FAQ: Crisis standards of care, round two

By Melissa Davlin, Idaho Reports

On Monday, Jan. 24, the Idaho Department of Health and Welfare declared crisis standards of care for part of southern Idaho.

The circumstances around this declaration are different than when IDHW declared crisis standards of care in fall 2021, prompting a number of questions from Idaho Reports viewers and readers, especially around the state’s backlog of positive results. Here are some answers to those frequently asked questions.

What areas of the state are under crisis standards of care?

Three health districts: Southwest District Health, Central District Health, and South Central District Health.

That covers eighteen counties: Adams, Washington, Payette, Gem, Owyhee, Canyon, Ada, Elmore, Boise, Valley, Gooding, Lincoln, Jerome, Twin Falls, Blaine, Camas, Cassia, and Minidoka.

That doesn’t mean other areas of the state are out of the woods. Idaho Department of Health and Welfare Director Dave Jeppesen said Tuesday that it’s likely the rest of the state will fall under crisis standards soon if trends don’t reverse. 

What’s different about this crisis standards of care declaration? 

The sheer number of positive cases is much higher than what Idaho experienced with previous surges, including the Delta spike that pushed Idaho into crisis standards of care in September. 

But during the fall surge, a higher percentage of patients ended up in the hospital and in ICUs across the state. This time around, ICU and hospital capacity wasn’t as much of an issue when the three districts entered crisis standards of care – although hospital admissions are still rising, and are currently at the same levels as they were in early September 2021. 

This time, hospitals are stressed for two major reasons: A healthcare worker shortage driven by the number of hospital employees contracting the virus and calling in sick, and a blood shortage affecting the entire nation. 

Tell me more about the numbers.

The state positivity rate, or percentage of tests that come back positive, is at 38.8 percent, by far the highest it’s been. That rate is even higher in some areas — 49.8 percent in East Idaho Public Health District, and 42 percent in Southwest Public Health District and Southeastern Idaho Public Health. 

Pediatric hospitalizations are also at the highest they’ve been, with Idaho hospitals reporting 22 children hospitalized with COVID-19 on Jan. 23. During the Delta surge, the highest number of children hospitalized at one time was 15.

Pediatric hospitalizations as of Jan. 24, 2022. Courtesy IDHW.

Why is there a backlog of positive test results?

Local public health districts are overwhelmed with the number of positive laboratory results, especially in the state’s most populous areas. As of Thursday night, that backlog was more than 42,000 positive results.

Previously, health districts tried to do investigations on each positive result, but that’s no longer possible because of the high volume of tests. Now, investigators are prioritizing high risk cases, such as those out of congregate care facilities.

Does that mean patients aren’t finding out they’re positive?

No. Clinics and providers tell patients directly what their results are, then report the information to the health district. From there, the health districts enter data and verify patients’ residency before officially reporting those cases to the state. It’s that last step that is causing the backlog. 

Why is that information important?

Entering that information is a critical step for understanding the spread of this variant. Patient information, such as age, sex, and race, can help epidemiologists know if waves affect certain segments of the population more than others. 

Also, not every pending positive lab result equals a new individual case. Some people test more than once and receive multiple positives. The state logs cases in individuals, not tests. But as an estimate, IDHW says add an extra 4,000 cases per day to last week’s daily counts.

Can people volunteer to help with data entry?

Unfortunately, that’s not possible, said Dr. Kathryn Turner, deputy state epidemiologist.

“By the time we get people in and get them trained up, we may be on the downside of the peak,” she said. “It’s a little bit harder than just bringing someone in and sitting them down in front of a computer.”

Idahoans who want to assist in other ways can visit volunteeridaho.com to join their local Medical Reserve Corps.

Why is there a blood shortage?

A number of factors: Blood drive cancellations and staff shortages at the American Red Cross due to illness, as well as transportation issues. 

Ultimately, those blood shortages affect a number of patients, whether or not they’re COVID positive, and could lead to blood transfusion rationing and surgery cancellations. We explored the issue on the Idaho Reports podcast.

<strong>Melissa Davlin</strong> | Lead Producer
Melissa Davlin | Lead Producer

Melissa Davlin is the lead producer and host of Idaho Reports. She has covered the Idaho Legislature since 2012. She also produces for Outdoor Idaho and Idaho Public Television. She has won multiple awards for her work, including a regional Emmy for her documentary on Chinese immigration in Idaho, Idaho Press Club broadcast reporter of the year for 2015 and 2019, the Idaho Press Club First Amendment Award, and the 2019 Boise State University Enhancing Public Discourse award. She lives in Boise with her husband and two children. 

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