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ChristianaCare announced Monday it has enacted Crisis Standards of Care protocols to help in their mission to address "unprecedented demand for hospital and health care services" amid a winter COVID-19 surge. 

Used in times of emergency "to guide decision-making when the demand for care surpasses the available resources," when contingency plans already in place begin to fall short, the Crisis Standards of Care designates a framework for healthcare providers to allocate resources in order to care for patients with the highest need when it is "no longer possible to deliver care according to normal standards."

'It's as bad as it sounds'

"At ChristianaCare, we take care of people. Our commitment to our community is unwavering," said Dr. Janice Nevin, president and CEO of ChristianaCare. "The health care system is under unprecedented strain. Never have there been this many people in our community who need hospitalization, emergency care and other health care services. We have taken this step to implement Crisis Standards of Care so that our caregivers have the flexibility and decision-making tools they need in order to deliver care to patients with the highest need at this time when the demand exceeds all available resources."

Changes detailed in a release from the healthcare system Monday include broad strokes like "advancing different care models" and "changing workflows," but also included simplified documentation requirements and modification of admissions and discharge criteria. 

Surgical, procedural, and diagnostic schedules would also fall victim to the new standards, as would how supplies and treatment resources are allocated and distributed. Non-urgent services will be put on the backburner for the time being. Decisions will be made in a "just, equitable, and transparent way," the hospital ensured. 

"This is a moment where we are being much more public about the severity of the situation. This is a dire situation we're facing. This is not a sustainable model for us," Dr. Ken L. Silverstein, chief physician executive, told WDEL. "The demand is outpacing the supply, and the community needs to hear that and the community needs to know that they can join with us arm-in-arm and help us mitigate the spread of this virus and help us curb this pandemic. They can get vaccinated; they can get boosted when they're eligible. They can wear masks; they can socially distance; they can wash their hands; they can be mindful of their social interactions. That's what we need. We need the community to work with us, and that's why [Monday] we are coming forth with a very public message about the circumstances that we face--and have been facing, really, day-in and day-out."

Delaware's hospital systems have been operating at a 100%+ capacity for weeks, and demand for services has only increased as COVID-19 continues to spread in the community, particularly among the unvaccinated. 

The hospital is bound by federal law not to turn anyone away, they are encouraging anyone who doesn't find themselves in an immediate COVID-related medical emergency to self-isolate and wait it out. You will not be turned away if you show up in need of care, hospital officials assured in a follow-up call. In this unprecedented time, if you have COVID but you're not experiencing a medical emergency, you do not need to go to the emergency room. 

"What I want to say to you is, it's as bad as it sounds, because it's really important to reinforce the message of what we're saying," Silverstein said. "We are here for you. We have a commitment to providing high-quality, safe care. We have a commitment to serve the community. We have a mission of service to the community, and we take that very seriously and people...who are engaged and working together with us, thank you. We need more of that. We can get through this. We can get through this together--and we will--this step that we've taken is really to address that, to position ourselves so that when you come through the door with that acute need, we will be able to address it."

On the heels of their announcement of a move to Crisis Standards of Care, ChristianaCare issued a joint statement on the current situation also signed by Bayhealth's Kevin Snyder, TidalHealth Nanticoke's Roger Follebout, and Trinity Health Mid-Atlantic's Mary Wascavage. That statement read: 

"Delaware hospitals have confronted the challenges of the COVID-19 pandemic for nearly two years, meeting the demand for acute care with comprehensive surge-capacity plans. We have postponed surgeries and procedures, re-purposed space within our facilities to accommodate more patients, and directed available resources, including staff, to meet the increased needs of our hospitals and emergency departments.

Our health care workers have carried the burden of caring for our community during the pandemic, and they have done extraordinary work under increasingly difficult circumstances.

Due to the dramatic increase of COVID-19 infection in recent weeks, we are treating more patients in our hospitals and emergency departments than at any time since the pandemic began. The current demand for care surpasses the normal resources that we have available. Each of our organizations is taking steps to ensure that we are able to prioritize care for those with the greatest needs.

Today, ChristianaCare, Bayhealth, TidalHealth Nanticoke, and Trinity Health Mid-Atlantic—Saint Francis Hospital are operating under Crisis Standards of Care protocols in order to have the flexibility and decision-making tools we need to deliver the best possible care to our community at this time.

We call on the community to recognize that the health care system has been stretched beyond capacity. We are in a moment of crisis, and we urgently need everyone to take action.

You can help end the current crisis in our hospitals. Get vaccinated and receive boosters as indicated. Prevent the spread of COVID-19 by wearing a mask, maintaining distance, handwashing, testing, and staying home if you feel unwell. Please avoid the emergency department for less serious health needs.

We look forward to the time when these changes in the way we deliver care are no longer necessary. Our hospitals and practices have served our community for decades, and we will continue to do so long into the future. With your help, we can end the current surge of COVID-19."

A reintroduction of the mask mandate

Following the issuance of this guidance, Gov. John Carney on Monday, January 10, 2022, announced a revision of his State of Emergency declaration once again requiring all individuals indoors to wear a mask, including at convenience stores, grocery stores, gyms, restaurants, bars, hair salons, malls, and casinos. 

The requirement goes into effect Tuesday, January 11, at 8 a.m. It also extends existing mask requirements at school and child care facilities. The governor's announcement also deploys 70 additional Delaware National Guard members--bringing the total number of deployed up to more than 300--to assist hospitals in dealing with non-clinical operations following the DNG's training last week in the medical field. 

"Our hospital systems are facing a crisis-level situation with record numbers of Delawareans seeking emergency care. We need all Delawareans in the fight as we face this winter surge of COVID-19 to make sure our hospitals are not overrun," said Carney. "I know we’re all exhausted by this pandemic. But at the level of hospitalizations we’re seeing, Delawareans who need emergency care might not be able to get it. That’s just a fact. It’s time for everyone to pitch in and do what works. Wear your mask indoors. Avoid gatherings or expect to get and spread COVID. Get your vaccine and, if eligible, get boosted. That’s how we’ll get through this surge without endangering more lives."

The policy for schools and similar facilities had been set to lapse in February prior to Monday's extension. Children under 2 years old don't need to wear masks, while children 2-5 years old are only strongly encouraged to do so. The SOE amendment also addresses a need for educators by offering incentives for the recently retired to return as substitute teachers in an effort to continue in-person instruction. 

Businesses with indoor settings are encouraged to provide masks for members of the public who may arrive without them, and signage is required to be posted. Eateries and bars are not required to have patrons don a mask while eating or drinking. Churches and houses of worship are exempt from the requirement. 

Spread at the University of Delaware

The University of Delaware spiked during the week of September 5, 2021, with 376 positive cases. From January 3 through January 7, 2022, the university saw 1,034 positive tests among all students and faculty tested, which may be slightly skewed by a change in testing policy, said Senior Director of External Relations Andrea Boyle Tippett. 

"Last week marked the beginning of our winter session, and while our classes were online, many students and faculty and staff were returning to campus--many for the first time," she said. "We have now implemented, because of Omicron, testing for everyone who's going to be on campus weekly during winter session. In the fall, we were primarily testing the unvaccinated, but because of Omicron during the winter, we are testing everyone. So we expected to see high returns and high positivity rates, and that's exactly what we did [see.] So in testing everyone who was on campus, we saw positivity rates that were about 9%, which was still significantly lower than the statewide average. But it obviously means that there are a number of members of our community who are ill at this time."

There's not much else they can do, said Boyle Tippett, other than follow guidance presented by the Centers for Disease Control (CDC), something they've been doing throughout the pandemic, she said. But there comes a time when the situation must be assessed as the landscape continually changes. Currently, the plan remains to keep as many classes as possible in-person. 

"There's conversations that are happening on a daily basis about the spring semester, and even into summer," Boyle Tippett said. "We are just--I feel like a broken record when I say this, but--we are just evolving as the situation evolves, as we have been since...the beginning of 2020. We just have to keep evolving and so we take it as as things come."

But with COVID-19 positive cases skyrocketing everywhere, when asked if this was a pivot point where another evolution of their approach might be called for, Boyle Tippett offered only: 

"We're just looking at it on a daily basis."

All students are required to wear a mask indoors whenever they're outside of their residence. For students in a dorm setting, this means any time they exit their room. Individuals who test positive for COVID-19, but remain asymptomatic are required to isolate for seven days--a protocol stricter than the CDC's recommendation of five days.

"We are following the protocol that we've been following all along, which is wearing masks in indoor settings. We have heightened cleaning protocols in place," she said. "We're doing essentially every best practice that we can to keep everyone safe on campus."

The university was conducting another 1,400 COVID-19 tests on both faculty and staff Monday, she said. 

While the situation currently remained cloudy, one thing that was certain was the tools available everyone can take advantage of to get onboard and help combat the virus. 

"We don't know [how long this situation will last,] but is there a way out? There is a way out: get vaccinated, get boosted when it's time, wear a mask, socially distance," Silverstein said. "I can't say it enough: vaccination is the strongest tool in our toolbox. It is the way we're going to curb the spread of this disease. And the people that are sick may not have availed themselves of vaccination. So let's get out there, and let's get our arms out."