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Viewpoint: Idaho hospitals adjust to meet challenges of latest COVID surge

Leaders at Saint Al's and St. Luke's say a return to crisis standards of care is likely, if COVID case surge continues at current pace

BOISE, Idaho — With the current surge in coronavirus cases, Idaho hospitals are on a course to likely go back under crisis standards of care in the near future. Medical leaders from Saint Alphonsus and St. Luke's say the chances of making the move to crisis standards of care are good if the COVID case surge fueled by the omicron variant continues at its current pace. Under crisis standards, it is possible that non-urgent or less-urgent care may not be provided in order to ensure timely response to the most severe life-or-death emergencies.

At this time both case and hospitalization numbers are rising rapidly. This week Idaho set records for the most COVID cases reported in a single day. The state reported 3,266 new cases on Friday, which beat Wednesday's 2,821 news cases after it had already beat the single-day high set the day before. All three were higher than the previous single-day record set way back on December 9 of 2020.

So, our hospitals are once again under a heavy amount of stress. Saint Alphonsus announced it will temporarily close three urgent care clinics on weekends because of employees being sick with COVID or isolating because of possible exposure.

Leaders at both Saint Alphonsus and St. Luke's Health Systems say the number of staff who are out because of COVID has risen sharply in the last two to three weeks. Saint Alphonsus Chief Clinical Officer Dr. Steven Nemerson says three weeks ago 20 Saint Al's employees were on leave because of COVID. This Thursday that number hit 157. St. Luke's Chief Medical Officer Dr. Jim Souza says their number went from 10 people out three weeks ago to 250 employees out this Thursday.

Statewide as of January 10, 346 patients were hospitalized with a confirmed or suspected case of COVID-19. 93 were in intensive care units.

As of the morning of January 14, there were 116 COVID-positive patients at St. Luke's Medical Center facilities. Of those 116, 96 are in isolation for COVID because they are infectious. Another 20 had a positive COVID test during their hospital stay, but are no longer in isolation because they are no longer infectious or they have a non-COVID-related diagnosis. At Saint Alphonsus, 81 patients are COVID-positive out of a total of 448 patients.

An important note; a spokesperson for the Idaho Department of Health and Welfare says the state only counts a hospitalization as "COVID" if that person is there because of the virus. If they went into the hospital for something else, such as a birth or a broken bone, and then tested positive, Idaho does not count that as a COVID hospitalization.

Doctors Nemerson and Souza say current indications point to the "likely" need to reinstate crisis standards of care before long. They're preparing for the worst and hoping for the best.
"There's no evidence that we're coming close to a peak, and so on that basis, we expect to see increasing numbers of patients on an ongoing basis, and at some point, we'll require a move back into crisis standards of care, most likely," Dr. Nemerson said. "Of course, God willing, we will get lucky and see a peak and a plateau, but right now that's not predicted."

"If you ask me to do an over/under on it, I'd say the odds are more probable than not," Dr. Souza said. "Because of our learned experience so far, we know in every wave there's been a spike in cases, two weeks later hospitalizations, two weeks later deaths."

Because of the increasing number of COVID patients and staffing issues, Dr. Nemerson says Saint Al's is starting to limit some non-emergency surgeries and procedures on a selective basis. Dr. Souza says St. Luke's has not gotten to that point yet, but they're getting prepared.

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