BOISE — Idaho state officials are pleading with the public to get vaccinated against COVID-19 as cases surge once again. Idaho Department of Health and Welfare officials earlier this week warned that hospitals are full, some just two weeks away from using “crisis standards of care,” otherwise known as health care rationing or triage.
Idaho Department of Health and Welfare Director Dave Jeppesen could activate the plan if the state’s health care systems become overwhelmed. Here’s what you need to know.
How did we get here?
A combination of Idaho’s low vaccination rate and a highly contagious delta variant of COVID-19 has brought cases raging again, more acutely and in a younger population. Now, children under 12 ineligible to get vaccinated against the virus are most vulnerable.
Cases fueled by the delta variant are filling emergency rooms and ICU beds. If Idaho continues on its current path, the state could see 30,000 COVID-19 cases a week by mid-October, according to the Department of Health and Welfare. The state’s peak was about 1,500 cases per day in December. That’s also when flu season gets going, which will complicate the situation.
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The further down this road we go, the more likely it is that crisis standards will be employed. There has been an uptick in some age groups — those 12 to 17, 35 to 44, and 65 to 74 — getting a COVID-19 vaccine. But only about 52% of the eligible population have received at least one dose in Idaho as of Friday, far lower than the national average of 70%.
What is ‘crisis standard of care?’
A committee of medical administrators, doctors and legal and public health professionals, as part of the state’s Disaster Medical Advisory Committee, set a plan in June 2020 for what to do when there is a limited supply of health care resources. The framework is intended to be used when “a disaster event overwhelms usual health and medical capabilities and capacities, resulting in an inability of the health care system to provide the standard levels of care to patients,” according to the document.
Idaho’s crisis standards of care plan is 48 pages long, with an additional 41-page guide and a 42-page set of checklists. You can download them by visiting the Idaho Department of Health and Welfare’s Emergency Preparedness page.
The state also created guidelines for nursing homes, should they need crisis standards of care.
Crisis standards won’t just apply to people with COVID-19. They will apply to patients who need medical care for any reason, such as car crashes, heart attacks, strokes and influenza.
Will hospitals turn patients away?
Hospitals likely won’t get to that point. Hospital officials have maintained that they would provide as much care as they can and provide treatments to keep patients comfortable, even if they’re denied a resource. Health care providers would also maintain contact with the patients, who could be brought back even if they can’t be treated immediately.
Activating the Crisis Standards of Care Plan may not mean shutting down a certain kind of treatment or service. Depending on the situation, the standards may apply to just one health care resource — such as oxygen or ventilators once hospitals begin to run short — or one region. But if the situation doesn’t improve, these standards likely would be activated statewide after hospitals ran out of resources they could share, Jeppesen has said.
But patients, regardless of diagnosis, would likely face significantly longer wait times for care. Smaller health care centers also may not be able to accept transfers from outside hospitals, according to the Department of Health and Welfare. Rural hospitals especially would suffer, the department said.
“Rural hospitals would likely need to care for higher complexity patients than they are used to during crisis standards of care and would likely struggle to even transfer traumas, strokes, or heart attacks,” DHW said.
Will people who didn’t follow COVID-19 guidelines be denied?
No, they will be prioritized the same way as people who faithfully followed the guidelines.
It is against the law and against medical ethics for Idaho’s health care system to triage patients based on things like politics, where they live or whether they obeyed mask mandates.
Has this happened in Idaho before?
No. These standards were created for Idaho in June 2020. Hospitals were close to implementing the plan last fall, but COVID-19 cases dipped just in time to prevent moving into crisis standards.
The use of crisis standards is extremely rare in the U.S. During the surge last summer, Arizona became the first state to activate crisis standards in July 2020. Several cities in Texas came close but were able to avoid that decision.
Who will be first, who will be last in line?
According to the plan, priority would go in order of:
- Children up through 17 years old.
- Pregnant women with a viable pregnancy, at more than 28 weeks of gestation.
- Adults by age, from younger to older: age 18-40, age 41-60, age 61-75 and 76 and older.
- Patients who “perform tasks that are vital to the public health response of the crisis at hand, including, but not limited to, those whose work directly supports the provision of acute care to others.”
- A lottery, or “random allocation,” if there is still a tie after going through the first four priority criteria.
The crisis standards of care may give Idaho hospitals a defense in lawsuits against them over patient care during the pandemic, Jeppesen told the Statesman in 2020.
They could point to the crisis standards of care activation and say, “we essentially were operating under unique circumstances that required us to depart from the usual standard of care, given the level of resources that were in the community,” Jeppesen said.
