After months of record-breaking numbers, Idaho in the past few weeks has seen a drop in COVID-19 cases, hospitalizations and its test postivity rate. The state might finally have seen the worst of its fourth COVID-19 surge.

But Idaho still might have a long way to go before it’s ready to deactivate statewide crisis standards of care, or health care rationing that allows providers to make decisions based on chance of survival if necessary. Even though the number of patients has declined, the caseload has not dropped enough so as not to overwhelm providers, public health officials say.

Dave Jeppesen, Idaho Health and Welfare director, has said the state is looking for improvements on factors that brought him to first activate crisis standards. Those include hospitals no longer needing to use nontraditional spaces to admit patients, boarding patients that must be admitted in emergency rooms or seeing staffers overrun by the patient volume.

“Believe me, nobody really wants to be in crisis standards of care,” Jeppesen said during a media briefing Tuesday. “We are excited for the possibility to get out, looks like we’re headed in the right direction.”

Idaho reported 435 COVID-19 patients hospitalized statewide as of Wednesday, down from its peak of nearly 800 on Sept. 24 but still about as high as the peak toward the end of last year. In intensive care units, there were 138 COVID-19 patients on Wednesday, down from 213 on Sept. 24.

Hospitals struggling with backlog of procedures, doctors say

Health care systems are now struggling through a backlog of delayed surgeries and other procedures since the latest COVID-19 surge began around July, according to St. Luke’s and Saint Alphonsus.

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Dr. Steve Nemerson, Saint Al’s chief medical officer, said there’s been only a slight decline in COVID-19 patients admitted to ICUs. And while COVID-19 cases might have reached a plateau, the number of patients needing hospitalization and ICU beds because of other things remains high, he added.

“We’ve reached record numbers in the past month that we literally have never seen in the history of the Saint Alphonsus hospital system,” Nemerson said.

Part of that is delayed care, Nemerson said — and now that the non-COVID patients are being brought back, their conditions can be more complex than they might have been a month ago. Nemerson said more than 1,000 patients are waiting for procedures, either surgeries or other interventions, at Saint Al’s.

Nemerson said staffing is a major factor in determining whether Saint Al’s would be ready to transition from crisis standards down one level, to contingency standards. Saint Al’s is currently using about 150 additional staffers sent by FEMA and the state to help take care of patients, particularly in the ICU.

“We just barely have enough” workers now, Nemerson said. If the health care system exits crisis standards too quickly, and the federal government pulls its support of additional staffers, it could easily fall right back into needing crisis standards again, he said.

Nemerson said he expects Saint Al’s to no longer need the crisis standards designation before the end of the year, and “hopefully within a matter of weeks.”

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At St. Luke’s, anywhere from 3,000 to 5,000 surgeries and procedures have been delayed, said spokesperson Christine Myron.

Dr. Frank Johnson, chief medical officer at St. Luke’s Boise, said the system has had to delay care for all kinds of patients, including those with cancer and gastrointestinal problems, neurosurgical cases and children’s procedures.

“It’s heartbreaking that we haven’t been able to get those procedures done,” Johnson told the Statesman on Friday. “We need to get them done.”

What will deactivating crisis standards look like?

Exiting out of crisis standards will be a similar process to when the state entered it, Jeppesen said. He said he will look at input from hospitals on whether they would be ready to deactivate the standards, but likely would need multiple hospitals to report that they’re no longer strained.

The crisis standards activation committee then would reconvene to decide whether to recommend exiting crisis standards. Jeppesen would take that recommendation and decide.

Jeppesen said the state also could choose to deactivate the statewide designation but maintain crisis standards in a certain region.

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Elke Shaw-Tulloch, deputy state epidemiologist, said hospitals in the state are still experiencing a high flow of patients. Every Idaho county but one is still classified as a community with high transmission, Shaw-Tulloch pointed out. The statewide positivity rate has fallen for seven straight weeks and was 10.3% for the week ending Oct. 30, but that’s still more than double the goal of 5%.

Johnson said the decline in COVID-19 cases is encouraging, but he pleaded with the public to continue efforts to get the COVID-19 vaccine, take care of chronic conditions to remain out of the hospital and support health care workers who remain “exhausted.”

“The job’s not done,” Johnson said. “We are not at the ‘mission accomplished’ stage.”