COVID-19 advisory group looks to revise crisis standards of care for hospitals

Colorado hospital capacity stretched with over 1,400 COVID-19 patients

By: - November 11, 2021 3:10 pm

Colorado Department of Public Health Chief Medical Officer Dr. Eric France speaks about crisis standards of care for hospitals on Thursday, Nov. 11, 2021. (Screenshot from Zoom)

Members of the group that advises Gov. Jared Polis on the COVID-19 pandemic met Thursday to review its recommended hospital crisis standards of care, which would inform hospitals about how to make triage decisions if the current hospitalization surge continues.

“There’s multiple steps you could take to alter your standard of care,” Dr. Anuj Mehta, a critical care pulmonologist at Denver Health who drafted the revised standards, told the Governor’s Expert Emergency Epidemic Response Committee. “The last step is triage, and by triage I mean unfortunately allocating certain resources to some patients and other patients maybe receiving less than standard or maybe receiving more palliative options.”

Right now, the only crisis standards of care activated in Colorado are related to the shortage of health care workers. For these other standards to go into effect, the GEEERC would need to approve the updated recommendations; Polis would need to authorize them; and finally, Dr. Eric France, Chief Medical Officer at the Colorado Department of Public Health and Environment, would need to activate them.

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Still, the advisory group is revising the standards in order to better fit with the current hospitalization surge, which involves significantly more patients who are not hospitalized with COVID-19. The standards, if activated, would apply to everyone, not just COVID-19 patients.

“We’ve activated the crisis standards of care for staffing and may need to activate the crisis standards for medical care and hospitals. As experts have advised me, the current hospital crisis standards really could be expanded based on our experience,” France said. 

For example, while hospitals early in the pandemic needed to make triage decisions based on ventilator availability, that supply issue has been resolved by compiling reserves. These updated crisis standards of care could focus on other factors that might need to be triaged, such as other types of oxygen delivery devices, renal replacement therapies or medications that are in short supply.

Mehta explained that the crisis standards of care for hospitals will likely revolve around three central considerations: how likely the patient is to survive without the resource being considered, how likely the patient is to survive with that resource, and whether the patient has access to alternate levels of care.

It’s a different approach than earlier on in the pandemic, when hospitals might have based decisions on which patients were most likely to die even if they received critical care resources.

Our ethical principle is to save the most lives.

– Dr. Anuj Mehta, critical care pulmonologist at Denver Health

“What we are largely talking about with most of these dilemmas is the other end of the spectrum,” said Dr. Matthew Wynia, the director of the Center for Bioethics and Humanities at the University of Colorado Anschutz Medical Campus. “It’s trying to find those people who will be OK even if they don’t get a service that they would normally get… These predicting models are almost the opposite. We’re not trying to predict mortality. We’re trying to predict whether you’ll be OK if you don’t get this service.”

One criteria Mehta doesn’t think should be baked into the crisis standards of care for hospitals, he told the GEEERC, is whether a patient is vaccinated against COVID-19.

“A lot of people have a gut reaction about this idea about people that have chosen not to get vaccinated are burdening the rest of the system,” he said. “Our ethical principle is to save the most lives, not to evaluate social responsibility.”

Other statewide measures

This review and update of the crisis standards of care for hospitals comes as the state tries to quell an ongoing surge in COVID-19 infections and hospitalizations.

Last week, Colorado hospitals activated the highest level of its patient transfer system that makes it easier to move patients between facilities. Earlier this week, CDPHE activated crisis standards of care for staffing.

Additionally, Polis signed an executive order Thursday that gives the green light for anyone over 18 to get a COVID-19 vaccine booster shoot, which goes further than current federal recommendations.

“We want to ensure that Coloradans have every tool they need to protect themselves from this deadly virus and to help reduce the stress on our hospitals and health care workers,” the governor said in a statement.

In a meeting with the GEEERC on Wednesday, Polis also shared additional measures that could be implemented to alleviate hospital stress. Those measures include adding an additional 500 hospital beds across the state, urging indoor venues to require proof of COVID-19 vaccination or a negative test, encouraging booster shots and scaling up the use of monoclonal antibody treatment. He has not suggested implementing a statewide mask mandate.

“If we see hospitalizations continue to increase, this is the playbook,” Polis said.

As of Nov. 10, over 1,400 people in Colorado were hospitalized with COVID-19 and 95% of the state’s ICU beds were in use.

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Sara Wilson
Sara Wilson

Sara Wilson covers state government, Colorado's congressional delegation, energy and other stories for Newsline. She formerly was a reporter for The Pueblo Chieftain, where she covered politics and government in southern Colorado. Wilson earned a master's degree in journalism from Northwestern University, and as a student she reported on Congress and other federal beats in Washington, D.C.

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