New Mexico prepares to ration care if pandemic worsens; no daily case report due to state glitch

SANTA FE, New Mexico — Top health officials say New Mexico has a solid plan in place to stretch hospital and health care resources as far as possible before having to ration care, but they also warned Tuesday that the state could face that prospect if the coronavirus pandemic worsens.

Confirmed infections in New Mexico are close to 110,000 since the pandemic began, with roughly half of those being reported in November. The number of related deaths reported in a single day hit record highs twice last week, and hospitalizations still are hovering over 900.

New Mexico did not report Covid-19 daily cases on Tuesday after a state computer network outage disrupted collection of laboratory data. Officials said Tuesday's data would be reported on Wednesday.

Meantime, Human Services Secretary Dr. David Scrase said there are hospitals around New Mexico facing extremely high demands and state health officials are expected to formally declare soon that providers are at a stage where rationing care. Such a step is likely despite a slowdown in the rate of spread and a decrease in the number of Covid-19 cases being reported daily in the state.

Under a crisis standards of care declaration, an established framework and guidelines would be used for making ethical decisions about triaging care.

“The trigger for when that happens is actually when the resources don't match the demand," said Dr. Michael Richards, vice chancellor for clinical affairs with the University of New Mexico Health System. “In our case, we've had months of this and months to prepare."

Local triage boards are up and running at hospitals around the state and a centralized call center has been helping to identify which hospitals have room and which ones need help. Unlike other states, the idea early on was for separate providers in New Mexico to work together to pool their resources since the state already ranked near the bottom nationally for the number of hospital beds per 1,000 residents.

Richards and other officials stressed that the tools used by the local triage boards to make decisions are objective and based on equity and fairness. They also said the foundation for developing those tools is rooted in plans that have been crafted over recent years and months by experts both nationally and in New Mexico.

The only criteria that would determine the allocation for resources and care is whether a person would be likely to survive a COVID-19 infection, officials said.

And the situation is fluid as pressure on the health care system changes daily, Richards said.

“There's no one bright line that we cross that then says we'll do this for every patient in every circumstance,” he said. “What I mean by that is that the health care professionals won't make decisions about allocation of resources until it's necessary. We will continue to build as much contingency capacity, use as much alternative ways of delivering the care as possible and only apply this as needed.”

As resources become more scarce, officials explained, the duty of health care providers shifts from focusing on the individual patient to making sure decisions maximize benefits for all patients.

Dr. Denise Gonzales, medical director at Presbyterian Healthcare Services, said hospitals around the state already have tried to boost capacity by increasing spaces where beds can be placed, putting more than one patient in a room, redeploying staff and hiring traveling nurses. They also are identifying patients who can be treated at home or at outpatient centers where they can get the medications they need without being hospitalized.

Gonzales said New Mexicans should feel reassured that physicians are doing everything possible to not limit any care.

“But we do need the community's help,” she said, making another plea that people limit their contact with others as much as possible, wear face coverings and wash hands to curb opportunities for the virus to spread.