Colorado could stop elective surgeries next week

If Colorado’s COVID-19 situation doesn’t improve in the next few days, the state could call in federal backup, stop nonemergency surgeries or even allow hospitals to ration care, Gov. Jared Polis said Thursday.

As of Thursday afternoon, 1,167 people were hospitalized with confirmed COVID-19 in Colorado. That’s 24 fewer than yesterday, but it’s not unusual for numbers to bounce around, meaning that it will take several days of declining hospitalizations before it can be said with any confidence the worst is over.

If the situation doesn’t improve in the next few days, the state has five levers left to pull, Polis said:

• Ask the Federal Emergency Management Agency to send in medical surge teams to supplement hospital staffing;
• Stop nonemergency procedures statewide;
• Reinstate crisis standards of care;
• Issue an executive order removing barriers to transferring patients between hospital systems;
• Scale up distribution of monoclonal antibody treatments in outpatient clinics and through mobile units.

A plan to distribute the antibody treatments is already in motion, with two buses delivering them starting Monday, and three others joining later, Polis said. Monoclonal antibodies are lab-produced versions of the substances the body produces to help fight the virus, and have to be given intravenously. They significantly cut the odds a person will be hospitalized if given in the first days of an infection, though not by as much as getting vaccinated.

“Unless cases drop off, you will see two or three” of the other options in the coming days, Polis said.

The state is ready to put in a request to FEMA, if necessary, Polis said. Some hospitals have already stopped performing nonemergency surgeries, ranging from replacing knee to removing tumors, to keep beds open in their intensive-care units.

The Colorado Hospital Association reactivated a center to coordinate transfers in August, but an executive order could remove barriers within the voluntary transfer system, said Dr. Eric France, chief medical officer for the Colorado Department of Public Health and Environment. It also would allow Colorado to coordinate with neighboring states.

“The goal is to make sure all beds are being used appropriately,” he said.

Activating crisis standards of care is generally a last resort, because they tell hospitals and other providers how to function when their resources are stretched to the limit, and provide legal cover if they can’t offer what’s normally considered minimum acceptable care. For example, under crisis standards of care, a hospital without enough beds in its intensive-care unit would have a procedure to follow, to prioritize care for patients who are sick enough to need an ICU, but more likely to survive than others. The patients on the losing end would still receive what care was available — they wouldn’t just be left to die — but they might not get resources that would give them a better chance to survive.

During the fall 2020 surge, the state activated crisis standards to stretch staffing and emergency medical response resources. Those standards were deactivated in mid-February.

State officials have said reinstating a mask mandate or capacity limits is off the table, though they encouraged local health departments to consider doing so if conditions warrant it in their areas. At least one county has said any mandate would have to come from the state to be effective, according to the Ouray County Plaindealer.

Polis also announced plans to host mass-vaccination sites for children ages 5 to 11 in the coming weeks, assuming the director of the Centers for Disease Control and Prevention signs off on smaller doses of the Pfizer vaccine for that age group, as expected. Clinics are planned at the Denver and Pueblo zoos, and the state has offered resources to schools that would like to hold vaccination events, he said.

The Pfizer vaccine is 91% effective in preventing any COVID-19 infection in that age group, and in trials it was 100% effective in preventing hospitalization, France said.

“Vaccines are the strongest layer of protection we can offer children,” he said.

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