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COVID Surge Forces Health Rationing    09/17 06:24


   BOISE, Idaho (AP) -- In another ominous sign about the spread of the delta 
variant, Idaho public health leaders on Thursday expanded health care rationing 
statewide and individual hospital systems in Alaska and Montana have enacted 
similar crisis standards amid a spike in the number of unvaccinated COVID-19 
patients requiring hospitalization.

   The decisions marked an escalation of the pandemic in several Western states 
struggling to convince skeptical people to get vaccinated.

   The Idaho Department of Health and Welfare made the announcement after St. 
Luke's Health System, Idaho's largest hospital network, 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.

   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.

   A hospital in Helena, Montana, was also forced to implement crisis standards 
of care amid a surge in COVID-19 patients. Critical care resources are at 
maximum capacity at St. Peter's Health hospital, officials said Thursday.

   And earlier this week Providence Alaska Medical Center, Alaska's largest 
hospital, also started prioritizing resources.

   Thursday's move in Idaho came a week after state 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 health care systems need our help," Jeppesen said.

   In Idaho's St. Luke's Health System, patients are being ventilated by hand 
-- with a nurse or doctor squeezing a bag -- for up to hours at a time while 
hospital officials work to find a bed with a mechanical ventilator, said chief 
medical officer Dr. Jim Souza.

   Others are being treated with high-flow oxygen in rooms without monitoring 
systems, which means a doctor or nurse might not hear an alarm if the patient 
has a medical emergency, he said. Some patients are being treated for sepsis -- 
a life-threatening infection -- in emergency department waiting rooms.

   The normal standards of care act as a net that allows physicians to "carry 
out the high wire acts that we do every day, like open heart surgery and bone 
marrow transplants and neuro-interventional stroke care," Souza said. "The net 
is gone, and people will fall from the high wire."

   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.

   Hospitalizations have skyrocketed. On Monday, the most recent data available 
from the state showed that 678 people were hospitalized statewide with 

   Meanwhile, the number of COVID-19 patients in intensive care unit beds has 
stayed mostly flat for the last two weeks at 170 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.

   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.

   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.

   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, has been 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.

   Now the medical group is also preparing to monitor patients who are released 
from hospitals earlier than normal or trying to avoid emergency rooms 
completely, said CEO Dr. David Peterman, and they will likely be sicker and 
need more care.

   "This is heart-wrenching. I've practiced medicine in southwest Idaho for 40 
years and I have never seen anything like this," he said.

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