By Melissa Davlin, Idaho Reports
During a weekly Idaho Department of Health and Welfare media briefing on Tuesday, IDHW Director Dave Jeppesen and Dr. Jim Souza, chief physician executive of St. Luke’s Health System, shared some insight into the onslaught of COVID patients that prompted the department to activate crisis standards of care last week: Souza with sobering numbers and statistics from the front lines, and Jeppesen with a personal story of what crisis standards of care means for all patients, regardless of whether they have COVID.
Here is a transcript of their remarks.
IDHW Director Dave Jeppesen:
“Last week, my family experienced what crisis standards of care means first hand. My mom had a stroke Thursday morning, just a few hours after crisis standards of care was activated statewide. Not only was it stressful that my mom had a stroke, there was added worry about the availability of health care when she went to the ER.
“Things were different in the ER. There were other patients receiving care in the waiting room. My mom fell when she had her stroke, and there was a concern that she had broken bones. The x-rays were done in a non-traditional X-ray area, with a longer wait than usual. Fortunately, she did not break any bones.
“Normally a person in her condition would be held overnight for observation. Because of crisis standards of care, after she was stable, she was discharged later the same day from the ER. My family and I took over monitoring her at home, and she is recovering well.
“The ER team at St. Luke’s was amazing. Despite the large patient load, they were caring, empathetic and positive. We are so lucky to have such talented healthcare professionals in Idaho, and those same dedicated health care professionals across the state need our help.
“They need the unvaccinated to please, consider choosing to get vaccinated. The vaccines work. They are safe and effective. And they need all of us to please wear a mask indoors and in crowded outdoor spaces.”
Dr. Jim Souza, St. Luke’s Health System
“Bottom line, our inpatient facilities are progressively becoming COVID hospitals, and that’s the same story for the rest of the state.
“Some detail on that: We’ve gone from 33 COVID hospitalizations across our system in July to 289 today. That’s at St. Luke’s. COVID, previously, accounted for about 8% of our adult hospitalizations, and today it accounts for 67% with this single diagnosis. You know, that’s an unprecedented event in modern medicine.
“In our ICUs, the story is a bit worse. In July, we had eight COVID ICU admissions across our facilities, and that accounted for 17% of our adult ICU hospitalizations. Today, we have 51 COVID ICU patients, and they account for 70% of our ICU patients.
“A few words now on what we’re seeing with the patients that is significantly different from the December surge, and I wanted to highlight five things.
“First, they’re younger. The age range of our adult patients today is 20 years to 85 years, with a two week running average of 58 years. That’s down from 72 years in the December surge.
“Of the 51 people with COVID in the ICU today, 36 are under the age of 55 and 13 are under the age of 40. We think this is probably in part due to maybe increased virulence of this Delta variant, but we mostly believe this is due to the higher rate of non-vaccination in this younger population.
“Which brings me to the second change in the pattern we’re seeing: The patients are overwhelmingly unvaccinated. Now, this is similar to the December surge because we had no vaccine at that time. But what’s new since the introduction of the vaccines is that we are mostly not seeing an entire segment of the population in our hospitals: The vaccinated. We’re not seeing them and we almost never see those individuals in our intensive care units.”
“For some specifics: Of our 289 hospitalized patients, 90% are unvaccinated, and of our ICU patients, 98% are unvaccinated. The ICU patients we do have who have been vaccinated are patients who are actively being treated for cancer with bone marrow, toxic chemotherapy, and patients with organ transplant, on immunosuppression.
“The third difference: These patients are more sick. We’re seeing increasing rates of mechanical ventilation, and that’s at least in part because this younger cohort of patients tends to choose more aggressive care when they’re hospitalized. You know, if we’re honest about it, 40-year-olds have not contemplated death before.
“For more specifics amongst our ICU patients: Of the 51 critically ill COVID adults, almost all of them are intubated and mechanically ventilated, and today, we have a total of 64 ventilators running versus a typical value in a flu season for us, in our health system, of about 23.
“We’re also seeing increasing rates of acute kidney injury. And we’re continuing to see what we believe is an increasing rate of clotting events. And we’ve known about the association of COVID with clotting since the beginning of the pandemic, but we’re seeing this now in younger patients, DVT (deep vein thrombosis) clots in the legs, clots in the lungs, pulmonary embolism, arterial clots in the heart, heart attack, and in the brain, stroke.
“Fourth difference: These patients’ length of stay in the ICU, if they survive, is longer versus what we saw in December. At that time, we had an average ICU length of stay of six days, and we’re now sitting at about eight. And remember, this is average. The many patients who die often do so relatively early after ICU transfer, and on the other hand, we’ve got many patients who occupy an ICU room for more than three weeks.
“The final, and really important difference, is that these patients are dying more frequently. When compared with our winter surge, when our ICU mortality was around 28%, we’re now seeing an ICU mortality rate of about 43%.
“We’ve had 80 deaths from COVID in our health system since the beginning of September. That’s four every day the sun comes up. Thirty five of those deaths occurred in the past week. Among the 80 deaths so far in September, 23 of those were in people under 60, 12 in people under 50, six in people under 40, and three of these occurred this month so far in people less than 30 years.
“In a really morbid exercise, just in the month of September, if you look at the ages of the people we have lost and you apply to them average lifespans, we have lost more than 1,100 life years. A life year is one person’s experienced year of life. Can you imagine that?
“And for the people who say we all die some time, yes, we do. But these people didn’t need to die now and they didn’t need to die like this. And I’d like you to think about those thousand-plus lost years of life in the past three weeks, just at St. Luke’s. Can you imagine all of the life and experiences contained within those thousand-plus years? We shouldn’t trivialize that. These people deserve better.
“The last thing I’d like to comment on is a bit of a false narrative of sort of binary outcomes — that you either live or you die from COVID. The true fact, you know, for those who practice with these patients, is that for those who don’t end up in the ICU, there are a substantial number who are ultimately going to make a full recovery and that is terrific.
“But for 30%, they won’t, and they’re going to have lingering symptoms. They’re going to need health care resources, and we don’t know for how long. For those who go to the ICU and survive, they will be terribly disabled for at least a short period of time. And I’m talking months and sometimes that will be permanent. You cannot spend four weeks on mechanical ventilation, paralyzed and sedated and then stand up and walk away.
“The lost wages, the increased health care cost for these individuals long into the future, need to be part of the total accounting for the cost of our experiment in naturally acquired immunity.”
Idaho Reports is airing a special on the implications of crisis standards of care, and the ripple effects of overwhelmed hospitals on all patients. The program airs 8 pm Friday, Sept. 24 on Idaho Public Television.