Editor's note: This story has been updated to reflect Idaho's decision on Thursday to expand "crisis standards of care" statewide.
A couple of weeks ago, Ed Crosby’s brother-in-law suffered a bad fall in North Idaho. He was airlifted to the region’s biggest hospital, the 330-bed Kootenai Health in Coeur D’Alene. He needed intensive care, but when he got there he had to wait.
“There were no beds available in the ICU,” Crosby recalls. “It was totally filled with COVID patients – almost all unvaccinated. It made me extremely angry.”
It took two days before a bed opened up, according to Crosby. That’s the current situation in North Idaho and in a growing number of places around the Mountain West. From Las Vegas to Albuquerque to Cody, Wyo., hospitals have become full of mostly unvaccinated patients ravaged by the delta variant.
The current COVID crush has prompted some hospitals to begin rationing care for everyone, regardless of their diagnosis. Medical providers in parts of Utah and Idaho, for example, have cancelled most surgeries. State health officials are warning everyone to avoid risky activities that might land them in the emergency room because beds are full and resources are strapped.
“There’s no question about it – the system is incredibly stressed,” says John Hick, medical director for emergency preparedness at Hennepin Healthcare in Minneapolis.
Hick is an expert in crisis standards of care, which are guidelines that hospitals and state public health agencies activate when overwhelmed.
“It’s about using the resources we have in the best way possible to maintain as close to usual standards of care as we can,” he says.
This doesn’t mean doctors are going around a COVID ward deciding who lives and who dies in. Instead, Hick says it’s about rationing the existing staff and equipment you have on hand. That might mean a patient, instead of getting four hours on a ventilator, may get two because that’s just enough to keep them safe.
Last week, Idaho health officials activated crisis standards of care for North Idaho, and on Thursday expanded the declaration statewide. Other states and healthcare systems in the region, including the Billings Clinic, are considering similar emergency measures.
Across the country, Hick says, the biggest problem right now is a shortage of critical care beds. The strain is especially acute in the Mountain West and the Great Plains because they don’t have as many large, tertiary hospitals as in the more densely populated East.
“The number of ICU beds for the population is just not adequate at baseline,” Hick says. “You throw in additional trauma, you throw in COVID, and you’re talking about a real crisis.”
It’s a crisis that Emily Farness, a 30-year-old ICU nurse at Kootenai Health, faces everyday.
“It’s been so physically tough,” she says. “It’s been emotionally tough and just draining on so many levels.”
Kootenai Health estimates about 97 percent of its COVID-19 patients are unvaccinated.
“Almost all of them tell me, ‘I had no idea it was like this. If I had only known I would have gotten vaccinated. If I had only known I would have taken this so much more seriously,’” she says. “For them it’s already happened. They can’t go back and change their decision.”
That’s why she wishes the unvaccinated could just get a glimpse of the fear and pain she and other nurses see everyday. The delta variant is putting more young, seemingly healthy people into the hospital. Farness says it can break their bodies down.
“Their breathing is so labored that they can’t take breaks off of their oxygen mask long enough to eat a solid meal,” she says. “They’re scarfing a few bites and then just giving up.”
Farness says they can spend a month or two in the hospital. When they do get out, they often have long-term lung damage, brain fogginess or other long-haul symptoms.
“Their prior quality of life might not be attainable,” she says. “The job they held before that was maybe fairly physical or mentally taxing – they might not be capable of returning to it. Personally, as someone who is young and healthy, that’s almost scarier than dying.”
Idaho's vaccination rate – which ranks among the lowest in the country – has remained stagnant for the past three weeks, and state public health officials aren’t expecting this surge in hospitalizations to ease anytime soon.
This story was produced by the Mountain West News Bureau, a collaboration between Wyoming Public Media, Nevada Public Radio, Boise State Public Radio in Idaho, KUNR in Nevada, the O'Connor Center for the Rocky Mountain West in Montana, KUNC in Colorado, KUNM in New Mexico, with support from affiliate stations across the region. Funding for the Mountain West News Bureau is provided in part by the Corporation for Public Broadcasting.