With her characteristic candor, Dr. Angela Dunn, laid out Utah’s current coronavirus crisis in a direct and straightforward manner for Gov. Gary Herbert.
The rapid growth in cases Utah has seen — the fourth fastest rate in the nation as of Tuesday — will overwhelm our hospital system, she wrote in a memo obtained by my Tribune colleagues.
If we don’t cut the daily number of new cases to 200 by July 1, the state should return to the “orange” risk level. (Given that we have averaged 480 cases per day for the past week, that kind of reversal is virtually impossible).
On our current trajectory, she wrote, many hospitals will reach their maximum capacity in 4-8 weeks.
“We are quickly getting to a point where the only viable option to manage spread and deaths will be a complete shutdown,” she wrote. “This might be our last chance for course correction.”
UDOH brief by The Salt Lake Tribune on Scribd
In response, Herbert tweeted that he “shares many of her concerns” but he would not again shut down the economy. The mayors of Salt Lake City and Salt Lake County asked the governor to allow them to make wearing masks mandatory, something else Dunn suggested, but Herbert won’t do it.
Meantime, Lt. Gov. Spencer Cox, in the middle of the governor’s race, hasn’t held a meeting of the Utah Coronavirus Task Force since June 9. Since then, we have seen 5,436 new cases and 35 people have died.
For now, the task force will only meet on an “as-needed” basis and evidently right now this group isn’t needed.
The messaging coming from the governor’s office continues to be a muddled mess, as the gauge on the state’s website labeled “RISK” indicates the danger is low when, as Dunn told a legislative committee recently, it is higher than ever.
We’re encouraged to wear masks and socially distance while at the same time being told that large chunks of the state can go to the “green” risk category and group gatherings of up to 6,000 people are permitted.
Herbert has always said that data will drive the decisions, not politics, yet all he has done as the virus explodes in much of the state is loosen restrictions.
As well as Herbert performed in the early stages of the outbreak, the governor could now be a modern-day Nero, if he’d only learn to play the fiddle.
We all took extraordinary measures to avoid overwhelming our hospital capacity, but we’ve seemingly abandoned that sense of community responsibility and resolute leadership from government officials in exchange for a short-term economic boost.
But what happens if — or when — we overburden our hospitals?
To find out, I talked to Mark Shah, who led a committee of doctors and medical experts to craft the state’s Crisis Standard of Care guidelines — plus an addendum specifically for this outbreak.
On the heels of Hurricane Katrina, hospitals began creating battle plans about how to prioritize patients in an emergency. They are intended to be implemented as a last resort in situations where contingency plans have been implemented and the system is overwhelmed.
They rely on a scoring system based on some basic criteria. A younger patient would get urgent care over an elderly patient. Pregnant women are given extra consideration. Those with underlying medical conditions will be less likely to receive care.
In a crisis, those with low scorers don’t get an intensive care unit bed or a ventilator, meaning they are more likely to die.
Patients who are in the ICU or on a ventilator and not improving may be moved to palliative care to make room for others. Likewise, if patients with higher scores need care, patients with lower scores could be removed from ventilators.
The decisions will be in the hands of a “crisis triage officer,” rather than the physician caring for the patient.
Shah said the crisis care guidelines also urge doctors to make sure patients know before going on a ventilator that they could be on the machine for a long time and they may or may not survive.
The overarching goal, Shah said, is to “do the greatest good for the greatest number.”
But make no mistake, these are putting people in the position — as we saw in Italy and New York — of deciding who lives and who dies.
That can be an emotional strain, even in the abstract. Bountiful City Councilwoman Kate Bradshaw was on a committee that created the crisis care guidelines for Lakeview Hospital. She said it was traumatizing to consider those decisions and she couldn’t help but think of how it could someday apply to her parents, grandparents and neighbors.
“To watch the numbers grow, to watch people resist wearing masks and making it a political battle about those things has increased my anxiety level dramatically,” she said.
Shah, who is also the medical director for Intermountain Healthcare Disaster Preparedness, said that, right now we have room in our ICUs. But if the current trend continues, Intermountain will pass 85% capacity in two weeks and max out in four weeks.
There are plans for some emergency beds, but once those are filled rationing becomes a reality.
“I think people are realizing that hospital capacity is not limitless,” Shah said, “and that we need to make sure we do everything we can as a community to protect that resource by being responsible for ourselves and our neighbors.”
We are, as Dunn said, at a crossroads. It is our last chance to change course. Absent any intervention or leadership from Utah’s government, which appears to not be forthcoming, it is critical we do those things we know work immediately — wear masks, stay home, practice good hygiene and socially distance.
Otherwise, we could well find ourselves in a position where some Utahns are left to die without medical help.
