Idaho asks FEMA and other states for help, in last-ditch effort to staff hospitals

Idaho Health and Welfare Director Dave Jeppesen addresses the media at a briefing Tuesday, Aug. 24.

Idaho Health and Welfare Director Dave Jeppesen addresses the media at a virtual briefing on Tuesday, Aug. 24. (Idaho Capital Sun photo)

BOISE – When August began, about 8% of the patients in Idaho hospitals had Covid.

Three weeks later, they’re now more than 20% of hospitalizations.

Almost none of the patients have been vaccinated for COVID-19, according to state data and multiple Idaho Capital Sun interviews — demonstrating both the safety of the vaccine, and how effective it is in helping the human body fight the coronavirus.

Idaho Health and Welfare Director Dave Jeppesen said Tuesday that the state is dangerously close to hitting “crisis standards of care,” when health care providers would be forced to triage patients and may not be able to give everyone life-saving care.

One local doctor says the COVID-19 surge is sapping energy and resources from Idaho’s health care system, at a time when the hospitals need to give other patients life-saving medical care.

Dr. Peter Cliften, who admits patients to St. Luke’s hospitals in Boise and Meridian, said the disease is now taking down families.

“You admit mom, and then dad gets admitted,” he said. “And the kids are in the ER, and sometimes they’re admitted. We’re seeing younger and younger patients that are sometimes even more ill than the older patients.”

Another local physician, Dr. David Peterman, said Idaho is headed for “scary territory” and that he is “extremely concerned about children.”

Peterman pointed to hospitals in other low-vaccination states like Texas, Florida, Arkansas and Louisiana, where children are being hospitalized.

“Any child that’s admitted to the hospital, and certainly any death, is preventable,” said Peterman, CEO of Primary Health Medical Group. “Of course I support vaccinations, but we can stop this in its tracks right today, right now, if I wear a mask and you wear a mask … particularly in schools.”

Idaho state officials last week issued a call for help from other states, and from the federal government.

“Idaho is experiencing a surge in COVID-19 cases and hospitals are at, or quickly nearing, capacity in ICU and Critical Care Units across the state and hospitals are reporting significant staffing challenges,” said a request sent Friday from the Idaho Office of Emergency Management to the Federal Emergency Management Agency.

Multiple Idaho hospitals are asking for help, it said. They don’t have enough nurses, nursing assistants or respiratory therapists, it said.

“Every effort has been made to fill the staffing requests. A handful of hospitals are reporting they are in full contingency mode and may need to request crisis standards of care in the near future,” the request said.

State officials from the Idaho Department of Health and Welfare reiterated their plea in a request to other states through the Emergency Management Assistance Compact.

They asked for 235 full-time health care workers:

•120 registered nurses

•35 clinical staff such as nurses or medical assistants

•20 respiratory therapists

•60 certified nursing assistants.

At first, the request said, workers would go to the Boise area and the Coeur d’Alene area — where Kootenai Health has been forced to stop taking in patients from other hospitals and projects a massive influx of patients. “Other locations may be added based upon future critical staffing shortfalls,” it said.

“FEMA is still working on the request,” Idaho Office of Emergency Management Public Information Officer Natalie Shaver told the Sun in an email. “For the (state-to-state request), there is some interest/response, but nothing is finalized yet, so we don’t have anyone here.”

There is stiff competition for a limited number of health care workers.

The pandemic has thinned the ranks of nurses, physicians and other health care staff who are willing to continue working at the bedside.

“We just have had this constant barrage of new and unprecedented things we have to take care of,” Cliften said. “A lot of my colleagues are just frustrated and tired, and trying our hardest not to get burned out and leave (the profession).”

Travel nursing agencies are trying to recruit to staff Idaho hospitals, offering premium pay rates. One agency is offering $4,600 to $8,000 per week. Some agencies pay for travel, housing and other essentials on top of the wages.

For one agency’s job openings in cardiovascular ICUs, Idaho’s pay rate was the highest offered in the U.S.

St. Luke’s Health System had 319 nursing job openings posted as of Tuesday, with signing bonuses of up to $7,500.

The late summer surge of COVID-19 has added to the already overstretched emergency rooms in Idaho hospitals.

“In the nine years I’ve been in St. Luke’s, I have not seen us boarding patients in the ER like we have been doing in the last four to six weeks,” Cliften said.

Cliften said his colleagues have gone into the emergency room to treat patients who normally would be admitted to the hospital, taking care of them for 24 hours and discharging them directly from the ER.

‘When I got my second COVID shot, I felt a weight lifted off my shoulders’

Before the pandemic, Cliften said he felt “pretty immune” to the psychological impact of a patient dying.

“That’s a part of taking care of patients in the hospital … helping people with that transition to death has always been something that we’ve kind of always had to learn,” he said.

Doctors also have to help families with “that emotionally difficult decision of when to let that loved one go,” he said.

“I had a time last December where I had a COVID patient a day dying, and that was something I was not emotionally prepared for, and that was probably one of the lowest times of my career in hospital-based medicine,” he said. “You think you’re immune to it, and it still hits you at times.”

Cliften said the hospital, like others in Idaho, lost employees to burnout from having to work extra shifts, as well as the emotional toll of COVID-19.

After months of watching patients die of COVID-19 and going through elaborate decontamination routines when they get home to their families, Idaho health care workers got access to the vaccine in December.

“When I got my second COVID shot, I felt a weight lifted off my shoulders, right? Because there was enough data behind vaccination where I did not feel that fear (about catching) COVID. I’m not a spring chicken anymore,” Cliften said. “I felt myself tearing up as I was leaving from that vaccination. ‘I’m finally there, I’ve got some protection behind me.’”

But the vast majority of patients he sees now didn’t make the choice to get that protection.

The crush of a fast-spreading delta variant is perhaps most apparent in Idaho’s intensive care units, which now have more COVID-19 patients than at any other time in the pandemic. There have been more than 100 people in Idaho ICU beds with COVID-19 every day since Aug. 11.

Jeppesen said Tuesday in a telephone town hall that he recently visited an ICU.

“It’s difficult to describe the sadness and the suffering that’s taking place there,” he said.

“They are looking for volunteers to help out at the hospitals, everything from housekeeping to medical staff,” he said, urging people who want to help with the crisis to visit volunteeridaho.com.

Idaho’s ICU hospitalization rates for COVID-19 are now higher than they’ve ever been, Jeppesen said.

An Idaho Capital Sun analysis of federal data shows that COVID-19 is also rapidly consuming the limited number of adult ICU beds that are staffed.

Cliften is a former U.S. Air Force physician who worked at Bagram Air Force Base. Asked how being on the front lines of the pandemic compares with that, he answered with a long pause.

“It’s different,” he said.

The base hospital had everything and everyone it needed to treat all the patients who came in, he said. That often included enemy combatants and even, he thinks, a war lord.

“While it was exhausting, I did that for six months, and then I was back in the states, and things were back to normal,” he said. “This has kind of been a high stress situation for now a year and a half, and it’s been exhausting. I’ve never seen anything like what we’re seeing now.”

The St. Luke’s Meridian hospital recently took what had been an observation area for post-procedure heart patients and turned it into an ICU-level care unit, he said.

“It’s like you get one patient moved out of the ICU, and you’ve got another one ready to come in,” he said.

Cliften recently had a patient in her 20s who couldn’t breathe. She needed a huge amount of oxygen, pushed to her lungs through a high-flow mask. She was deteriorating.

“I was talking to our crisis nurse, an ICU-level nurse … trying to make a decision of whether to take the last ICU bed. ‘Should we?’” he said. “I had one patient who was 50, and he deteriorated faster (so he) got that bed and ended up getting intubated.”

Luckily, the 20-something patient turned around without ICU care, he said.

“It’s hard when you have patients that are saying, this is torture, we would do anything to get better,” said Cliften.

There is no cure for COVID-19 that he can give them — or that anyone can give them. He can only try to keep them alive and as comfortable as possible, and then urge them to get vaccinated after they’ve recovered.

About half of the people who come in unvaccinated remain skeptical, he said. He is baffled by “the politicization of health care and medical care” and measures that can protect people from a potentially deadly disease.

More than half of Idahoans remain unvaccinated and vulnerable to severe illness from COVID-19.

With a rising number of cases and a shortage of trained professionals to care for those who end up in the hospital, the state is barreling toward crisis.

Many of those unvaccinated Idahoans are children.

With school starting, Cliften and others are bracing for the worst: an influx of pediatric patients sick with the disease. Cliften also worries, personally, because his child is enrolled in the West Ada School District, which has so far decided not to require masks.

While deaths are rare from COVID-19, children are increasingly being hospitalized because of the coronavirus. Idaho currently has seven children in the hospital with COVID-19, according to federal data.

Children so far make up about 1.8% of all the hospitalizations from COVID-19 in Idaho, and about 0.7% of children known to be infected have been hospitalized, according to data from the American Academy of Pediatrics and Children’s Hospital Association.

Health leaders are worried about what will happen if more children become seriously ill — especially when COVID-19 coincides with the arrival of other respiratory viruses.

The largest pediatric ICU in the state is in Boise, with just 12 beds.

This story is republished with permission from Idaho Capital Sun, part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a 501c(3) public charity. Contact Editor Christine Lords for questions: [email protected].