‘Absolutely on fire, out of control’: Omicron surge pushes primary care toward crisis

Otto Kitsinger/AP

With COVID-19 spreading rampantly in Idaho, doctors’ offices and health clinics are flooded with patients seeking tests and medical care. The rapid, omicron-fueled rise is causing health leaders to worry about the implications the most recent surge will have on primary care.

At Primary Health Medical Group, a large primary care provider in the Treasure Valley, the COVID-19 test positivity rate from Monday through Friday was 46.7%, said Dr. David Peterman, the medical group’s CEO.

Between Monday and Friday, Primary Health clinics tested over 2,000 people each day and saw over 2,500 patients per day — record numbers for the provider. On two consecutive days during the week, Primary Health recorded over 1,000 positive tests, and the group has conducted over 15,000 tests since Jan. 3.

“This is absolutely on fire, out of control,” Dr. Peterman told the Idaho Statesman by phone Saturday. “Control of a respiratory pandemic is achieved when you have 5% or less (positivity). We’re at nine times that. It’s just unbelievable.”

In September, when the state activated crisis standards of care at hospitals, Primary Health’s highest test positivity rate was 27.4%.

The deluge of patients this month has “absolutely overwhelmed” Primary Health’s urgent care clinics, in part because the record numbers of patients are arriving at a time when many staff members are out sick. Out of 600 employees, 9% were out as of Friday, forcing clinics to curtail hours or close entirely.

On Friday, four Primary Health clinics were closed out of 21 in the Treasure Valley. On Saturday and Sunday, seven clinics were closed.

All of Primary Health’s clinics are closing an hour early each day, at 7 p.m., to allow strained staff to finish their nightly work.

While talking to a Statesman reporter on Saturday, Dr. Peterman said he received notice that another staff member at one of his clinics has tested positive.

“Every time I get one of these emails, my heart sinks,” he said.

About 97% of Dr. Peterman’s employees are vaccinated, but the omicron variant is known to cause breakthrough cases. Even though research shows vaccinated people — especially if they have received a booster dose — are highly protected from severe illness, sick employees still have to stay home for several days.

The implications of that are serious for primary care providers and threaten to cripple their ability to care for all patients, Dr. Peterman said.

In normal times, Primary Health averages about 40,000 phone calls per month. This month, the medical group expects to receive over 80,000, and receptionists are struggling to respond to the torrent of inquiries.

“If we can’t get (our patients) an appointment, if we can’t communicate with them, their chronic problems — their hypertension, their diabetes — may not get the same attention it should get,” he said. “We saw that happen somewhat with delta, but not to this degree.”

He added, “The cascading implications of omicron are enormous.”

Primary care providers are the first place many patients seek care, and though Dr. Peterman said his providers have not been delaying appointments, he’s concerned that longer wait times, or having to wait on hold on the phone, may push some patients to delay seeking treatment.

‘Everyone needs to wear a mask’

Between the last week of December and the first week of January, the number of children testing positive for COVID-19 doubled at Primary Health.

Using the zip codes of each child tested, Primary Health calculates positivity rates for school districts in the Treasure Valley. The week of Jan. 3, those rates were between 26% and 31%, depending on the district.

The Caldwell School District closed down on Thursday and Friday due to staffing shortages and student absences. Across the Valley, schools are facing similar issues.

“Everyone needs to wear a mask when they’re indoors,” Dr. Peterman said. “That would slow this down immediately ... if you don’t get vaccinated and you don’t wear masks, this will continue to spread.”

The week of Jan. 2, the most recent date available, the state’s overall test positivity rate was 25.7%, according to the Department of Health and Welfare. The week before that, it was 17.2%.

Hospitals in the Treasure Valley are also facing a growing number of COVID-19 patients and intensive care patients. Research has shown that omicron is likely less virulent than previous versions of the coronavirus. But research also shows it is multiple times more transmissible than delta, and hospitalizations are at record highs in many parts of the country.

A combination of the variant’s accelerated spread and its impact on hospital staffing could push Idaho hospitals into crisis standards of care once again.

“I think it’s very important for the public to understand that it’s not OK that everyone’s getting omicron,” Dr. Peterman said. “It’s not OK.”