The omicron surge’s likely peak last week does not change the crisis facing Colorado’s front-line health providers, the head of an emergency physicians group said Friday, and he called Gov. Jared Polis’s comments to Colorado Public Radio about the pandemic “shocking” and a “smack” to providers statewide.

The doctors organization – the Colorado chapter of the American College of Emergency Physicians – wrote to Polis late last week, urging him to activate a key tenet of the crisis standards of care amid a critical staffing crisis; the group also warned that health providers are struggling and don’t feel supported by the state. But Polis and state officials have said they have no intention of triggering the crisis standards, in part because the omicron wave appears to be subsiding.

But omicron’s record-setting surge is only part of the problem facing Colorado health providers and emergency care workers in particular, said Ramnik Dhaliwal, the president of the emergency physicians group.

“From our perspective, flattening doesn’t mean that things are suddenly better,” he said Friday. ” … Further, the other problems brought up in the letter are still there. This nursing shortage is here to stay and will take a long time to rectify. With that, our hospitals and (emergency departments) will continue to have difficulty in the coming months with capacity issues related to workforce.”

He said his group still supports activating the crisis standards of care, which would immediately create uniformity and equity – while ensuring providers have liability protections – in how emergency departments choose who needs to be admitted and who can be referred to care elsewhere. Hospitals and emergency rooms in particular have been inundated with patients in recent months, but omicron’s remarkably infectious nature has led to more cases among providers, whose ranks have already been thinned by burnout, prompting quarantines and exacerbating the staffing crisis.

Dhaliwal’s group met with Scott Bookman, Colorado’s COVID-19 incident commander, and other representatives from the state Department of Public Health and Environment earlier this week, officials said. Bookman and his team told the physicians they would work on messaging to urge Coloradans not to go to the ER for COVID-19 testing, which is further gumming up the works. 

According to Dhaliwal, the state also said it would work on “ramping up” EMS support, which has also been strained; supporting and expanding the health workforce; and ensuring uniformity across hospitals who are enacting their own crisis standards. The officials also said that previous state action ensured liability protection for providers already. But Dhaliwal said the workforce effort was a long-term play, not the short-term response needed; that the uniformity push would also not be immediate; and that physicians were still concerned about liability. 

But if the crisis standards were enacted, he continued, those things would click into place immediately. The Colorado Medical Society came out in support of activating the standards this week, as did Anuj Mehta, a Denver Health physician and researcher who helped rewrite the standards, and Matt Wynia, a University of Colorado and Colorado School of Public Health professor and bioethicist. 

Wynia warned on Wednesday that delaying the deployment of the crisis standards made them less effective – and the situation worse on providers – with each passing day. He also criticized the state’s decision not to have a set threshold that would trigger their activation, a stance Dhaliwal echoed.

“One key lesson from the pandemic is that states should have criteria they follow that would automatically prompt the issuance of (crisis standard) guidance, rather than hoping that the Governor will recognize a crisis in time and have the political will to act on it,” he said in an email. “We’ve seen over and over that most governors won’t.”

To compound providers’ frustration, Polis spoke to Colorado Public Radio’s Ryan Warner earlier this week, after the physicians group’s letter became public. In that letter, the group warned that providers were exhausted and that they didn’t feel supported by the Polis administration or legislature.

Asked about that exhaustion, Polis told Warner that “everybody is exhausted.” He noted a legislative priority was waving licensing fees for various health care workers.

“Of course, first and foremost our health care workers,” he said of exhaustion among the general public. “This has been hard on them, but you know what? It’s been hard on teachers. It’s been hard on grocery store workers. It’s been hard on every single Coloradan.”

He reiterated his position that the COVID-19 emergency is over because of ebbing cases, the availability of vaccines, the state’s ready supply of equipment and ventilators, and hospital capacity’s recent stabilization. Polis told Warner that if, “God forbid,” Dhaliwal was correct and the situation worsened, then Colorado’s chief medical officer, Eric France, “will likely advance” the crisis standards of care.

But if omicron continues to decline, “it’s very unlikely those types of measures would be taken.”

Dhaliwal, who read the transcript of the interview earlier this week, said Polis’s comments about providers’ exhaustion and the emergency being over were “quite shocking.” 

“I think that’s shocking to anyone who’s in the health care space providing care,” he said, adding that it felt like a “smack” to providers across the state. “We have a light at the end of the tunnel, but we’re definitely in the thick of it. I would love for Governor Polis – he’s welcome to go to any one of the EDs in his state and assess what’s going on. Go to one of the urban EDs and see for himself. If he was a patient and had to go in like a normal person through the emergency department, would he feel the same way?”

In statement earlier this week, Polis spokesman Conor Cahill called the crisis standards a “grim tool that should rarely if ever be used.”

“If strain was so acute to warrant rationing of care to Coloradans, the Governor would consider pausing all elective surgeries before getting to crisis standards of hospital care,” Cahill wrote in an email. He noted that the state has spent millions of dollars to bring in traveling providers to support hospitals. But front-line workers here have said that travelers are not an adequate substitute to full-time staff.

Polis “expects the hospitals to do more to address the work conditions that has led to so many healthcare professionals leaving their jobs,” Cahill continued, “and the Governor and Chief Medical Officer (Eric France) will continue to closely monitor the trends in cases and hospitalizations on a daily basis.”

Dhaliwal reiterated that for providers, the crisis is still very much underway: The staffing issues have not been solved and will not be in the near future; COVID-19 hospitalizations remain at one of the highest levels of the pandemic; and non-COVID patients are sicker and coming to the hospital in higher numbers than they did pre-pandemic.

He described a major hospital in Denver – which he declined to name – that had “one of their best days ever” recently in terms of capacity.

“And they’re at 100% capacity right now,” he said. “That’s their ICU, that’s their hospital – that’s their whole hospital. Our assessment of ‘good’ now is really skewed because the normal is different. In the next two weeks, I pray this is a plateau because we’ll be continuing at this new standards.

“But if we have any worsening, we’re going to be in a lot of hurt and difficult situations.”