Colorado health officials activated a long-dormant emergency provision to help hospitals adjust their staffing, as employee shortages exacerbate a hospitalization crisis that’s already surpassed forecasts for the entire month of November.

Thirty-seven percent of Colorado’s hospitals say they’re projecting a staffing shortage in the next week. To alleviate the beleaguered workforce situation, whose struggles are a major contributor to the state’s unprecedented hospital capacity crisis, Colorado chief medical officer Eric France has triggered the crisis standards of care for staffing, which gives facilities the ability, among other things, to move providers around in a facility outside of their traditional roles without threats to their licenses. The provision had been activated during much of the pandemic but was stood down earlier this year, as the situation appeared to be permanently improving.

“I hope it’s sending a message to the people of Colorado that our hospitals are stressed,” France told the Denver Gazette on Tuesday. “We all should be doing our part to stay healthy and not do things to end up in the hospital.”

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In a statement, the state Department of Public Health and Environment wrote Tuesday afternoon that the standards “expand the availability of health care workers and health care resources to combat the COVID-19 pandemic and to serve patients seeking non-COVID-19 related care” and “assure that guardrails and supports are in place to optimize workplace safety, health care worker resilience in the face of moral and physical stress, patient safety, and health outcomes of COVID-19 and non-COVID-19 patients.”

It may also mean more patients per staff person or longer wait times for patients, officials have said.

The hopes for a relatively normal end to 2021, expressed by Gov. Jared Polis in the spring, have been dashed. Nine and a half percent of the state’s COVID-19 tests have returned positive on average over the past week, double the rate that signals sweeping, uncontrolled spread. There are more COVID-19 patients hospitalized now than at any point since Dec. 17: There are 1,426 Coloradans in the hospital with confirmed COVID-19 cases, 130 more than there were Friday, when state experts predicted there would be 1,393 by Nov. 25.  

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According to a New York Times tracker, Colorado has the third-worst rate of spread in the United States. The state’s per-100,000 case rate has gone up 44% in 14 days, far outstripping the two states who have higher overall rates. Its sixth highest for per-100,000 hospitalizations, and the state is ninth highest for both rate of deaths and average daily deaths. The state’s clocked more than 37 deaths per day on average.

Colorado “is in a shockingly bad state,” said Jon Samet, the dean of the School of Public Health and a member of the team that projected a late-November peak. Nearly a year after a giddy Gov. Jared Polis welcomed the first batch of free, effective vaccines into the state, the virus’s resurgence has wiped out months of steady improvement.

As of Tuesday afternoon, there were 101 intensive care beds left in the state, a number that fluctuates regularly as hospitals shift their space and patients are discharged. That’s out of 1,537 total ICU beds, the lowest number of any point in the pandemic. Staffing is playing a significant, if not dominant, role in that strain. Hospitals generally have the space, the Colorado Hospital Association has said, but they lack the staff to care for patients in that space.

The staffing provision of the crisis standard aims to alleviate that, France said. Chief medical officers from hospital systems and facilities across the state requested the activation, which France said the state has worked on over the past week. 

“It provides them with the ability on how to use staff, move people up into higher roles than before, expanding how they use facilities,” he said. “While they’ve been doing that already, what the activation – or reactivation – does is sends a strong message to all health care workers in Colorado that we recognize the stress they’re under, the stress of having full hospitals, of caring for patients in this surge.”

“By reactivating,” he continued, “we’re saying the state recognizes the stress we’re under, and allows and understands that there will be actions and activities in your practice that differ from conventional care because of the taxing situation you’re in.”

As an example, France described a hospital switching a post-anesthesia unit — and the nurses who work there — into an intensive care ward. More floors could be opened and care can be extended “into other parts of hospitals that they hadn’t been using before,” he said. It also extends liability coverage, he added, to protect providers’ licenses.

Critically, the change does not trigger the far grimmer decision to begin rationing care. The state has never activated that provision, which would involve experts deciding which patients would receive scarce resources based on their likelihood of survival. France said he would convene a group of experts to re-evaluate those provisions Thursday.

Samet said the state is “pushing closer than before” to activating those crisis standards.

“Even last year, when we were talking the December peak, we still had more reserve capacity than now,” he said.

The activation is the latest step taken by the state to help abate the hospital crisis. Cosmetic surgeries have been suspended, and hospitals have taken the unprecedented step of working together to transfer patients across the state, with or without their consent. The state is pushing monoclonal antibody treatments, which can help prevent hospitalizations if given to high-risk patients early on in their infections. 

There are still fewer COVID-19 patients now than there were in early December 2020. But the gap is narrowing, and Samet said the state “could get there.” His team’s projections, released Friday, gave a 40% chance that Colorado would peak at roughly 1,500 hospitalizations between now and Dec. 31. But there are nearly 100 more patients than there were on Friday; the state has already surpassed the 1-in-10 scenario. The team estimated there was a roughly 1-in-20 chance of surpassing 1,600 in that time, and an even smaller risk of surpassing last year’s peak.

There are multiple factors stressing hospitals. Though COVID-19 is playing a role, it alone doesn’t threaten statewide hospital capacity. Staffing is a major problem. But so, too, is a rush of more typical hospital patients who are in worse shape than they normally would be. France and hospital officials have said that’s likely a result of Coloradans delaying care in the first year of the pandemic.

Despite the current crush, hospital officials and France have urged residents to continue going to the hospital and to their physicians when they need treatment for chronic or acute medical issues. Otherwise, they’ve warned, the state risks facing a repeat of this same crisis down the line.

“Do not miss out on routine care,” France said. “Go to the doctor if you’re not feeling well. Hospitals are a safe place to be. They want to see if you have an acute issue.” 

Why a surge now — and when it will end — remains elusive. Pockets of unvaccinated residents are undoubtedly playing a role, Samet said, and eventually, if those people remain unvaccinated and behaviors don’t change, the virus will burn through them. The delta variant, which remains dominant, has been proven to be more transmissible; that will mean more hospitalizations and, inevitably, more deaths. But it remains unclear if delta is more severe than other strains.

But there’s a growing body of research indicating that as hospitals near capacity, there’s a higher rate of COVID-19 mortality, said Beth Carlton, who also serves on the modeling team. 

“(In) the early days of the pandemic, a lot of the models were running scenarios of very high deaths if capacity was exceeded since some people wouldn’t get care/ventilators,” she said last week. “But these studies suggest even if hospitals stay below their estimated capacity, as hospitals fill up, the risk of death due to COVID-19 increases. … This is worrying as we approach hospital capacity in the current wave.”

The end of the current peak is still three to four weeks away at least, Samet said. It will “continue a while.” Officials for Banner Health, the capacity of which has been particularly hammered by this surge, told the Gazette that the system is projecting its peak won’t come until Dec. 18. The modeling team’s projections, already surpassed, indicate hospitalizations won’t fall below 1,000 until early 2022.

With the wide availability of vaccines, state leaders have grown increasingly frustrated with the virus’s resurgence. Polis, Samet and Scott Bookman, the state’s COVID-19 incident commander, have all said they did not imagine the pandemic would be nearing its worst-ever levels as 2021 wound down.

“We shouldn’t be here,” Samet said. “What else can I say?”