For every Idaho ICU bed, up to 14 patients will need it during coronavirus outbreak
Blaine County discovered in the past week that it holds the largest cluster of the novel coronavirus disease in Idaho. It had 36 confirmed COVID-19 cases as of Monday.
The small hospital there cannot handle an influx of patients with COVID-19.
The St. Luke’s hospital in Ketchum has one ventilator and two intensive care beds — but, as of last week, is no longer admitting people to be hospitalized. If a resident of Sun Valley or Ketchum has respiratory failure, sepsis or other serious complications that need ICU care, they’ll have to be transferred to hospitals more than an hour away — in communities that may be contending with their own outbreaks.
And like many of Idaho’s rural counties that lack ICU beds, Blaine County has a lot of people in high-risk age groups. More than 17% of its population is 65 or older — an estimated 3,800 people — according to U.S. Census Bureau data.
It’s not just Blaine County. A recent study says that hospitals across the state don’t have enough capacity to handle a moderate outbreak.
Harvard researchers projected this month that between 11,016 and 33,049 Idahoans will need ICU care at some point due to COVID-19, and the state doesn’t have enough ICU beds for them.
Why is ‘flattening the curve’ important? Look at Idaho hospitals
Health care experts across the country have warned that people need to isolate themselves, use good hygiene, stop gathering in large groups and take other actions to “flatten the curve” of the coronavirus cases, which is rising steadily.
Why is that important? If outbreaks go unchecked, hospitals will be overcome.
The latest research from the Harvard Global Health Institute projects that anywhere from 244,553 to 733,658 people in Idaho will be infected at some point with the novel coronavirus.
A “moderate estimate” says that about 5% of people with the virus become critically ill, according to ProPublica, an investigative reporting nonprofit that built localized models of the findings.
“Even in a best-case scenario, with cases of coronavirus spread out over 18 months, American hospital beds would be about 95% full,” ProPublica reported.
“Some regions would have the capacity to handle the surge in hospitalizations without adding new beds or displacing other patients,” said the ProPublica story published March 17. “But in most other scenarios where the virus spreads faster or infects more people, hospitals would quickly fill their available beds with patients, and they would be forced to either expand capacity, limit elective surgeries and other non-necessary treatments, or make life-and-death decisions about care, similar to what has happened in the worst-hit regions of Italy, where some doctors have received guidance to only treat patients ‘deemed worthy of intensive care.’ ”
In the best-case scenario — prevention measures work, only 20% of Idahoans contract the virus, the outbreak is spread evenly over 18 months, and hospitals can free up most of their ICU beds — there will be one ICU bed for each COVID-19 patient. In the worst-case scenario, there would be one bed for every 14 patients.
“In the Boise, ID region, intensive care units would be especially overwhelmed and require additional capacity,” ProPublica reported based on the Harvard estimates. “Without coronavirus patients, there are only 95 available beds on average in intensive care units, which is 4.4 times less than what is needed to care for all severe cases.”
It is unclear how much Idaho hospitals can ramp up capacity to improve those numbers, but the estimates show why it’s important to “flatten the curve” and try to slow the spread of the virus.
Idaho has 555 intensive care unit beds statewide, according to the Idaho Hospital Association. Those numbers are based on what hospitals report to the state. (Data from the American Hospital Directory show that more than 100 ICU beds in the state are for children and babies, who typically haven’t needed critical care for the virus.)
Those ICU beds are not sitting empty. They hold patients with heart attacks, car crash injuries and other serious health problems that don’t stop happening when a pandemic begins.
The Harvard study determined that, based on the usual number of beds taken up already, Idaho hospitals would have between 155 and 244 ICU beds to hold COVID-19 patients.
The Idaho Hospital Association is part of Gov. Brad Little’s working group to guide the state’s coronavirus response.
“Regarding bed utilization, hospitals have crafted processes and strategies as part of their emergency response planning and are refining them in light of this outbreak,” Idaho Hospital Association Communication Director Darryl-lynn Oakes said in an emailed statement. “They will implement plans to free up space when needed. This can include a number of actions and is based on both the community need and the needs of the individual patient. It is critical that Idahoans look at the guidance and recommendations coming from their local hospitals to have the latest information on how they are addressing community needs.”
Not enough ICU beds, not enough ventilators
About half of ICU patients with COVID-19 will need a ventilator to breathe, according to estimates provided to the American Hospital Association and reported by The New York Times.
Based on the Harvard study’s projections, that means between about 5,000 and 16,000 people in Idaho would need a ventilator at some point. The state has 404 ventilators, according to the Idaho Hospital Association.
Gov. Little has said that Idaho could get more ventilators from the national strategic stockpile, which contains thousands of the units. Manufacturers are capable of producing more as well.
But the beds and ventilators alone aren’t enough. They need trained staff, such as registered nurses, respiratory therapists and anesthesia providers.
“Each of the three domains, ICU beds, ventilators, and critical care staff, are an essential component of the resources to manage a COVID-19 pandemic,” the Society of Critical Care Medicine said this month.
“For example, if a hospital has mechanical ventilators but not appropriate staff to operate them, the ventilators are not useful for patient care,” the society wrote. “Simply adding more of one resource element without considering the interconnectedness of the health care system’s many assets is unwise and potentially unsafe in planning for or managing a pandemic such as COVID-19.”
There were 680 respiratory therapists and 620 nurse anesthetists in Idaho as of May 2018, according to the federal Bureau of Labor Statistics. (An anesthesia practice in Boise last week laid off 53 nurse anesthetists, citing projected revenue shortfalls as hospitals cancel elective surgeries due to COVID-19.)
The BLS lists 13,790 registered nurses in Idaho. Many of those are not experienced in ICU care.
Research has found a link between nurse staffing levels in the ICU and the risk of death.
There is no mandatory limit on how many patients each ICU nurse can take, under Idaho or federal law. California, one state with a nurse-to-patient ratio, says each registered nurse in an ICU can care for no more than two patients at a time.
The emergency declaration issued by Gov. Little earlier this month seeks to bring more health care providers into the workforce, such as licensing nurses who had gone into retirement.
This story was originally published March 23, 2020 at 3:42 PM.
