Denver Health Colleagues,

As this crisis extends into and beyond its second year, Denver Health transitioned from an Incident Command Structure to a COVID Coordination Task Force staffed by clinician leaders from every department. We made this structural change to prioritize the voices of clinicians in decision-making, reduce the distance between the frontlines and leadership, and embed our response throughout our clinical services because it will take all of us to respond.

To coordinate our shared response to the ongoing public health crisis, the COVID Coordination Task Force is meeting thrice-weekly and communicating at least weekly to describe our shared response. Today, we are sharing five messages.

Crisis Standards of Care

On November 9, 2021, the State of Colorado activated Crisis Standards of Care for healthcare staffing. On January 7, 2022, the State activated the crisis standards for Emergency Medical Services. Crisis Standards of Care give facilities the permission to make difficult decisions about prioritizing care for patients. Denver Health has not activated crisis standards. Averting the need to activate them is a high priority.

However, signs of our ongoing crisis are everywhere: we have stood up two additional inpatient medicine teams, stood down operating rooms for many elective procedures, all placed our graduate medical education programs under emergency ACGME status. Meanwhile, our partners at Denver Public Schools are dealing with staff shortages and the State of Colorado remains under Public Health orders.

Record Inpatient Census

As of this morning, a record 145,982 Americans are hospitalized with COVID. Denver Health is, likewise, currently experiencing our highest inpatient census of COVID+ patients. Our patients continue to need medical care for a range of conditions, and ~60% of our COVID+ hospitalized patients were identified incidentally, meaning that they were not hospitalized for COVID. Fewer of our COVID+ patients are requiring ICU admission compared with prior waves.

Tragically, the Omicron wave is directly impacting many of our staff and their families. This has resulted in staffing shortages at the exact time when staff are most needed, creating added stress for those at work and can cause feelings of guilt for those who are sick.

Our mission remains to support each other and our staff as we provide the highest possible care for all, even as we deal with what feels, for many of us, like the most difficult phase of the pandemic.

Pandemic to Endemic

We have now been caring for people with COVID for almost two years. 5.5 million people around the world have died, including 834,077 Americans, and 10,773 Coloradoans. We remember and mourn them, while working to keep more people from joining their number.

Vaccinations remain effective against severe disease, hospitalizations, and death. The high rates of Omicron among both vaccinated and unvaccinated people will result in higher levels of protective immunity in our community. The transition from pandemic to endemic is not a specific event. It happens when enough of our community has protective immunity against severe disease from future variants that people who get COVID can be treated through the established healthcare infrastructure without profoundly disrupting our work and lives.

According to modelling from the University of Colorado School of Public Health, the current wave of Omicron infections is projected to peak and come down much more quickly than what we experienced with Delta. We can expect continued challenges for several weeks but are hopeful that after this wave has passed, we can focus on recovery, on integrating the care of people with COVID into our usual work, and on addressing other important healthcare needs that have been de-prioritized while responding to COVID.

Helping navigate the current crisis and prepare for the future is our shared work as the Covid Coordination Task Force.

Signs of Recovery

Over 96% of our Denver Health workforce is fully vaccinated and we have ample supply to provide booster doses for everyone who is eligible and has not already gotten one.

Our supply teams have amassed a large supply of effective PPE that is available for staff. N95 masks provide more protection than surgical masks that provide more protection than cloth masks. N95 and surgical masks are not required but are available to all staff. We encourage people to choose a mask that provides the level of protection they need and want.

Our clinical teams have learned care for people who are COVID+ and have an increasing number of evidence-based treatments in their armamentarium, which are especially valuable for high-risk patients. New therapeutics are available at DH for those at risk for progression to severe disease, including :

  • Monoclonal antibodies (treatment)

    • Sotrovimab

  • Oral antivirals (treatment)

    • Nirmatrelvir/ritonavir (Paxlovid)

  • Intravenous antivirals (treatment)

    • Remdesivir (Veklury)

  • Pre-exposure prophylaxis (prevention

    • Tixagevimab/cilgavimab (Evusheld)

Message of Gratitude

In the ongoing crisis, we are no longer hearing ‘thank-yous’ as often from our community as we did in the early stages of the pandemic. And yet, we remain at work to care for our patients, each other, and our community. So, thank you for being here and caring for all and for each other.

Sincerely,

Abraham Nussbaum, MD

Anuj Mehta, MD

Bob Belknap, MD

Rebecca Hanratty, MD

Kris Gaw, COO

Simon Hambidge, MD, PhD

Tom Mackenzie, MD

Connie Price, MD

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