Let’s avoid the nightmare of crisis standards of care in Idaho before the next wave hits

In September, health care systems in Idaho, strained from record numbers of COVID-19 admissions, finally became overwhelmed with COVID-19 patients, prompting the state to declare crisis standards of care. Under crisis standards of care, health care can be withheld from non-emergent and non-COVID-19 patients.

Hospitals postpone surgeries for patients with cancers and aneurysms. Intensive care units fill with seriously ill COVID-19 patients in volumes above capacity, forcing physicians to make tough decisions that they have never made in their careers; they decide who will live and who will die.

For example, when the number of patients requiring a ventilator exceeds the number of ventilators available, those patients who are least likely to survive may not be offered one. Or someone who is not expected to survive may be taken off their ventilator to give it to someone with a better chance.

It’s like combat triage, where the most critically wounded, who might survive under different conditions, are placed to the side and given comfort care only. From September through November 2021, Idaho physicians faced these types of decisions daily while nurses and staff carried out their orders, regardless of the wishes and pleadings of patients and families.

During the same time, when needs were at their greatest, hospitals lost staff for many reasons. Some simply quit. Others were out sick. Some did not comply with vaccination rules and were either fired or prevented from working. Others were fired for voicing opinions publicly, typically on social media platforms. Reduced revenues resulted in layoffs, all placing even greater stress on remaining caregivers, many of whom were travelers.

The fourth “Delta” wave of COVID-19 had another new, pernicious component: hostility against caregivers. Simply asking immunization status against SARS-CoV-2 on admission could trigger angry outbursts founded in the highly charged debates and theories surrounding vaccines and treatments. Families accused doctors of withholding unproven alternative medications, of infecting their loved ones with the virus or of falsifying COVID-19 admission numbers to garner more federal funding.

Many caregivers felt abused by the very people whose lives they risked their own to save. Rather than expressing gratitude, some surviving patients left the hospital threatening lawsuits.

Moral injury occurs when someone is forced to perpetrate or witness an act that they feel is morally reprehensible. The chaos brought on by the pandemic — inconsistent official decrees, misinformation, hospital policies, shortages, distrust — and the brutal decisions necessary to deal with the onslaught inflicted moral injury on vulnerable caregivers depleted by exhaustion, depression and despair.

Even though Idaho no longer is in crisis standards of care, this pandemic is not over. We will have another wave. If nothing changes, some people who are reading this article will die, or someone close to them will die of COVID-19.

However, that nightmare doesn’t have to happen. Vaccination doesn’t prevent getting the disease, but it does dramatically reduce the severity of the disease and the risk of hospitalization and death. New therapeutic agents are on the horizon. Even during a pandemic, life can go on nearly normally. That is what everyone wants, no one more than Idaho’s health care providers.