As overrun Idaho hospitals ration care, doctors fear a COVID peak may still be weeks away

COVID-19 cases in Idaho are up more than 40% in the last two weeks, and hospitalizations up 25%. Some hospitals in the state's northern part are having to ration the care they give. Idaho has one of the nation’s lowest vaccination rates. Only 40% are fully vaccinated. William Brangham discusses the state's rationing of care with Brian Whitlock, the CEO of the Idaho Hospital Association.

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  • Judy Woodruff:

    The surge of COVID cases in Idaho has gotten so bad that some hospitals in the northern part of the state are having to ration the care they give.

    Idaho has one of the nation's lowest vaccination rates. Only 40 percent of the population is fully vaccinated.

    As William Brangham tells us, many of the ICUs have been pushed to their limits.

  • William Brangham:

    Judy, the decision by state officials to allow for the rationing of care means that, if hospitals are so overtaxed, they can decide to limit ICU rooms to just those patients who are most likely to survive, and then move other patients to non-hospital rooms for their care.

    Elective surgeries have also been canceled or seriously cut back. And these problems seem to be accelerating elsewhere in the state. COVID cases are up more than 40 percent in the last two weeks, and hospitalizations up 25 percent.

    Brian Whitlock is the CEO of the Idaho Hospital Association. All of the state's full-service hospitals are members of the organization. And he joins me now from Boise.

    Brian Whitlock, great to have you.

    I'm sort of alarmed to hear what's going on in your state right now. Can you just give us a sense of what you're hearing from different hospital officials?

  • Brian Whitlock, CEO, Idaho Hospital Association:

    Thanks, William. I appreciate the opportunity.

    Our hospitals all across the state have been stressed for a couple of weeks. What we saw starting at the beginning of August was just a rapid increase in the number of positive cases, which translated into hospitalizations, which translated into ICU visits and also an increase in the amount of COVID deaths.

    So that's been concerning since the beginning of August, and we have been doing all that we can to prepare, to move into contingency modes, to move hospital space into nontraditional spaces like classrooms, hallways and other areas, where we can at least try to meet the demand that's coming through the doors. But we have reached the point where we are almost on overload and have an inability to transfer patients to other areas of the state or even the region because of the lack of capacity around the state.

  • William Brangham:

    When people hear terms like rationing or crisis standards of care, they are troubling sounding terms.

    In a practical sense, if I'm a patient who's been in an ICU for a while or I'm a patient who's arriving at an ICU, what does that mean for me?

  • Brian Whitlock:

    It means that there may be a longer wait if you are just arriving.

    I had a sobering conversation just yesterday, where all of our hospitals get on a call each day and we try to load-level and make sure that we can transfer patients. One small critical access hospital, they jumped in as all of our larger tertiary hospitals were saying that their ICUs were completely full and they couldn't take transfers.

    And this tiny hospital just said we just had a COVID patient pass away in our ICU. We will have an ICU available in about 30 minutes to try to off-load some of the pressure on these larger hospitals that have just been inundated and in some cases are on divert.

    So, if you did need to go to an ICU, that might be closed, and they might have to send you to the next closest ICU.

  • William Brangham:

    Are hospitals there at the point where they might have to choose a ventilator goes to this patient and perhaps not that patient?

  • Brian Whitlock:

    William, those are difficult conversations to have, but they are taking place.

    If you have somebody in an ICU that's been on a ventilator for a couple of weeks and is not showing any sign of improvement, and you do have somebody who it might be younger whose conditions may not be as acute as that person that's been in the ICU for a couple of weeks, those are conversations that are taking place about moving that one patient into comfort care and freeing up the ventilator in order to hopefully save the life of another patient.

  • William Brangham:

    Are these patients that are filling these ICUs unvaccinated patients, by and large?

  • Brian Whitlock:

    More than by and large. Almost all of the patients that we are seeing in the hospital and certainly in the ICU are unvaccinated.

    We do see some vaccinated people with breakthrough cases that do need hospitalization, but it's nowhere near as serious as it would be if they were unvaccinated.

  • William Brangham:

    I mean, that's got to be incredibly dispiriting for hospital staffs to know 95 percent of the patients could have avoided this with a free, safe vaccine.

  • Brian Whitlock:

    And that's the challenge.

    Our nurses and our doctors and all our hospital personnel are going to continue to be passionate and provide that compassionate care. But there is some fatigue, knowing this is entirely preventable, when you have a hospital that has 200 beds in North Idaho, and more than 100 of those beds are taken up with COVID patients that didn't need to be there. It could have been prevented.

    And yet you still have people who have other conditions, heart attacks, breast cancer. I mean, there are other things that — you mentioned elective surgeries have been canceled, but now some of the urgent surgeries are also being postponed because those hospital beds are being taken up by COVID patients who are unvaccinated.

  • William Brangham:

    We have seen — and I have talked to health and hospital officials in various parts of the country. Do you have a sense as to where that hesitancy is coming from?

  • Brian Whitlock:

    I think there is a lot of misinformation.

    I think, in today's world, people get information from social media. They have friends who have friends who are on social media who heard somebody say something.

    And my encouragement is that most physicians, most researchers don't accomplish their findings on YouTube, and peer review doesn't mean the most number of likes that you get on social media.

    And so, please, do your research, but do it with credible sources of information, and then make a decision. And, hopefully, that decision is that you choose to get a vaccine. That's the only way that we're going to get ahead of this pandemic.

  • William Brangham:

    Lastly, do you have a sense of the arc of this? I mean, I understand — I have read one analysis that you might be up to 30,000 new cases per week mid-month this month.

    Do you have a sense of how bad this might get?

  • Brian Whitlock:

    I think all of our hospitals and health systems that are doing their projections fear that it still may be a couple of weeks out before we peak.

    And when you look at all of the projections in their totality, some of those are saying we may not even peak until the middle of October. And, yes, in a small state like Idaho, when you're having 30,000 cases predicted, that is overwhelming. And that may still be five or six weeks away.

    That has our hospital personnel very, very concerned and hopeful that they will see the seriousness of this crisis that has been declared in North Idaho. And I will tell you, the rest of the state probably is not far behind, unless something drastic happens.

  • William Brangham:

    Brian Whitlock, CEO of the Idaho Hospital Association, thank you very much for your time.

  • Brian Whitlock:

    Thank you, William.

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