The omicron variant’s unprecedented surge is straining Colorado’s already exhausted health care workforce, and a physician who helped write hospitals’ emergency triage plans late last year said Friday the state would benefit from enacting them now.

“From a staffing perspective, it’ll get worse,” said Anuj Mehta, a researcher and Denver Health intensive care physician. “We might start seeing certain units being shut down. … Urgent cares shutting down, labor and delivery (departments) shutting down. There’s high potential for that in the coming weeks. It’s going to be much harder to access health care.”

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Omicron has led to staggering case and positivity rates across the state, setting and re-setting records in successive days. COVID-19 hospitalizations statewide are rising after a monthlong reprieve, and Colorado’s top epidemiologist told reporters Wednesday that this wave won’t peak for weeks to come. Perhaps more pressing is the surge’s impact on hospital workers: The variant’s wildfire-like spread, coupled with its ability to evade immunity, is leading to a surge in breakthrough cases among health care staff, whose ranks have already been thinned by exhaustion and burnout. 

“Omicron has done something that I think we all hoped would never happen but unfortunately is happening,” Mehta said. “Omicron has decimated the ranks of health care workers because we’re seeing so many people test positive.”

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At Denver Health, 40% of health care workers who’ve self-reported for testing recently are positive for the virus, Mehta and hospital spokeswoman Rachel Hirsch said. Fortunately, because those workers are vaccinated and because omicron generally causes less severe disease, Mehta said he wasn’t aware of any of his recently infected colleagues becoming seriously ill.

But the rolling waves of infection mean providers are routinely dropping out to isolate for at least five days, further exacerbating a critical staffing shortage. Mehta’s wife, a primary care physician, volunteered to go work a shift in an emergency department because of staffing shortages; systems and hospitals across the state are increasingly turning to outpatient providers, like those at urgent or primary care clinics, to fill in for infected hospital workers.

Cara Welch, spokeswoman for the Colorado Hospital Association, said she couldn’t say with certainty that the virus was infecting more providers now than in previous waves, “but it sure seems that would be likely, just given the transmissibility of omicron.” As of Friday afternoon, more than half of the state’s hospitals said they were anticipating a staffing shortage in the next wee. Welch said that figure is likely an undercount.

Rachel Herlihy, Colorado’s epidemiologist, said this week that the virus is spreading so widely that patients in the hospital for non-COVID-19 reasons are testing positive at higher rates, which increases the exposure risk for health care workers.

In November, hospital capacity was strained to its tightest points of the pandemic. The crisis was centralized at the hospitals but exacerbated by short staffing at long-term care facilities, which can act as step-down facilities for recovering patients. Gov. Jared Polis surged scores of new beds into hospitals and long-term care buildings, which helped to stabilize the situation. But long-term care staffers are getting sick now, too, Mehta said, and several nursing homes have recently refused admissions because they’re too short-staffed.

“We were already operating on razor-thin margins,” he continued. ” … We’re seeing emergency department wait times and waiting rooms extending into multiple hours for lower-acuity issues, and then waiting rooms kind of bursting at the seams.”

The crisis standards of care for staffing – which broadly allow fewer staff to cover more space and beds than would otherwise – have been in place since November. But the state has not enacted its triage standards, which dictate how hospitals should deploy resources, if they become overwhelmed. 

Mehta led the effort in November to re-write the triage standards. At the time, COVID-19 hospitalizations were at their highest point in a year. Even more pressing was the spiraling staffing crisis, coupled with a rush of typical hospital patients who were sicker than patients were pre-pandemic.

The state has not had to activate its crisis standards of care for triage, which many providers have said would be a worst-case scenario and a sign of the extreme, near-fracturing strain placed on hospitals here. But Mehta said Friday many hospitals were already using strategies outlined in the plan.

“I mean, I think we’re there, ” he said when asked if the state needed to institute the rest of the crisis standards. Anecdotally, he said, he’s heard of providers discharging patients early or referring emergency room patients to outpatient care elsewhere, as opposed to admitting them, so long as it’s safe to do so. Both of those strategies are key parts of the crisis standards. 

But the wrinkle, Mehta continued, is that these decisions are not happening in a uniform way. The crisis standards, if activated by Polis statewide, would give detailed guidelines on how to ration resources equitably and uniformly, in a way that could be tracked.

Welch said enacting the standards is “certainly the end of the road we’re trying not to reach.” She said hospitals were still able to transfer patients between them, meaning that there was still some flexibility left within Colorado’s hospital system. 

“But I think the crisis standards are still out there as the last major lever we have to pull,” she said. “It seems like we’re moving in that direction still as the case and hospitalization numbers continue to go up and as our staffing challenges continue.”

Mehta said Colorado’s hospital system would benefit the crisis standards being activated, for several reasons: It would give liability protection to hospitals making those decisions; it would centralize the decision-making about patients away from providers directly treating them; and it would ensure inequities common in health care aren’t perpetuated.

It would also serve as a wake-up call to the state, he said, and would help health care providers who are already past the point of exhaustion.

“It’s hard to imagine the mental health getting worse, but it will obviously get worse,” he said. “I have no doubt about that. I couldn’t imagine it getting worse (six weeks ago) and it’s worse (now). We don’t know what the floor is for mental health for health care workers. That’s going to be an ugly floor because my God, the people who continue to show up for their job every day – how do you define that as anything other than a hero?”