many people as possible to survive.
“We have reached an unprecedented and unwanted point in the history of our state,” Gov. Brad Little said.
Pennsylvania finalized a similar plan early in the pandemic, but thus far hasn’t needed to use it. While Pennsylvania’s alarming summer surge continues to fill hospitals and ICU beds, a high level of resources remained available as of Thursday.
That’s not the case in Idaho, where 626 people were hospitalized with confirmed or suspected COVID-19 in the state of 1.85 million people, including 169 in intensive care, according to the Idaho Statesman. That’s 130 more hospitalizations than during the pandemic’s previous peak in the state last winter.
State officials doubt the present surge has peaked.
It’s unclear to what extent doctors and nurses are denying care or finding it impossible to provide care and equipment as they would normally.
However, at Kootenai Health, northern Idaho’s largest hospital, intensive care nurses with help from two less specialized nurses are each caring for up to six COVID-19 patients. Normally, there’s one ICU nurse for every patient.
The hospital also moved some COVID-19 patients to a make-shift ICU in a conference center and turned part of the ER lobby into treatment space. It has stopped doing elective surgeries, including urgent ones, and is straining to accept trauma patients needing transfer from smaller hospitals.
The situation is affecting all patients — not just those with COVID-19.
“Things that we would normally take care of very quickly, we may have to hold that off until we get more resources available for those patients,” Dr. Robert Scoggins, the chief of staff for critical care, told Boise State Public Radio News.
As in most other places, the vast majority of Idaho’s COVID-19 patients are unvaccinated, and the average age of patients who die has fallen significantly since the first half of the pandemic.
“It’s a much younger population losing their lives to COVID-19 this year,” said Kathryn Turner, Idaho’s deputy state epidemiologist, according to the Idaho Statesman.
The situation in Idaho gives insights into the politics surrounding COVID-19 and the real-life consequences.
Idaho is deep red. Its voters favored former President Donald Trump over President Joe Biden, 64% to 33%.
Little, the Republican governor, defeated his Democratic opponent by 22 percentage points in 2018, giving Republicans their seventh consecutive win in the race for governor.
Moreover, Idaho has one of the lowest COVID-19 vaccination rates, with just over half of eligible residents fully vaccinated.
Yet its situation shows that, when COVID-19 is at its fiercest, governors’ responses have much in common, regardless of political party.
Little, in his official announcement of the crisis standards, 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.”
Little reached out for help even before Idaho’s situation reached the breaking point.
In late August, he called in 220 federal health care workers and mobilized 150 members of his state’s national guard to help hospitals. The U.S. Department of Defense is sending a 20-person medical response team.
Early in the pandemic, Little ordered a partial shutdown, banned some large gatherings and urged residents to stay home. But the measures have ended, and Idaho businesses are mostly operating as normal.
Little has declined to impose new restrictions, saying those are best left to local communities to decide.
Idaho is the latest in a string of states to face COVID-19 surges that severely strained and in some cases overloaded their hospitals.
The surge is attributed to the more contagious delta variant, which originated in India and arrived in the United States around late winter. It has hit hardest in southern states, which also have lower levels of vaccination.
There were recent signs the national surge might have peaked, but cases turned upward again early this week.
Meanwhile, more states are considering the possibility of having to ration care as in Idaho. Last week the governor of Hawaii signed an order releasing hospitals and health care workers from liability if they have to ration care.
Early in the pandemic, Pennsylvania finalized plans for rationing resources in the event of shortage of things such as hospital beds and ventilators. As in several states, a points-based system generated an uproar from people with disabilities who worried they would be at a disadvantage. Gov. Tom Wolf and other state officials vowed there would be no such discrimination.
Thankfully, although Pennsylvania hospitals became severely strained during the surge that peaked in December and January, the emergency guidelines have thus far never been needed.
Even as Pennsylvania faces another troubling surge that has dramatically increased the number hospitalized and in intensive care, there is plenty of hospital capacity remaining, according to data posted by the state health department as of Thursday.
As of Thursday afternoon, 2,323 people were hospitalized with COVID-19 in Pennsylvania, including 560 in intensive care and 277 on breathing ventilators. However, the state said resources including 566 ICU beds and more than 4,000 breathing ventilators remained available.
A high level of vaccination among Pennsylvanians is credited with holding down hospitalizations and deaths.
Whereas in Idaho only about 61% of adults 18 and older have received at least one vaccine dose, the level is 84% in Pennsylvania.
The Associated Press contributed to this report.
READ MORE: COVID-19 kills more than 6,200 unvaccinated people in Pa., but only 213 who got the jab: state data
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