Gov. Jared Polis opened the door to letting hospitals decline to admit or treat some patients as he signed a pair of executive orders Sunday to help the state deal with a high level of COVID-19 hospitalizations, tight hospital capacity and staff shortages.
There are nearly 1,200 COVID-19 patients hospitalized in Colorado, the most since December, as the highly transmissible delta variant continues to run roughshod through the state’s unvaccinated population. Nearly 80 percent of those hospitalized with coronavirus are unvaccinated, and almost 40 percent of hospitals expect to be short staffed during the next week.
“I am very concerned that we are going to exceed capacity and what dictates capacity is going to be the number of safely staffed beds,” said Dr. Anuj Mehta, a pulmonologist with National Jewish Health and Denver Health, who serves on the Governor’s Expert Emergency Epidemic Response Committee. “It’s no longer a question of ventilators. It’s a question of safely staffed beds. If you typically have one nurse for two ICU beds, and now you’re asking that one nurse to care for four ICU patients, that’s not safe anymore.”
COVID-19 vaccination levels have risen steadily in Colorado for months, but people younger than 12 aren’t yet able to get vaccinated, a situation that’s expected to change soon. The statewide vaccination rate is higher than 60 percent overall, which means more than 2 million people in the state are still unvaccinated.
The executive orders represent a big warning flare to Coloradans that the state could be in for some of its roughest months of the pandemic as the holiday season approaches.
Hart Van Denburg/CPR NewsThe COVID-19 ICU at Rose Medical Center, Denver, Nov. 13, 2020.
What the new executive health orders say and do
One order authorizes the state health department to direct hospitals and freestanding emergency departments to redirect patients to other facilities.
The other clarifies when emergency decision-making measures, called “Crisis Standards of Care,” can be activated. It also directs the state’s insurance division to prepare emergency rules to help address staffing shortages.
Both orders expire in a month but can be reactivated.
Colorado is able to activate its Crisis Standards of Care in sections. No plans are currently active, but the governor’s move Sunday opens the door for that.
The guidelines essentially set out how to make the most grave medical decisions if the crisis overwhelms hospitals and resources become scarce. They help dictate how the medical community should allocate things such as ventilators and intensive care unit beds in extreme cases when patient needs exceed the resources available. Those standards would help determine who gets care and at what level.
In practice, invoking the standards is more likely to mean that one hospital can transfer a patient to another, less crowded, hospital, even over the patient’s objection.
Hospitals in other western states like New Mexico, Wyoming, Utah, Idaho, Montana, and Alaska have all either activated their own crisis standards or have come close in recent weeks.
Currently, 78 percent of those hospitalized for COVID-19 are unvaccinated, and they aren’t divided evenly across the state. On the Western Slope in Montrose County, for example, just 54.8 percent of the eligible population has received even one dose of the vaccine. Consequently, that region of the state is out of ICU capacity. Meanwhile, up the road in Eagle County in the central mountains, where 92.3 percent of the eligible population has received at least one dose, 57 percent of ICU beds are available.
Hart Van Denburg/CPR NewsNurses at Rose Medical Center’s COVID 19 intensive care unit pull on gowns, gloves, face masks and shields, Denver, Nov. 13, 2020.
Colorado has response plans but no statewide mandates
Should the crisis deepen in parts of Colorado, the state has individual plans for personal protective equipment, staffing, EMS and hospitals to help decide which patients get what levels of care. There’s also one for palliative care and hospice services.
PPE was in short supply and presented a huge challenge early in the pandemic, but that plan was deactivated in June 2020. The ones regarding health care staffing and EMS were deactivated in February as the state came down off the big peak at the end of last year.
At the same time, Polis took no action to mandate changes among people at risk of spreading the virus, like a statewide mask mandate or restrictions on public gatherings. Since responding aggressively at the start of the pandemic with what amounted to lockdown orders, the governor has been reluctant to institute anything similar.
Frontline providers have said healthcare workers are exhausted heading into their 20th month of the pandemic. If the hospitals fill up too much, everything gets more challenging. Resources get scarce, hospitals need to move people around, staffing gets pinched, frontline nurses and doctors have to work longer shifts. The potential to compromise the quality of care grows.