Colorado weighs how to ration health care should COVID surge continue to worsen

Colorado hasn’t yet reached the point where hospitals are rationing care, but a group of experts advising the governor are planning how best to do that should the state’s COVID-19 situation continue to worsen.

As of Thursday, 72 beds were available in Colorado intensive-care units — a 12% decrease in one day — and only 570 general beds were open statewide.

If the current acceleration in COVID-19 hospitalizations continues, the state could run out of hospital beds by the end of December, though Gov. Jared Polis has called on facilities to find space for 300 to 500 more patients. It’s not clear how hospitals would find enough staff for those additional beds, though.

State officials have estimated Colorado has 2,000 to 2,200 beds that could potentially be used for COVID-19 patients, and as of Thursday afternoon, 1,466 of them were full. If all of those beds were filled with people who have the virus, it would leave very little room for anything else to go wrong, from a bad flu season to traffic injuries during a snowstorm.

Dr. Eric France, the state’s chief medical officer, said at a Thursday meeting of the Governor’s Expert Emergency Epidemic Response Committee that it’s possible Colorado will need to activate its hospital crisis standards of care, which allow for rationing, in the next few weeks.

The advisory group will need to meet again to approve any changes to the crisis standards, and Polis would have to authorize their use. At that point, France would make the call on activating them.

Crisis standards outline what hospitals should do to maximize their resources, and give legal protection if they can’t provide the normal level of care. They were written when Colorado faced its first COVID-19 wave in spring 2020, but would apply to all patients, not just those receiving care for the virus.

Right now, only the crisis standards that relate to staffing are in place. That means hospitals aren’t authorized to ration care, but patients may receive it from a nurse who doesn’t have extensive experience in their type of care, or is handling more patients than is considered ideal.

The state has already taken a flurry of actions to try to keep people out of the hospital or free up more resources to care for them, including expanding the locations where people can get monoclonal antibody treatments to reduce the odds they’ll be hospitalized with COVID-19; temporarily halting cosmetic surgeries; asking the Federal Emergency Management Agency to send health care workers to hotspots; requiring hospitals to accept any transferred patient they have the ability to care for; and allowing almost all adults to receive booster shots.

If the situation worsened enough to require rationing, decisions would depend on the answers to three general questions, said Anuj Mehta, a pulmonary critical care physician at Denver Health, who wrote a first draft of updates to the current guidelines:

• Will the patient get better with a lower level of care?
• Would the patient likely die anyway, even with maximum care?
• And if patients would be fine with outpatient care, can they get it, or would factors like being uninsured get in the way?

The current standards for rationing care largely rely on a formula to quantify patients’ odds of surviving the next month and the next year. Patients would receive a score based on how well their organs are functioning now, with added points if they are older or have a condition that increases their risk of dying in the next few months. A lower score is better.

If two patients have equal scores, the hospital’s triage team can consider other factors, such as whether either patient is a child, health care worker, first responder or essential worker; if either is pregnant; or if either is the sole caregiver for a child or vulnerable adult. If all else fails, the last step is a random drawing.

The existing standards were set up to determine who wasn’t likely to be helped if they got the last ventilator, Mehta said. Now, hospitals largely have enough ventilators, but they may not have enough staff to care for everyone who could benefit from a bed in an intensive-care unit, or even one on a regular floor. There also may be shortages of equipment like dialysis machines and high-flow oxygen set-ups, he said.