UNMH and Pres adopt crisis standards again to prepare for a flood of patients

By: - November 19, 2021 6:55 am

A “prone team,” wearing personal protective equipment (PPE), prepares to turn a COVID-19 patient onto his stomach in a Stamford Hospital intensive care unit (ICU), in Stamford, Connecticut. (Photo by John Moore / Getty Images)

New Mexico’s health care workers are seeing a “slow-motion car wreck” as patients suffering from COVID-19 and complications from delayed treatment push hospitals beyond capacity, two leading physicians said Thursday.

As winter approaches, they said, there’s no end in sight. If the vaccination rate freezes where it is and everyone’s behaviors stay the same around physical distancing, “then it’s kind of like watching a car wreck in slow motion,” Dr. Jason Mitchell, chief medical officer at Presbyterian Healthcare Services told reporters at a news conference Thursday. “You can see the path, and I don’t know if it’s two months off or three months off or four months off, but we definitely can’t stay on the same trajectory.”

Presbyterian and University of New Mexico Hospital declared they were moving to using the Crisis Standards of Care in the Albuquerque and Rio Rancho metropolitan areas, because of unsustainably high volumes of COVID patients coming now and expected in the future, Mitchell said.

The standards allow hospitals to ration treatment and health care workers to prioritize people who need care the most to keep up with the rate of COVID-19 cases arriving at New Mexico emergency rooms. With the standards, hospitals can also redistribute patients from overcrowded facilities to ones with fewer patients. 

“Unfortunately, we haven’t seen much relief yet from this,” Mitchell said. “The primary reason is that our COVID cases continue to climb, and so although we’ve taken this action to accommodate how it’s been, we continue to see more and more hospital patients with COVID.”

“We are still giving all the care,” he said. “We still provide very safe care.”

Nationwide, the Crisis Standards of Care are being used in at least Idaho, Alaska and Montana, though several other states look like they may have to declare soon as hospitals hit capacity and go beyond it.

The beds are filling up

Out of all of Presbyterian’s hospital beds across the state, 20% are filled with COVID-positive patients, Mitchell said, and of those, 87% are unvaccinated people.

“What this tells us is that the vaccine keeps us very, very safe, and the unvaccinated really are the ones that are suffering from this, along with our health care workers,” he said.

UNM Hospital has also seen a rise in COVID cases, said Dr. Rohini McKee, its chief quality and safety officer. About 30.6% of all New Mexicans are unvaccinated, she said.

They are also seeing a large number of patients for many other issues, she said, many of whom are much sicker than they’ve been in the past, probably because they have delayed care during the early parts of the pandemic.

Nearly two years into the pandemic, health care workers are exhausted, Mitchell said. Presbyterian has nearly 500 traveling nurses working in their hospitals to help their existing staff take breaks as they deal with so many patients.

“We’re doing everything we can, but ultimately, there are people that will become exhausted and leave health care if this goes on much longer,” he said.

Mitchell said the solution for New Mexicans “could be six weeks away.”

If we had everybody in New Mexico get vaccinated, in six weeks, seven weeks, this would be over, and the volumes would be gone. I know that sounds almost unbelievable, but that's actually how it works. The vaccine is very, very effective and that’s what it takes.

– Dr. Jason Mitchell, Chief Medical Officer at Presbyterian Healthcare Services

State waivers

In response to ongoing medical staff shortages, N.M. Health Secretary David Scrase signed on Oct. 25 a public health order allowing hospitals to adopt the crisis standards for the second time.

To qualify for a waiver, a hospital must provide only essential medical procedures. He said at least more than a dozen facilities already qualified, because the state of New Mexico implemented this policy when hospitals experienced the same issues during the height of the pandemic in 2020.

One of those places is the UNM Health Sciences Center.

Mitchell said the order allows each hospital organization to also declare it’s going to use the Crisis of Standards of Care without the need to ask permission from the state.

The governor and Scrase gave hospitals the ability to simply declare they were switching modes. “And so we have declared that, that we are in Crisis Standards of Care, and then we partner of course, across the state to help level out patients across the state,” Mitchell said.

So far, the only New Mexico hospital that has applied for the waiver is San Juan Regional Medical Center in Farmington, state Department of Health spokesperson David Morgan wrote in a Nov. 4 email.

That said, there's still not a lot of resources, and so it provides some respite, but probably not enough.

– Dr. Jason Mitchell, Chief Medical Officer at Presbyterian Healthcare Services

DOH spokesperson David Morgan confirmed the San Juan Regional Medical Center in Farmington applied for the waiver in a Nov. 4 email.

Circumstances can vary greatly between different regions and facilities in the state, Health Department spokesperson Jim Walton wrote in an email Thursday. The department requires hospitals to first temporarily suspend any non-medically necessary procedures before implementing crisis plans or standards, he wrote. They also must continue to follow all licensing requirements.

As the volume of COVID-positive cases change — and they will probably continue to go up — Mitchell said hospitals will continue to adapt. 

How you can help

During the winter, things can get much worse with the flu and people gathering indoors, Mitchell said, so Presbyterian is expecting influenza and COVID cases to potentially increase.

McKee said the state is probably in a worse place this winter than it was last year because of the Delta variant.

“I would strongly urge the unvaccinated to consider getting vaccinated, and if you are not vaccinated, please follow CDC guidelines when it comes to wearing a mask over your nose and mouth in all public, indoor settings,” she said. “Think about protecting the vulnerable in your own families and communities, especially the elderly, and the children who can’t get vaccinated.”

Ways the public can help, Mitchell said, include:

  • If you are ready for a booster, it’s time to get one. “It makes a big big difference and returns that immunity back to shortly after you’ve got that second shot.”
  • If you haven’t been vaccinated, now’s the time to do it. “So if you’re ambivalent about it, if you’ve been thinking about it and waiting, now’s the time to get vaccinated.”
  • Get your flu shot, McKee said.
  • As you gather for the holidays, get vaccinated and gather to feel safe. “But if you have the sniffles, or don’t feel right, please don’t go to the event, and get tested. It’s super important that you get tested.” And gathering in smaller groups is always safer, Mitchell said.
  • If the weather is nice, try to gather outside as much as possible, Mitchell said.

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Austin Fisher
Austin Fisher

Austin Fisher is a journalist based in Santa Fe. He has worked for newspapers in New Mexico and his home state of Kansas, including the Topeka Capital-Journal, the Garden City Telegram, the Rio Grande SUN and the Santa Fe Reporter. Since starting a full-time career in reporting in 2015, he’s aimed to use journalism to lift up voices that typically go unheard in public debates around economic inequality, policing and environmental racism.

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