Idaho’s hospitals at the brink

Editor’s note: This article expands on Aug. 24 breaking news coverage.

Idaho’s hospitals are full of delta variant patients. According to Idaho Department of Health and Welfare (IDHW) Director Dave Jeppesen, on Aug. 24, one rural Idaho hospital was unable to find an ICU bed for a patient. During the IDHW weekly media briefing on the same day, Jeppesen remarked that: “Our ICU usage is the highest it’s ever been,” and he qualified that statement by saying that Idaho was past the peak usage of ICU beds from the previous COVID-19 surge.

To one journalist’s question about hospital capacity, he replied: “If the question is how close are we to (running out of) hospital capacity, I would say we are over hospital capacity right now…We’ve had one today — we had a patient (who) needed to come out of a rural setting and we were unable to find an ICU bed this morning. We’re hoping one opens up this afternoon. But that’s kind of where we are at the state level.”

Hospital staffing

The problem with the current surge in COVID-19 cases is not so much a lack of beds but the lack of staff, especially trained nurses.

Portneuf Medical Center in Pocatello recently opened a new special care unit this summer, increasing the number of its patient beds; but like many other hospitals around the state, it needs more staff. Portneuf has been coordinating with other southeastern Idaho hospitals and looked into making up staff shortfalls using the Southeast Idaho Medical Reserve Corps, CEO Jordan Herget told the Idaho State Journal.

Bingham Memorial Hospital in Blackfoot is currently short on experienced nurses, and is seeking to bring in additional staffing help, according to the same report.

Kootenai Health announced on Aug. 9 that its “leadership reached out to resources at the state level to request help,” stating that it was struggling to find enough nurses to care for the sickest patients and had pulled employees off their other duties in clinics and outpatient areas to help with the surge in COVID-19 cases.

The staffing problems at Kootenai Health are acute. Kootenai has over 176 unfilled positions for nurses for just its main hospital in Coeur d’Alene, and there are over 300 unfilled positions for nurses throughout the entire Kootenai Health network.

The St. Luke’s Health System has its own staffing constrictions, mostly due to the current surge in COVID-19 cases. St. Luke’s offered a bonus in early August if certain staff members took extra shifts. A $2,500 bonus was available to registered nurses and respiratory therapists if they signed up and worked six additional 12-hour shifts between Aug. 1 and Oct. 2. Many health care support services workers in the St. Luke’s system got the same offer, with a bonus of up to $1,500.

Crisis Standards of Care

The State of Idaho hasn’t put its health care Crisis Standards of Care into place, but according to IDHW, it is ready and prepared to do so immediately if the State of Idaho Medical Advisory Committee deems it necessary. Based on statements made by IDHW spokespersons during the weekly COVID-19 media briefings, Idaho has been prepared now for weeks, as cases of the COVID-19 delta variant have created a surge of hospitalizations.

The Crisis Standards of Care are a state plan of how to ration hospital care in the event of a natural disaster or other catastrophic event that threatens Idaho’s health care system. The standard can be activated if and when “a disaster event overwhelms usual health and medical capabilities and capacities, resulting in an inability of the health care system to provide the standard levels of care to patients.”

The three broad categories used to evaluate crisis conditions are space, staff and supplies. In the crisis standards document, space is at a crisis condition when a facility is unsafe or damaged, or non-care areas are repurposed to accommodate patients. Supplies are at a crisis is they run out or are redirected away from critical care needs. Staff is at a crisis if there are not enough trained staff to care for patients “even with extension techniques.”

In the event that the crisis standards would be used, they would apply to more than just people with COVID-19. They would apply to anyone who needed medical care for any reason at the hospitals and other care facilities affected by the standards. Conditions of a non-emergency nature would likely not be treated immediately.

“We will keep a close eye on this…to do everything we can to avoid (the) Crisis Standards of Care, but we are ready should hospitals recommend we move to Crisis Standards of Care,” Jeppesen remarked.

Comparing COVID-19 surges

The numbers for hospitalizations and ICU usage for the entire state as compiled by IDHW are indicative of why the current surge is of such concern. For hospitalizations, the peak from the winter holiday period surge was 496 on Dec. 1, 2020. Hospitalizations on Aug. 19 were 422. ICU peak usage on Dec. 18, 2020, was 122. On Aug. 18, it was 140, which is the highest usage to date in IDHW’s dataset of vetted and verified COVID-19 statistics. Complete data for the state after Aug. 20 was not yet available on Aug. 24 when this article was submitted for publication.

In the St. Luke’s Health System, the peak of COVID-19 hospital admission was 33% on Dec. 6, 2020 during the previous COVID-19 surge. On Aug. 22, COVID-19 admissions for the health system were 30%.

Kootenai Health has added capacity since the pandemic began, so it is difficult to compare its current bed occupancy to the previous three COVID-19 surges. It now has 330 beds, 200 of which are for acute, critical and medical/surgical care. Behavioral health and women’s and children’s services, including pediatric and neo-natal, use the other beds. As of Aug. 24, 91 beds, or 27.6% of its 330 beds, were taken up by COVID-19 patients, out of which 34, or 10.3%, were ICU beds occupied by COVID-19 patients.

Kootenai Health, St. Luke’s and Saint Alphonsus are among the largest hospital care providers in the state and all three provide transparency of their COVID-19 capacity, both now and have for the last year and half. A comparison around the state is difficult because other hospitals choose not to report as much information or can not report because of the limited budgets that most rural hospitals operate under. While the number of ICU beds in important, as mentioned, it’s staffing that is the more critical need.

The most important metrics

Some numbers speak for themselves. Over 98% of current COVID-19 cases in Idaho, of which all are currently the highly contagious delta variant, are unvaccinated individuals. Over 98% of all COVID-19 cases currently hospitalized in Idaho are unvaccinated individuals. Over 98% of all recent COVID-19 deaths in Idaho were unvaccinated individuals. The Pfizer-BioNTech vaccine received full FDA authorization for individuals aged 16 and over on Aug. 23. The vaccine is free and available at most pharmacies and health care providers.

What COVID-19 costs

The following cost-benefit analysis compares two treatment approaches to COVID-19.

Over the last few months, we’ve floated inquiries to several hospitals, health care organizations and research groups to ascertain the following statistic: What is the cost of being hospitalized with a case of COVID-19?

Last Friday, Aug. 20, the venerable Kaiser Family Foundation provided an answer: the average cost was upward of $20,000. It looked at multiple studies that examined what payer organizations paid hospitals for their COVID-19 care. For example, one study found that Medicare-fee-for-service averaged $24,033, while another study of private Medicare Advantage plans averaged $17,094 for those over 70.

In June and July of this year, there were approximately 113,000 preventable COVID-19 cases in unvaccinated people in the United States. The bill for their care was approximately $2.3 billion, according to the foundation. That comes out to roughly $20,000 per hospitalization.

Then we looked at the cost of the alternative to hospitalization, which is the prevention of the COVID-19 disease through vaccination, which is recommended by an overwhelming consensus of medical professionals, as determined by a review of recent publications available through PubMed. Approximate cost to the U.S. government for one dose of the Pfizer-BioNTech (now named Comirnaty) vaccine: $19.50. The cost to an individual in the United States for a COVID-19 vaccination: $0.