- More than 9 months after COVID-19 vaccines were first administered to the general public, health systems in multiple states are reporting having to ration care.
- The Idaho Department of Health & Welfare has implemented Crisis Standard of Care, essentially rationing care in order to save as many people as possible.
- In Montana, the governor deployed at least 400 National Guard troops to help a hospital system that will imminently start rationing care.
As the Delta variant surged in the United States, hospitals in some states have become overwhelmed. As a result, some non-COVID patients are starting to be affected by the ongoing pandemic and in some cases are facing rationing of medical treatment and inability to find a hospital bed.
When hospitals run out of beds or staffing is low, tough decisions need to be made about who gets a priority of care. There are reports about hospitals choosing who gets an intensive care unit bed and who doesn’t — a difficult but sometimes necessary decision with the limited resources that are available.
One of the biggest concerns at the start of the COVID-19 pandemic was that COVID-19 patients could overwhelm hospitals and healthcare workers would have to make agonizing decisions about who would be treated.
For the first 18 months of the pandemic, that worst-case scenario was largely-avoided in most hospitals. Now, more than 9 months after COVID-19 vaccines were first administered to the general public, health systems in multiple states are reporting having to ration care.
Providence Alaska Medical Center, a major hospital system in Alaska, warned last week that they are no longer able to provide a consistent standard of care for each patient.
“We are faced with a situation in which we must prioritize scarce resources and treatments to those patients who have the potential to benefit most,” the Medical Executive Committee wrote in an open letter.
“We have been required to develop and enact policies and procedures to ration medical care and treatments, including dialysis and specialized ventilatory support,” the committee wrote.
The Idaho Department of Health and Welfare (DHW) has implemented Crisis Standard of Care, essentially rationing care in order to save as many people as possible.
The department clarifies that people should be ready to get a different sort of treatment in the hospital than they might expect. They may have to wait for beds, or they may be given repurposed beds in areas like conference rooms.
Additionally, some people who are extremely ill may not be given lifesaving access to therapies like ventilators if they are in short supply.
“In other words, someone who is otherwise healthy and would recover more rapidly may get treated or have access to a ventilator before someone who is not likely to recover,” the Idaho DHW said.
“The situation is dire — we don’t have enough resources to adequately treat the patients in our hospitals, whether you are there for COVID-19 or a heart attack or because of a car accident,” said Idaho DHW director Dave Jeppesen.
In Montana, the governor deployed at least 400 National Guard troops after the Barrett Hospital & HealthCare system said they would imminently have to implement crisis of standard care meaning care would be rationed, according to the Associated Press.
These states are just one of the most extreme examples of what happens when so many people need care in a pandemic and there is just not enough staff or resources to go around.
While the pandemic may have taken over headlines, other smaller medical issues still need to be treated. In the ER, physicians still have to treat patients who show up with critical conditions unrelated to COVID-19. These include traumas, heart attacks, strokes, organ transplant complications, and even the extremes of diabetic complications.
Intensive care units throughout the country have seemingly filled up with COVID-19 patients, many of them unvaccinated, leaving people who also need beds for non-COVID reasons frustrated waiting for an opening.
When intensive care unit beds become scarce, hospitals must reconfigure resources, create contingency plans for additional beds or treatment of these patients, and sometimes make decisions as to which patients get priority.
“While unfortunate, this is not the first time we have had to ration resources,” said Arthur Caplan, PhD, founding head of the Division of Medical Ethics at NYU Grossman School of Medicine in New York.
Caplan explained that making decisions about who gets treatment is not a new phenomenon. “We routinely see this with patients waiting for a transplant,” he said.
While it may not seem fair to some, ethicists and committees must make difficult decisions on patient outcomes — especially in times when there are limited resources.
“Physicians and nurses do not want to sort out people for medical care. Their responsibility is to treat everybody equally and to not make judgments,” Caplan told Healthline.
Rationing of care comes in various forms. “We can see it not only with hospital beds and staff, but also with things like dialysis machines and even palliative care,” Caplan told Healthline.
As people have concerns regarding COVID-19 and coming to a hospital, some are leaving their healthcare on the back burner and are waiting until the last moment to seek medical advice or treatment.
But experts say waiting to seek emergency medical care can in certain cases end up as a life-or-death scenario.
Experts say while it may be frightening if medical care is being rationed, it is not a good idea to wait if you have concerning symptoms. Instead, they stress that people can try seeking care from primary or urgent care professionals.
Seeking early medical care allows clinicians in many cases to treat conditions before they require more intensive treatment. Getting antibiotics early for an infection from a primary or urgent care physician may mean you can avoid being admitted to the hospital when there few beds to go around
“With the stress currently being placed on the healthcare system, people should think about strategies to minimize the need to be seen at the hospital if possible. As the old adage goes, ‘An ounce of prevention is worth a pound of cure,’” said Alex Jahangir, MD, division chief of Orthopedic Trauma at Vanderbilt University Medical Center in Nashville, Tennessee, and the chairman of the Nashville Metro Coronavirus Task Force.
Not everything needs to come to the hospital.
If you are unable to see your primary care professional, simple conditions like the occasional dry cough, nasal congestion, or even a rash can likely be treated with over the counter remedies and without a hospital visit.
By using telemedicine for things that you can easily see or hear, patients have access to an entourage of professionals that can quickly and efficiently take care of them. If telemedicine is not something you are comfortable with, going to see a professional at an urgent care center can be equally effective.
Jahangir told Healthline, “with flu season just around the corner, one of the easiest things to do is to receive the flu vaccine to lower the risk of becoming seriously ill.”
“People with chronic conditions such as diabetes and hypertension should be vigilant in ensuring these chronic conditions are under control to avoid a crisis that would require a hospital visit,” he said.
Undoubtedly, some medical conditions cannot wait for a primary care doctor appointment, an urgent care facility, or even telemedicine. Some conditions will need emergency medical attention such as a traumatic injury, shortness of breath, or any type of chest pain or stroke-like conditions, to name a few.
Health officials are pleading with the public to get vaccinated and take measures to safeguard their health.
“Our hospitals and healthcare systems need our help,” Idaho DHW director Jeppesen said. “The best way to end crisis standards of care is for more people to get vaccinated. It dramatically reduces your chances of having to go to the hospital if you do get sick from COVID-19. In addition, please wear a mask indoors in public and outdoors when it’s crowded to help slow the spread”
Rajiv Bahl, MD, MBA, MS, is an emergency medicine physician and health writer. You can find him at www.RajivBahlMD.com.