EIPH 10.08

Amid concerns over hospital capacity, Eastern Idaho Public Health’s board overhauled its pandemic response plan Thursday, Oct. 8.

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Regional health officials on Thursday unanimously approved a sweeping overhaul to their pandemic response plan. Until hospitals across the region are overwhelmed, officials won’t issue more social restrictions.

Besides a stay-home order if hospitals are past the brink, the only remaining restrictions in the plan are mask mandates and slight event restrictions at the so-called moderate-risk level. Seven of eight counties here are under those health orders by Eastern Idaho Public Health’s board.

The reversal of eastern Idaho’s more aggressive pandemic planning follows announcements by regional health care administrators that hospital staff resources are being stretched thin treating a rise in COVID-19 patients, a strain that’s been slightly worsened as an unprecedented surge of new virus cases sends more people to the hospital.

At the high-risk level, the board now says it will “work with local and community leaders to develop local education and mitigation efforts.”

The board officially moved Madison County to the high-risk level, nearly two weeks after the county’s active case rate breached the original threshold. The metropolitan area of Rexburg, the seat of Madison County, is the worst hotspot in the nation, according to the New York Times.

Eastern Idaho’s health board’s plan previously called for a ban on events of more than 50 people in an area that reached high-risk, but the removal of restrictions in that level makes the designation largely symbolic, board members recognized.

“It is simply a notifier, if you will,” said board Chairman Bryon Reed.

Earlier in the meeting, when reviewing written public comment the board received, Reed addressed why the health board didn’t move Madison County to high-risk last week.

“It was probably an oversight in my place to not mention that our staff was working really hard on that,” he said. “We were all working ... to make sure any decision we make would be the correct one, in regards to our plan. We did mention the need to probably revisit the plan. We didn’t tie it directly to that.”

Resource strain

Last weekend, “there was a point across the region where almost every ICU bed across the region was filled. That’s not a position anyone wants to be in,” said David Hoffenberg, an administrator at Eastern Idaho Regional Medical Center, the region’s largest hospital.

Hoffenberg and Casey Jackman, an administrator at Idaho Falls Community Hospital, couldn’t provide the health board with a clear threshold for capacity to trigger other mandates.

“It’s hard to place a number because it depends on what else is going on in a facility,” Hoffenberg said.

Jackman agreed. “We could have 40 (active cases) per 10,000 (people), if those people were responsible and quarantined and stayed away from people who were at risk, we’d be fine,” he said.

Several officials, including health district Director Geri Rackow and Reed, said complying with those mandates should be “personal responsibility,” as opposed to a result of legally enforcing the mandates. If enforced, violators could be charged with a misdemeanor, carrying up to $300 in fines or 6 months.

Bed counts or head counts?

September brought more than 2,000 new coronavirus cases to eastern Idaho, a surge that was even worse than the summer spike that prompted waves of mask mandates across the region. The first seven days of October brought almost 900 cases.

This week marked the highest amount of eastern Idahoans hospitalized on a given day — 36 as of Wednesday night. That’s nearly 1/5 of the 191 Idahoans actively hospitalized with COVID-19 on Oct. 5, the latest day for which reporting is available.

But representatives from nearby hospitals have told the health board that bed counts don’t accurately represent hospital capacity. They’ve warned a bed isn’t any good without nurses to treat a patient. And, they say, their staffing concerns are worsening.

EIRMC, the region’s largest hospital that handles the brunt of trauma cases. The hospital had 26 COVID-19 patients Thursday morning, Hoffenberg said. One time over the weekend, Hoffenberg said the hospital had 31 COVID-19 patients.

Jackman, at Community Hospital, said: “We haven’t even looked at canceling elective surgeries yet to preserve nursing staff.” He said, “to my knowledge, there hasn’t been one COVID patient who’s had to leave this area because we couldn’t handle them.”

The health board removed reference to bed capacity metrics in the regional pandemic plan. Rackow said the health district and hospitals are working to develop a data reporting system that more accurately represents hospital capacity.

“That’s not a simple number to pull out of the air,” she said.

Addressing the ‘yo-yo’

While mandates have remained consistent in eastern Idaho’s three larger counties — Bonneville, Jefferson and Madison — smaller counties have seen their mandates placed and lifted, time and again, by the regional health board.

The board tried to address the “yo-yo” effect Thursday by requiring that for two weeks, counties’ active case rates drop below the threshold that prompted mandates before the board lifts them. Before the change, the plan said the mandates must stay in place for two weeks and they can be lifted after a county’s rate drops for one week.

In smaller counties, just a few cases can cause steep increases or declines to active case rates. Several times, a county has seen its active case rate drop for a week or so, only to see it shoot up soon after.

Dr. Barbara Nelson, the board’s voting physician, and Teton representative Bill Leake spearheaded the change. Health district epidemiologist James Corbett said it “will probably help” address the “yo-yo” effect.

Reporter Kyle Pfannenstiel can be reached at 208-542-6754. Follow him on Twitter: @pfannyyy. He is a corps member with Report for America, a national service program that places journalists into local newsrooms.