Ashley Carvalho was a few hours into her night shift as a doctor at a hospital in Boise, Idaho, earlier this month when she received a text from her fiancé asking how she was doing.
She thought of the COVID-19 patient, a man in his 40s, whose condition had worsened within an hour of starting work that night. She thought of the conversation she had had to have with his young family about switching to comfort care and his death shortly after.
She thought of the second person with COVID who died soon after, as well as the other patients who had filled all 14 intensive care beds — all with the same disease, all unvaccinated — who needed her attention.
She thought about the abuse she had received from a man’s angry relatives, who had called her names for not being with him. ivermectin, a wormer that is falsely promoted in conspiracy circles as a cure, but that the FDA has warned against use in COVID patients. She thought about how the police had to remove the man’s family after his son-in-law told her, “If you don’t do this, I have a lot of ways to get people to do something, and they’re all in my gun safe at home.”
Her eyes filled with tears, she took a selfie and sent it to her fiancé: “It’s like this,” she wrote.
Like other medical workers in her state, Carvalho is exhausted and annoyed. Idaho currently has the lowest vaccination rate in the country, and the number of vaccine doses administered has not risen significantly – but infections have. From Saturday there were 686 patients hospitalized in the state with COVID, 180 of them in ICUs. That’s hundreds more than what flooded hospitals during the previous wave in December 2020, before safe and effective vaccines were widely available.
Carvalho and her colleagues cannot comprehend how they ended up in this situation. She has anger – sure – but that takes too much energy. She’s usually just sad and burned out.
“I think it’s a bit of a hopeless feeling,” she told BuzzFeed News on Tuesday night after she ended her shift. “Last year around this time I was very concerned about COVID, and I was hoping and hoping that the day we would have a vaccine. It never occurred to me that there would come a day when we to have a vaccine, and I’m actually more anxious now because we have something that can really prevent this and people are not taking it.”
Currently, 50 out of 51 COVID patients ICUs that are part of the St. Luke’s Health System — a chain that spans southeastern Idaho, eastern Oregon and northern Nevada — are unvaccinated. Hospital admissions have skyrocketed. In July, there were 33 patients with COVID in all St. Luke hospitals. This week, there were 289. Currently, more than two-thirds of all patients at St. Luke’s facilities are being treated for the same virus, St. Luke chief physician Jim Souza told reporters in a online briefing on Tuesday.
“That’s an unprecedented event in modern medicine,” he said.
Idaho is what a state looks like when it fails flatten the curve. As in other mountain states, beds are running out. In response to patient crowds, which are not expected to abate anytime soon, the Idaho Department of Health and Welfare (DHW) last week crisis standards of care. When these plans are implemented by hospitals, formulated in April 2020 in the hopes that they will rarely need to be used, help guide overwhelmed medical personnel to ration scarce resources.
The crisis standards apply to all patients, not just patients with COVID-19. “There are already many patients who have had to postpone surgery or other treatments, and if you end up in a hospital, you can be treated in a waiting room or a hallway,” says DHW director Dave Jeppesen. “Every nurse and doctor will treat more patients than usual. You may have to wait much longer than usual for care. You may even need to be transferred to a healthcare facility that could be hours away.”
Last Thursday, the day crisis standards were first activated, an elderly adult was admitted to a hospital after suffering a stroke. In normal times, she would be held overnight for monitoring, but was instead released that same day. The woman was Jeppesens’ own mother.
“Not only was it stressful for my mother to have a stroke, there were also concerns about health care availability when she went to the emergency room,” he said. “It was different in the ED. There were other patients receiving care in the waiting area.”
When things really go to hell in Idaho, crisis standards guide physicians in determining which patients receive care and which do not. They involve a complex calculation of health factors to save as many lives as possible. In the event of a tie, doctors may have to resort to a lottery system. Hospitals can even universal do not resuscitate order for all patients suffering from cardiac arrest – although this has not yet happened in Idaho and would never apply to children.
Susie Keller, the CEO of the Idaho Medical Association, told BuzzFeed News she’s heard nightmarish stories from members who are beginning to confront these rationing decisions — about who gets an ICU bed, a COVID patient, or someone in cardiac arrest.
“It’s not a sudden nightmare. It’s a nightmare that we’ve seen coming and our doctors have warned about it,” Keller said. “We haven’t reached our peak yet.”
Souza, St. Luke’s chief physician, said his network has already mobilized teams to help clinicians make “highly morally challenging decisions.” He doesn’t know of any patients who have died from rationed care, but he thinks it’s only a matter of time. “I don’t know the names of such people yet, but I do believe we will know their names,” he said.
as the Delta variant of the coronavirus tears through Idaho and the rest of the US, Souza said he and his St. Luke’s colleagues have noticed several key differences from the December 2020 wave. Patients are younger (58 years on average, less than 72), they are sicker and need more mechanical ventilation, they stay longer in the ICU and die more often (the ICU death rate has increased from 28% to 43%). At St. Luke’s hospitals, about 80 people have died from COVID in the past three weeks.
“If you look at the ages of the people we’ve lost and you count on them the average lifespan, in the month of September alone, we’ve lost more than 1,100 years of life,” Souza said. “Can you imagine that? And for the people who say, ‘We’re all going to die at some point.’ Yes we do. But these people didn’t have to die now. They didn’t have to die like this.
“Can you imagine all the life and experience in those 1,100 years?”
Medical Groups in Idaho have argued with residents to get vaccinated, but met resistance from many in the very conservative state – a symptom of the politicization of the vaccines by some on the right. Idaho Republican Governor Brad Little Received a Covid Vaccine he called “safe and effective” in January, but months later — like other conservative governors across the country — he signed an executive order prohibiting state officials from requiring residents to be vaccinated in order to access facilities. Citing the need for “less government regulations”, this month Little also stated that he would challenge plans from President Joe Biden to require US companies with more than 100 employees to mandate either a vaccine or routine testing for staff.
Disinformation is also widespread. Republicans in a county that includes Boise voted for nomination this month a fringe doctor who has called vaccines “fake” to a regional health council. Elsewhere, a home health nurse who watched videos of false conspiracy theories on YouTube told her family not to get vaccinated, even though their mother was in a coma with COVID. The nurse then became infected herself and died last month. Her mother has recovered, but says she is still not sure if she will take an injection.
The charged environment leaves medical workers feeling let down and even resentful for continuing to advocate for health measures that the public no longer seems interested in. “The good wishes from the start of the pandemic feel like they’ve pretty much dried up,” said Souza, whose 15-bed clinic was in the McCall ski resort. defaced with a swastika during the weekend.
Kenneth Krell, a physician at an Idaho Falls hospital, said: the statesman of Idaho that the early days of the pandemic, when he and his colleagues were hailed as heroes, are long gone.
“I think we all have something in common that the public” [is no longer] our allies,” Krell told the paper. “But in cases that are surprising, sometimes patients have real hostility. They say they can’t have COVID, that this is all a lie, even though we’re getting ready to intubate them.”
Boise’s doctor, Carvalho, said she now compares medical workers to Vietnam War veterans who saw the public turn against them. “We’re tired of pointing fingers at us, being called the bad guy, because we’re trying to promote a vaccine that’s life-saving,” Carvalho said. “I know there are good people out there, but it really feels like the public isn’t on our side.”
Even primary care providers who have cared for a patient’s family for 20 years now hear that they are no longer trusted, according to Keller of the Idaho Medical Association. At work, medical workers in Idaho face an onslaught of needless deaths, she said, but outside of that, they are part of a community of people pretending the pandemic doesn’t exist. “It’s pretty daunting,” she said. “Think they feel like they live in two different worlds.”
In Idaho Falls, Krell drove to work last Saturday and felt ambushed. He had received a call that the IC was overloaded, and although it was his day off and he had worked 36-hour shifts, he got into his car and drove in. He knew his colleagues would too.
When he arrived at Eastern Idaho Regional Medical Center, he stopped in front of a whiteboard and wrote a message for his colleagues – who went viral later when it was shared on social media.
“What sustains us in the end and what we will remember about surviving this madness are the remarkable people who have endured this with us, the best of humanity – all of us – who have shown the best of our calling,” he wrote. . “We got through this together and supported each other. We have saved lives and lost lives, and we both did so with compassion and ability.
“We will not forget this.”