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It’s Idaho’s first time activating crisis standards of care. Here’s what that means

An emergency department sign is shown Sept. 10 at Kootenai Health in Coeur d’Alene.  (Associated Press)
By Kyle Land and Becca Savransky Idaho Statesman

BOISE – Idaho’s Department of Health and Welfare this week activated crisis standards of care across the state for the first time as COVID-19 cases and hospitalizations surge.

It’s a dire situation health officials had been hoping to avoid.

Public officials are continuing to urge people to get vaccinated as a key way to reduce the strain on health care systems and prevent serious illness.

So how exactly does crisis standards of care work, and how could it affect you?

How does Idaho compare against available health care in other states?

Other states facing high numbers of COVID-19 cases are considering rationing care, even if not statewide like Idaho.

The largest hospital in Alaska recently adopted crisis standards, and such Western states as Nevada and New Mexico are expected to ration care in the near future. New Mexico had enacted crisis standards last December, but lifted them once hospitalizations subsided.

Intensive care units across the South are also near 100% capacity in several states, including Texas and Florida, according to data from the New York Times.

However, the Idaho Statesman could not find a state besides Idaho that had implemented crisis standards across all its health systems.

Will vaccination status be considered when care is prioritized?

Vaccination status is not listed as part of the considerations for prioritizing care. It is also against the law and against medical ethics for Idaho’s health care system to triage patients based on politics or whether people wore a mask.

“The goal of providing care quickly and efficiently must be guided by fairness, equality and compassion,” according to Idaho’s crisis standards of care plan. “As such, (this) is grounded in ethical obligations that include the duty to care, duty to steward resources, distributive and procedural justice, and transparency. Its guiding principle is that all lives have value and that no patients will be discriminated against on the basis of disability, race, color, national origin, age, sex, gender, or exercise of conscience and religion.”

Under the plan, people who have a higher likelihood of survival will be given care before those who are more likely to die.

Should there not be enough of a certain resource, care could be prioritized in the following order:

1. Children up through 17 years old.

2. Pregnant women with a viable pregnancy, at more than 28 weeks of gestation.

3. Adults by age, from younger to older: age 18-40, age 41-60, age 61-75 and 76 and older.

4. Patients who “perform tasks that are vital to the public health response of the crisis at hand, including, but not limited to, those whose work directly supports the provision of acute care to others.”

5. A lottery, or “random allocation,” if there is still a tie after going through the first four priority criteria.

Dr. Steven Nemerson from Saint Alphonsus Health System said Thursday that so far, he doesn’t know of a single patient who has been taken off a life-support therapy so that therapy could be given to another patient with a better prognosis.

“While that has yet to occur,” he said, “if we continue on this path, it will.”

What is an example of crisis standards of care?

Under crisis standards of care, the focus is on saving as many lives as possible, according to Health and Welfare. So patients who are more likely to survive could be treated first.

According to the standards, patients could be given a priority score based on a number of factors.

For example, if the demand for ventilators is exceeding supply, hospitals could put into place universal “Do Not Resuscitate” orders. That means if an adult patient goes into cardiac arrest, they could “receive NO attempts at resuscitation,” according to Health and Welfare’s strategies for scarce resource situations.

“The likelihood of survival after a cardiac arrest is extremely low for adult patients. As well, resuscitation poses significant risk to health care workers due to aerosolization of body fluids and uses large quantities of scarce resources such as staff time, personal protective equipment, and life-saving medications, with minimal opportunity for benefit.”

Is there any data on the transmission of the virus in schools?

Many school districts are tracking COVID-19 cases among students and staff. But school districts track their cases in different ways, and the rules for who has to quarantine across districts also vary.

For example, the Boise School District, which mandates masks, this week has reported 125 positive cases among students and staff. In the two previous weeks, the district has reported 93 and 121 cases, respectively. Those case numbers are far higher than the numbers the district reported most weeks last school year. The district is also following strict quarantine guidelines from Central District Health, and has had hundreds of people quarantining each week since school started.

District officials told the Idaho Statesman earlier this month, though, that most of the quarantines for exposures – based on their contact-tracing efforts – were prompted by exposure outside of school, not in the classroom. They said they weren’t seeing spread in the school system in a “major way.”

But other districts are taking different approaches. The Nampa School District, which has a mask-optional policy, isn’t contact tracing. Kathleen Tuck, the district’s spokesperson, told the Statesman earlier this month if it did, it would have to send home “pretty much the whole classroom” when students test positive.

Already, many schools have had to close in the region due to high numbers of students and staff out due to the virus.

Public health officials had warned, given how transmissible the delta variant is, that there could be significantly more spread in schools this year than there was last year. Although younger people are more rarely hospitalized for the virus, they could spread it to friends and family who are more vulnerable and not vaccinated.

It’s difficult to track exactly how much spread is occurring in schools, though, as many districts are not actively contact tracing.

What is Gov. Brad Little doing in response? What rules are in place?

Little issued a statement Thursday saying Idaho had “reached a historic point,” and that the state had taken “many steps” to prevent hospitals from reaching this level of crisis.

However, no new mandates or restrictions have been announced, and none were in place before Thursday’s announcement. Little has announced the state will set up three centers for monoclonal antibody treatment, which have shown to be effective in treating COVID-19.

After President Joe Biden announced last week that businesses with more than 100 employees would have to require vaccines or weekly testing, Little said the state would seek avenues to legally fight the order.

He did call on more Idahoans to choose to get the vaccine, which he called the best defense against COVID-19. He also has taken actions to help with staffing at hospitals, including a National Guard activation.

Is it safe to still be going to large events, such as football games?

The short answer: no.

“It is not safe to have those events, but we don’t know that we can change the trajectory,” Dr. Nemerson said. “The best thing would be if people are going to attend those events that they cover their faces and stay separate, but we’ve seen that that doesn’t happen.”

He suggested changing the conversation.

Instead of addressing people he believes won’t change their behaviors, he recommended speaking to those who are “responsible” and want to take steps to protect themselves from COVID-19.

“People can select not to attend those events, even with a mask,” he said, “and people can also select to frequent businesses that practice COVID-safe behaviors.”