Clinicians depart a patient room after re-positioning a COVID-19 patient into the supine position in the Intensive Care Unit at Lake Charles Memorial Hospital on Aug. 10, 2021. in Lake Charles, Louisiana. (Mario Tama/Getty Images)
The COVID-19 situation in Colorado continues to worsen, as the state now ranks fifth in the nation for new infection rates and hospitalizations reach new peaks this year.
It has caused Gov. Jared Polis to implement tactics to help hospitals that are reaching or exceeding capacity, such as two executive orders he signed over the weekend to redirect patient care. On Tuesday, he announced that the state had asked the Federal Emergency Management Agency to deploy medical teams to areas with especially full hospitals.
He has implemented all five of the measures he floated last week as a response to the acceleration of cases: calling in FEMA, removing barriers for transferring patients between hospitals, halting cosmetic and elective surgeries, scaling up distribution of monoclonal treatment and setting the stage to activate crisis standards of care.
He has not implemented any mask mandates or suggested that he will do so, though some think it could be necessary.
“A year ago, we had criteria for when to implement things like mask mandates and we have blown past that,” said Dr. Matthew Wynia, the director of the Center for Bioethics and Humanities at the University of Colorado Anschutz Medical Campus. “I understand the political basis, because people really don’t enjoy mask mandates, but without it there’s a fair number of people who just won’t do it … I hate it, but I think it ought to happen right now for a month. We’ve got to make our way through this.”
The state’s response also includes the implementation, for the first time during the pandemic, of an emergency transfer system for hospital patients. This development is due to a “monumental strain on the state’s health care system,” according to a Colorado Hospital Association statement.
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Statewide, about 1 in every 51 people is contagious with COVID-19 as roughly 2,600 new cases are reported daily. There are now over 1,200 people hospitalized with COVID-19 in the state as of Nov. 2, the highest level since last December. About 80% of those hospitalized are unvaccinated.
As of Nov. 3, two state regions comprising 12 counties in the West and San Luis Valley report having no available ICU beds.
“The 20% that haven’t yet chosen to get protected are putting themselves at risk — which you can certainly argue is their own business, and I have no qualm if they have a death wish — but they are clogging our hospitals,” Polis said during Tuesday’s update.
Emergency hospital transfers
On Wednesday, Colorado hospitals activated the highest tier available of the Combined Hospital Transfer Center to manage patient transfers.
That means patients may be transferred to hospitals with higher capacity, even if it goes against their wishes. Hospitals can now send sicker patients to more specialized care centers and move recovering patients to hospitals with more available space and staff.
The Colorado Hospital Association reactivated the CHTC under Tier 1 in August. Tier 3 brings it from an individual hospital or regional level to a statewide level.
“This is an extraordinary step taken by the state’s hospitals and health systems,” Dr. Darlene Tad-y, vice president of clinical affairs with the Colorado Hospital Association, said in a statement. “Even when under immense pressure, the state’s health care system continues to work collaboratively with each other and our partners at the state to ensure the best care possible is available to every Coloradan that needs it. However, activating Tier 3 of the CHTC should send a clear message to Coloradans: our health care system is in jeopardy of being overwhelmed.”
In addition to high COVID-19 hospitalization numbers, hospitals across the state are also caring for more patients who may have delayed care due to the pandemic. That is contributing to the capacity issues, explained CHA’s senior director of communications Cara Welch.
“We have a lot of patients that it seems may have delayed their otherwise preventative care during the pandemic. And now they’re showing up really sick in our hospitals,” she said.
Crisis standards of care could be next
The state could activate so-called crisis standards of care if COVID-19 trend lines continue to look dire. An executive order that Polis signed Sunday opened the door for the state to activate those plans.
Crisis standards of care are guidelines from the state to hospitals and other health care providers about how they should operate when demand exceeds resources. They are designed with the “intention of maximizing patient survival and minimizing the adverse outcomes” that could occur when the volume of patients and their needs surpasses available capabilities, according to the state’s published plan.
“In some cases — worst case scenarios — what we hear is that could lead to prioritizing certain patients and to determine, if there’s limited resources, which patients would receive those resources,” Welch, with the CHA, explained.
There are different frameworks for areas such as staffing, hospitals, EMS transport and personal protective equipment. Colorado previously activated standards of care for PPE, staffing and first responder transport.
Dr. Eric France, chief medical officer of the Colorado Department of Public Health and Environment, said during an Oct. 28 briefing that the state’s hospital and staffing crisis standards of care are likely to be activated because of the hospitalization numbers.
In practice, that could look like redirecting health care workers to help with overloaded units, having patient family members assist with hygiene or having health care workers work longer, less frequent shifts.
It feels like a lot of people in Colorado are ready to be done with this ... They want to behave as if everything is normal, but unfortunately things are not normal in the health care system right now. Things are really bad.
– Dr. Matthew Wynia, of the CU Anschutz Medical Campus
“There’s nuance within crisis standards of care. There are a lot of different strategies, and it’s all in an attempt to avoid a situation where you literally have to say ‘Normally I’d put you on a ventilator but we don’t have one for you, so we’ll have to keep you on oxygen and cross our fingers.’ That’s what we’re trying to avoid,” Wynia said.
He said that the state was able to avoid those types of worst-case scenarios in previous surges because of widespread mask-wearing and social distancing, which people aren’t as keen to do as the pandemic nears its second year.
“It feels like a lot of people in Colorado are ready to be done with this,” Wynia said. “They want to behave as if everything is normal, but unfortunately things are not normal in the health care system right now. Things are really bad.”
In Tuesday’s update, state epidemiologist Dr. Rachel Herlihy said projections put the state’s hospitalization peak sometime in November or early December. Based on the current trends, she said the state’s capacity shouldn’t be exceeded. Still, state leaders continue to urge caution and encourage vaccination.
“As you can see with the projections, it’s going to be tight,” Polis said. “It is tight, and it’s going to be tight for the next several weeks.”
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