Idaho rations health care statewide amid massive COVID surge
By The Associated Press
9/16/2021
BOISE, Idaho — Idaho public health leaders on Thursday expanded health care rationing statewide amid a massive increase in the number of coronavirus patients requiring hospitalization.
The Idaho Department of Health and Welfare made the announcement after St. Luke’s Health System, Idaho’s largest hospital network, on Wednesday asked state health leaders to allow “crisis standards of care” because the increase in COVID-19 patients has exhausted the state’s medical resources.
Idaho is one of the least vaccinated U.S. states, with only about 40% of its residents fully vaccinated against COVID-19. Only Wyoming and West Virginia have lower vaccination rates.
Crisis care standards mean that scarce resources such as ICU beds will be allotted to the patients most likely to survive. Other patients will be treated with less effective methods or, in dire cases, given pain relief and other palliative care.
Thursday’s move came a week after Idaho officials started allowing health care rationing at hospitals in northern parts of the state.
“The situation is dire – we don’t have enough resources to adequately treat the patients in our hospitals, whether you are there for COVID-19 or a heart attack or because of a car accident,” Idaho Department of Welfare Director Dave Jeppesen said in statement.
He urged people to get vaccinated and wear masks indoors and in crowded outdoor settings.
“Our hospitals and healthcare systems need our help. The best way to end crisis standards of care is for more people to get vaccinated. It dramatically reduces your chances of having to go to the hospital if you do get sick from COVID-19,” Jeppesen said.
One in every 201 Idaho residents tested positive for COVID-19 over the past week, according to a tally by Johns Hopkins University. The mostly rural state ranks 12th in the U.S. for newly confirmed cases per capita. More than 1,300 new coronavirus cases were reported to the state on Wednesday, according to the Idaho Department of Health and Welfare.
Hospitalizations have skyrocketed. On Monday, the most recent data available from the state showed that 678 people were hospitalized statewide with coronavirus.
Meanwhile, the number of COVID-19 patients in intensive care unit beds has stayed mostly flat for the last two weeks at 70 people each day — suggesting the state may have reached the limit of its ability to treat ICU patients.
Though all of the state’s hospitals can now ration health care resources as needed, some might not need to take that step. Each hospital will decide how to implement the crisis standards of care in its own facility, public health officials said.
Kootenai Health in the city of Coeur d’Alene was the first hospital in the state to officially enter crisis standards of care last week.
At the time, Chief of Staff Dr. Robert Scoggins said some patients were being treated in a conference center that had been converted into a field hospital. Others received treatment in hallways or in converted emergency room lobbies. Urgent and elective surgeries are on hold across much of the state.
On Wednesday, nearly 92% of all of the COVID-19 patients in St. Luke’s hospitals were unvaccinated. Sixty one of the hospital’s 78 ICU patients had COVID-19. St. Luke’s physicians have pleaded with Idaho residents for months to get vaccinated and take steps to slow the spread of coronavirus, warning that hospitals beds were quickly running out.
Public health officials have warned Idaho residents for weeks to take extra care to ensure they don’t end up in hospitals. Last week, Jeppesen said residents should take their medications as prescribed, wear seatbelts and reconsider participating in any activities such as cycling that could lead to injuries.
The health care crisis isn’t just impacting hospitals — primary care physicians and medical equipment suppliers are also struggling to cope with the crush of coronavirus-related demand.
One major medical supplier, Norco Medical, said demand for oxygen tanks and related equipment has increased, sometimes forcing the company to send patients home with fewer cylinders than they would normally provide. High-flow oxygen equipment — normally used in hospital or hospice care settings — is also being more frequently requested for at-home patients, said Norco President Elias Margonis.
“It seems like they’re discharging aggressively to free up beds for new patients coming into the hospitals,” Margonis said. “What that means is we’ve seen an uptick of the at-home liter flow rate of oxygen.”
Margonis spent much of his morning on the phone with public health leaders and hospitals, trying to determine how the crisis standards of care will change the way patients are discharged from hospitals. Already, the company has seen an increase in customers seeking specialty oxygen equipment that flows at a rate of 8, 12 or 20 liters per minute rather than the standard 4 or 5 liters per minute, he said.
“When someone goes home, we bring their bed, we bring their wheelchair, we bring their cannula, their oxygen,” Margonis said. “This is where we’re saying, it’s important that you can’t just discharge the problem, even if the patient is on the mend and on the way to getting healthy. To recover, they need the right support.”
Primary Health Medical Group, Idaho’s largest independent primary care and urgent care system, late last month was forced to shorten operating hours because its waiting rooms were so packed with patients that staffers were staying hours past closing in order to see them all. Meanwhile, the company was dealing with higher-than-normal numbers of staffers out sick because they had been exposed to coronavirus in the community or had symptoms and were awaiting tests. Vaccination provides strong protection against becoming seriously ill with coronavirus, but the highly contagious delta variant can still cause “breakthrough” cases in vaccinated people.
As case numbers continued to increase, three of Primary Health Medical Group’s 21 clinics in southwestern Idaho have had to stop operating on weekends, said CEO Dr. David Peterman.
Now the medical group is also preparing to monitor its patients who are released earlier than they normally would be from the hospital after emergencies, Peterman said.
“We will see more visits with patients that are avoiding the emergency room and patients who are sicker and need more care,” Peterman said. “We are setting up a system right now to make sure over this weekend that we are immediately notified if one of our patients is discharged early from the hospital so we can make sure those patients are OK.”
Resources have been exhausted across the medical system, Peterman said.
“This is heart-wrenching. I’ve practiced medicine in southwest Idaho for 40 years and I have never seen anything like this,” he said. “I feel for the doctors and the nurses and the staff in the hospital who are making very difficult decisions.”
1 in 500 US residents has died of Covid-19
By CNN Wire
9/15/2021
(CNN) — The United States has reached another grim milestone in its fight against the devastating Covid-19 pandemic: 1 in 500 Americans have died from coronavirus since the nation’s first reported infection.
As of Tuesday night, 663,913 people in the US have died of Covid-19, according to Johns Hopkins University data. According to the US Census Bureau, the US population as of April 2020 was 331.4 million.
It’s a sobering toll that comes as hospitals in the US are struggling to keep up with the volume of patients and more children are grappling with the virus. In hopes of managing the spread and preventing more unnecessary deaths, officials are implementing mandates for vaccinations in workplaces and masking in schools.
They are fighting against a sharp upward trend in cases and deaths: The US is reporting a more than 30% increase in average daily cases and a near tripling of average daily deaths over the past month, according to data from the US Centers for Disease Control and Prevention.
But with only 54% of the population fully vaccinated, the rate of people initiating vaccinations each day has declined over the past month.
Health experts have hailed vaccinations as the best source of protection against the virus, noting that the majority of people hospitalized with and killed by Covid-19 are unvaccinated. In Pennsylvania, from January 1 to September 7, 97% of the state’s Covid-19 deaths were among unvaccinated people, Pennsylvania’s acting secretary of health said Tuesday.
Another layer of strong protection, experts say, is masking.
The CDC recommends people — even those fully vaccinated — wear masks indoors in areas with substantial or high community transmission. More than 99% of the population lives in a county with one of those designations.
In Ohio, where children’s hospitals are overwhelmed with Covid-19 and respiratory cases, Gov. Mike DeWine is encouraging schools to issue mask mandates since the state legislature has told him it would overturn any mandate he issued.
“Reasonable people may disagree about a lot, but we can all agree that we must keep our children in the classroom so they don’t fall behind and so their parents can go to work and not take time off to watch their kids at home,” DeWine said.
The combination of masks and vaccinations is the way to keep children in school, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told CNN Tuesday.
“If you surround the kids with vaccinated people and you have everybody wear a mask, you can get a situation where the children will be relatively safe in school,” Fauci told CNN’s Jake Tapper.
Fight brewing over vaccine mandates
In the effort to manage the spread of the virus, many officials and experts have promoted vaccine mandates — but others are opposing such measures.
New York issued an order in August requiring all health care workers be vaccinated against Covid-19 by September 27. But on Monday, 17 Catholic and Baptist medical professionals filed a federal complaint seeking to prevent the state from enforcing the mandate, saying they oppose getting the vaccine for religious reasons.
On Tuesday, a federal judge issued a restraining order temporarily suspending New York state from enforcing its vaccine mandate if health care workers claim a religious exemption.
Because the mandate does not require health care workers to receive their first dose of the vaccine until September 27, the judge’s order states the temporary restraining order “does not, as a practical matter, go into effect until that date.”
A hearing is scheduled for September 28.
After the ruling, New York Gov. Kathy Hochul’s press secretary, Hazel Crampton-Hays said in a statement that the governor is considering all legal options.
“Governor Hochul is doing everything in her power to protect New Yorkers and combat the Delta variant by increasing vaccine rates across the State,” Crampton-Hays said.
In Los Angeles, despite a mandate that all city employees be inoculated against the virus, nearly a quarter of the police force is seeking an exemption, according to Mayor Eric Garcetti’s office. Those who are not vaccinated will be required to show evidence of weekly testing and a negative COVID result if regularly reporting to work.
By November 1, Nevada workers who serve “vulnerable populations” must show proof of vaccination under a new emergency regulation passed Tuesday.
New hires must have at least one dose by their start date and must follow through on the required vaccination schedule to remain employed. Workers are allowed to ask for a medical or religious exemption.
Booster meeting won’t be a slam dunk
On Friday, the US Food and Drug Administration (FDA) will meet to discuss whether most Americans need a booster of their Covid-19 vaccine.
Unlike other meetings to discuss the vaccine, this one, with requests from Pfizer to authorize a third dose for most people, won’t be a slam dunk.
“This will be much messier than in December,” said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University. The FDA committee was quick to recommend authorization of vaccines made by Pfizer and rival Moderna last December.
When the FDA’s Vaccines and Related Biological Products Advisory Committee meets Friday, it will be presented with dueling data, some of it suggesting there’s a need for boosters, but other pieces of data suggesting there is no such need.
Three separate articles published last week in the CDC’s Morbidity and Mortality Weekly Report suggest that we don’t need boosters.
On the other hand, an Israeli study found that over time, the vaccines’ power to keep people from getting very sick with Covid-19 diminished. Looking at illnesses in the second half of July, that study found that those who’d received their second dose of Pfizer’s vaccine in March were 70% more protected against severe disease than those who received the second shot in January.
President Joe Biden announced plans last month to begin administering booster doses next week. While she wouldn’t say directly if that date would be met, CDC Director Rochelle Walensky said Tuesday she is hopeful about the timeline to get doses administered.
If the booster does get approved, experts will still have to wait and see how much protection is added by the third dose.
“I would hope that that would sustain us for an extended period of time, but I don’t know that right now,” Fauci said. “We’re just going to have to do the boost, and then follow people long enough to determine what the durability of that protection is.”
