A few weeks after Idaho’s first-ever declaration of crisis standards of care, Gov. Brad Little took a call from Gloria, a woman in Kimberly.
“I have a question for you,” she said during a Sept. 28 AARP Idaho telephone town hall. “I got my vaccine. I rolled up my sleeve. I did my civic duty. Yet, I have a hip that came apart. I’m laying here in pain, and I can’t get … an operation to get it fixed” because of the COVID-19 surge driven by unvaccinated patients. “Isn’t that discriminating against me?” she asked.
The governor told Gloria she was one of many Idahoans suffering the consequences of a stubbornly low vaccination rate.
“You make a very valid point,” Little told her. As the delta variant raged through Idaho, unvaccinated people “are showing up and plugging up the hospitals,” he said. “So, good people like you can’t get your surgery. And you say, is it fair? It’s not fair at all, and I feel sorry for you.”
Gloria was one of thousands of Idahoans whose surgeries, medical procedures and treatments have been sidelined by the COVID-19 surge that began in July.
‘We are really pleading with everyone’
That surge forced Idaho into “crisis standards,” a framework for health care providers to use when they don’t have enough resources for all the patients who need them.
Even before hospitals reached that “crisis standards” breaking point, they began to shut down non-emergency surgeries. At the peak of the crisis, hospitals turned surgical areas into overflow bed space, or COVID-19 units. The “elective” surgeries put on hold weren’t nose jobs or tummy tucks; they were tumor removals, aortic aneurysm repairs, spine surgeries, joint replacements.
Idaho Director of Health and Welfare Dave Jeppesen on Monday announced that, with the exception of the northern region, Idaho hospitals no longer need to operate under crisis standards.
But doctors from Idaho’s largest health systems warn: Idaho isn’t back to normal. Hospitals have thousands of backlogged surgeries to work through, and they expect fallout from the COVID-19 surge. They’re also nervous about a coronavirus resurgence or a nasty flu season.
“We are really pleading with everyone to do their part, so that we don’t have this momentary relief and then go right back into a bad situation again,” said Dr. Patrice Burgess, Saint Alphonsus Health System executive medical director, said during a media briefing Monday.
“We are not sharing a ‘mission accomplished’ message,” said Dr. James Souza, St. Luke’s Health System chief physician executive.
‘This is a moment’ for ‘looking forward’
St. Luke’s is now in “contingency” mode. That means the eight-hospital system is abnormally full, and nurses and doctors are abnormally busy. About 21% of St. Luke’s adult hospital patients Monday were there because of COVID-19, Souza said. In the intensive care units, it’s even more pronounced: 40% of the patients are there for COVID-19, he said.
Before the pandemic, those beds would have been filled with patients recovering from now-delayed surgeries. The other beds? Those continue to be filled with sick and injured patients whose car crashes and strokes didn’t stop to make room for COVID-19.
Other hospitals around the state are also in contingency status, according to state health officials.
“We don’t believe this will be our last surge of COVID. We hope it’s the worst one,” he said. “I think all you need to do is look to North Idaho, to have insight into how volatile the situation remains. Or you could look at what’s coming out of Western Europe, the eastern seaboard, or now some of these hotspots like Michigan with early influenza outbreaks.”
St. Luke’s averages about 50,000 inpatient procedures per year, Souza said. That’s about 1,000 per week. Some are emergency, life-saving operations that surgeons did even during crisis standards; most aren’t. The health system began to delay procedures in August, after an already unusual year and a half.
“If we ran our operating rooms at 120% (capacity), we staffed them up, we ran them on weekends (or) longer into the days and evenings — even if we did that … it would take us about six months to work through that backlog,” Souza said.
Kootenai Health in Coeur d’Alene is the major hospital serving North Idaho, in the Panhandle region that remains under crisis standards.
A top medical executive from Kootenai Health told the Sun earlier this month that they were behind on procedures for more than 2,000 patients — even some who need open-heart surgery.
In addition to the backlogs, hospital officials expect more patients to end up in the hospital because their diabetes or heart disease or blood pressure wasn’t properly managed during the surge — either because they feared going to the doctor, or because procedures and appointments were delayed.
“It’s really worrisome, is the short story,” Souza said. “We expect to see a surge in suboptimally managed chronic disease.”
There’s also a “black cloud” of the pandemic, he said: new and worsened mental illness. If untreated, it could put more Idaho lives at risk.
It’s not ‘mission accomplished,’ but there is hope
Jeppesen said the lingering effect of crisis standards will be felt for a while. The number of people waiting for care is “in the thousands,” he said during a media briefing last week.
“This, in my mind, is one of the most pressing topics right now, is really the backlog of medical procedures — primarily surgeries — that have been delayed,” Jeppesen said. “I want to just emphasize that life-threatening or critical surgeries have continued. I don’t know of any situations where … hospitals have not been able to take care of something that was truly urgent or truly life threatening. But it’s going to take a long time to catch up on that backlog.”
He stressed, as others have, that Idaho may avoid a repeat crisis if people follow public health recommendations. That includes getting immunized against the coronavirus and influenza.
Burgess described how her optimism waxed and waned as she witnessed this pandemic, including the resistance to vaccines.
The 1918 influenza pandemic took three years to resolve, she said. She’d hoped the record-fast development of safe and effective vaccines would abbreviate the COVID-19 pandemic.
That didn’t happen.
Instead, the virus, and vaccines to keep it from killing people, became polarized, she said.
“But I think there is a light at the end of the tunnel,” she said. “I don’t yet know exactly when that is, but I do think we’ll get there.”
Audrey Dutton, senior investigative reporter, joined the Idaho Capital Sun after 10 years at the Idaho Statesman.