Coronavirus patients are flooding and straining hospitals across the United States, especially in the western states, where administrators are placed in the position of having to ration care as their facilities are pushed to their breaking point by the delta variant.
Alaska last week joined Idaho in adopting statewide crisis care standards that provide guidance to health care providers making tough decisions about how to allocate limited resources. Several Montana hospitals have either activated crisis care standards or are considering it as the state is hit by COVID-19.
Under the guidelines, providers can prioritize treatment of patients based on their chances of recovery, which impacts anyone seeking emergency care, not just those with COVID-19.
“At the end of the day, it’s about deciding, at that point, who we think is most likely to benefit from what may be a limited resource,” said Michael Bernstein, regional chief medical officer in Alaska for health care company Providence.
Typically, crisis care standards involve a scoring system to determine the patient’s ability to survive, sometimes including their estimated “life years” and organ function. Such guidelines do not call for taking vaccination status into account, just as emergency rooms do not prioritize certain car accident victims based on the driver’s alcohol consumption.
Yet the vast majority of COVID-19 patients crushing hospitals are unvaccinated, months after the vaccine became widely available to American adults.
On Friday, intensive care units in Alabama, Georgia, Idaho, Kentucky and Texas were all over 90% of their capacity. The intensive care units in Alaska and Montana, meanwhile, were 84% and 77% full, respectively, according to federal data.
With Alaska having recorded its highest rate of COVID-19 hospitalizations since the start of the pandemic, Providence Alaska Medical Center in Anchorage decided to put in place standards of crisis care earlier this month. ci so that physicians do not have to make decisions about patients themselves.
“This also ensures that it is fair [and follows] principles of justice, fairness because we all want to do what’s right, ”Bernstein said. “And these types of choices can cause moral pain for health care providers. “
While emergency rooms typically require doctors to sort and treat patients with the most urgent needs first, this practice is not common when it comes to making decisions about “more critical treatments.” “.
The medical center, especially the intensive care units, has been “very full” which, according to Bernstein, is “in large part because many COVID patients will progress to needing this level of care.”
At Providence Alaska Medical Center, the wave of COVID-19 patients represents about 24% of hospital patients, with about 87 to 90% of all unvaccinated patients.
Nationally, a quarter of the eligible population, or about 70 million people, have not received any doses of the COVID-19 vaccine. Health officials have repeatedly called recent outbreaks a “pandemic of the unvaccinated,” which President BidenJoe BidenHaitian Prime Minister Warns Inequality Will Drive Further Pelosi Migration: House To Pass 3 Major Spending Laws This Week Erdoğan Says Turkey Plans To Buy Another Russian Defense System MORE reiterated Friday in a speech.
“In a country as big as ours, that 25% minority can do a lot of damage,” Biden said. “And they do a lot of damage.”
Idaho is another state where hospitals are under high stress, as authorities instituted statewide crisis care standards earlier this month. Last week there were a record number of hospitalizations for COVID-19, said Toni Lawson, vice president of government relations at the Idaho Hospital Association.
“It’s pretty serious overall, but the standards of crisis care have really given our hospitals the flexibility to provide care to as many patients as possible,” she said.
Hospitals are participating in statewide calls to organize where patients go, as non-critical patients are sometimes transferred to smaller hospitals to make room in larger hospitals for severe cases.
“Right now, when you go to the hospital, you can’t end up receiving care at the same facility,” Lawson said. “You may need to be transferred to another hospital due to capacity issues. “
In several hospitals, providers are adding beds to cope with the influx of new patients.
Gabe Kelen, director of the Johns Hopkins Office of Critical Event Preparedness and Response, said healthcare providers may consider other options like increasing the number of patients each nurse manages, shutting down services such as elective surgeries and assessing the risk of releasing occupants from the bed to make room for other patients.
But delaying care for several months for some patients, such as those with cancer, could put their health at risk.
“Vaccine deniers, obviously, in a lot of our minds, really, really, really hurt the whole system, whereas someone with a heart attack attacks only their own heart – they don’t attack the heart. everyone, ”Kelen added.
But Kelen, who is also a board member for the American College of Emergency Physicians, said people had to look at him through a medical lens.
“We will do our best to save your life, whether you are vaccinated or not, because that is the oath we have taken,” he said.
Meanwhile, the healthcare industry is taking a hit of a different kind, with many hospitals across the country experiencing staff shortages due to burnout. Compared to the start of the pandemic, there are more demands on staff to also perform tests and vaccinations, Kelen said.
Kristina Orfali, professor of bioethics at Columbia University, said it was important for hospitals to communicate standards of crisis care to patients upon admission.
“It’s sad, but it’s important that we know that, and… there’s more transparency about what it is, and I think we should somehow communicate all of this better,” she said. declared.
Other states have taken steps to revamp their standards of crisis care amid the pandemic, with Hawaii having released a plan earlier this month. A spokesperson for the Arkansas Department of Health said the state is working to finalize its standards.
Tennessee said last week it was restricting the use of monoclonal antibody treatments to people not vaccinated against COVID-19, following Tips from the National Institutes of Health prioritize those who are not fully immunized and who are at high risk of developing severe COVID-19.