爱达荷州博伊西——士兵在首都的停车场对病人进行分组通常是科幻小说的素材。
然而，这就是博伊西的现实，在那里，军队指挥紧急护理诊所外的人改造成一个设施冠状病毒爱达荷州和全国的感染和死亡人数激增。
在初级卫生医疗集团的诊所里，医生助理尼科尔·托马斯额外工作12小时来帮助解决问题。她戴上护目镜、N95口罩、外科口罩、手套和身体覆盖物，每天检查36名有症状的患者。她说，有时候，他们中的一半人对新冠肺炎检测呈阳性。
“我有病人在车里哭，因为他们认为他们会死，”托马斯上周说，靠在病人之间的桌子上。“有人说只是轻度感冒，还有人在ICU靠生命维持。就医学而言，我们不知道这会对他们产生什么影响。”
这里曾经是一个有家庭医生和紧急护理的机构，治疗诸如割伤和感冒之类的疾病，现在变成了一个新冠肺炎诊所，展示了一群病毒患者是如何纠缠在一起的健康护理系统。在一个保守的州，许多人抵制流行病的限制，过度工作的员工自己生病或辞职以避免压力。
爱达荷州控制冠状病毒的努力失败了，健康官员称。到目前为止，仅1000多人死于新冠肺炎，大约是每年死于流感和肺炎人数的4到5倍。确诊感染人数已超过10万。
选择性手术大多已经停止，以节省床位和工作人员。新冠肺炎病人被送回家，带着监护设备照顾自己。感恩节聚会后，官员们担心感染人数激增，这可能会迫使他们在没有更多空间或任何人可以治疗的情况下，做出艰难的选择。
“我们什么时候能达到绝对容量?我只是不知道但我们很紧张，”圣卢克卫生系统副总裁巴顿·希尔说，该系统在爱达荷州西南部和中部设有医院。
“我做梦也没想到我们会受到这样的挑战，”初级卫生医疗集团的首席运营官史蒂夫·朱迪在参观托马斯工作的诊所时说。
他被一个去新冠肺炎参加考试的年轻女子打断了，她走出了考试区，看上去很困惑。她抽血了，不知道自己应该在哪里，她透过面具说道，眼神呆滞。朱迪在确定她的检查没有完成后，轻轻地带她经过一排接电话的工人，然后回到检查区。
诊所里挤满了工作人员，支持托马斯和另外两名检查病人的医生助理。加起来，他们一天要见近110个人，要求做胸部x光和血液测试来做出诊断。另外70名没有症状的人每天在停车场接受免下车新冠肺炎测试。
爱达荷州西南部的初级卫生保健中心的20个诊所通常一方面有紧急护理，另一方面有家庭医生。其中八个已经被改造成只能看到新冠肺炎病人的设施。
病人至少需要两天才能预约检查。到12月30日，初级卫生保健将把另外三个设施变成新冠肺炎诊所，如果需要的话，还计划改变更多的设施。
“我不在医院，”儿科医生兼初级卫生医疗集团首席执行官大卫·彼得曼博士说。“但我告诉你，我们在初级保健方面达到了最大限度。我们离定量医疗已经很近了。我们大概还有10到15天。”
他的员工中大约有20%的人离开了，因为他们正在隔离或已经检测出病毒呈阳性。朱迪说，在员工再也无法承受压力并辞职后，他正试图填补50个空缺。他把前台的工资提高了2.5美元，达到每小时14美元。
打给诊所的电话从大流行前的每月3万个增加到现在的8万个。博伊西诊所有六名工作人员接听电话。当他们不在电话上时，他们会打包测试工具。
“我们正在努力工作，”朱迪说，她担心他的员工。“他们几乎都在加班。”
官员们说，在圣卢克医院系统，越来越多的工人因为新冠肺炎而失业。除了取消选择性手术，医院还试图节省床位，让160名患者——其中140名是新冠肺炎患者——带着测量血液含氧量的设备回家。
现在，医院正在计划如果整个地区没有足够的工人或床位，该怎么办。卫生保健工作者必须选择谁接受治疗，谁不接受治疗。
“这是我们真正处于所谓的‘危机标准’风险中的时候，”希尔说，并指出国家将决定何时建立这些标准。“我们非常担心接下来的两周。”
爱达荷州的危机计划将病人分为几类，优先考虑那些患有威胁生命的疾病或受伤但预计会活下来的人，只给那些没有活下来的人舒适的护理。
几个月来，农村地区通常避免了大量的新冠肺炎感染，但现在它们很普遍。最近，爱达荷州南部的感染激增填满了医院的床位，迫使一些病人转移到博伊西地区。
当人们在3月份开始生病时，共和党州长布拉德·利特尔(Brad Little)发布了一项为期一个多月的居家命令，阻止了病毒的传播。但失业率从不到3%飙升至近12%。
限制逐渐取消，但随着感染和死亡人数再次激增，利特上个月恢复了一些规定，包括将集会限制在10人或更少。他还调动了100名国民警卫队队员来解救医务人员，让他们接受移动测试支持、设施去污和新冠肺炎筛查方面的培训。
尼可拉斯·奥尔是两个在初级保健诊所外面的车里会见病人的士兵之一。
“有些人确实看起来有点紧张，”他说，根据他们是生病了，有预约，还是感觉很好，但想做个测试，来指导他们去哪里。
虽然利特尔是去年春天第一批公开戴口罩的州长之一，但他拒绝发布全州范围的授权，称如果可以选择，更多的人将戴口罩。
阻力很大。约64%的爱达荷州选民支持唐纳德·特朗普总统，特朗普总统一直对戴口罩不屑一顾，并嘲笑当选总统乔·拜登在竞选期间戴口罩。
一些治安官说他们不会强制要求戴口罩。一位立法者将利特比作希特勒，因为他发布了流行病限制。共和党主导的立法机构计划下个月立法，限制州长宣布紧急情况的能力。
在博伊西，有一个面具的命令，抗议者最近走进商店和餐馆没有面罩，抱怨他们的权利受到侵犯。
与此同时，在初级保健诊所内，医生助理托马斯(Thomas)戴上了无菌防护设备，工作人员在下一个病人之前对检查室进行了消毒。
诊所不再有时间给所有新冠肺炎检测呈阳性的人打电话。大多数人会收到一条短信。只有高危人群中最有可能死亡的人才能接到电话，那是人类的声音。
“不传染他人是现在游戏的名称，”托马斯说。但是她不抱太大希望。"我想我们会越来越忙的."
Overtaxed Idaho health facilities on brink of rationing care
BOISE, Idaho -- Soldiers triaging patients in parking lots in a capital city is normally the stuff of science fiction.
Yet that’s the reality in Boise, where troops direct people outside an urgent-care clinic revamped into a facility forcoronaviruspatients as infections and deaths surge in Idaho and nationwide.
Inside Primary Health Medical Group's clinic, physician assistant Nicole Thomas works extra 12-hour shifts to help out. She dons goggles, an N95 mask, a surgical mask over that, gloves and a body covering to examine 36 patients a day with symptoms. Some days, she says, half of them test positive for COVID-19.
“I've had patients crying in the car because they think they're going to die,” Thomas said last week, resting against a desk between patients. “There are some people that it’s just a mild cold, and there are some people in the ICU on life support. We don’t know, medicine-wise, how it’s going to affect them.”
What was once a facility with family practice doctors and an urgent care that treated things like cuts and colds has become a COVID-19 clinic, showing how a crush of virus patients is straining intertwinedhealthcare systems. In a conservative state where many are resisting pandemic restrictions, overworked staff are getting sick themselves or quitting to avoid the stress.
Idaho’s attempt to hold the coronavirus in check is failing,healthofficials say. Just over 1,000 people have died from COVID-19 so far, about four to five times the number of annual deaths from flu and pneumonia. Confirmed infections have surpassed 100,000.
Elective surgeries mostly have been halted to conserve bed space and staff. COVID-19 patients have been sent home with monitoring devices to care for themselves. After Thanksgiving gatherings, officials fear a surge of infections that could force difficult choices about what to do with patients when there's no more room or anyone available to treat them.
“When would we reach absolute capacity? I just don’t know. But we’re nervous,” said Barton Hill, vice president of St. Luke’s Health System, which has hospitals in southwestern and central Idaho.
“I never dreamed that we would be challenged like this,” Steve Judy, chief operating officer of Primary Health Medical Group, said as he visited the clinic where Thomas works.
He was interrupted by a young woman there for a COVID-19 test who wandered out of an exam area, looking confused. She had blood drawn and wasn't sure where she was supposed to be, she said through her mask, eyes glazed. Judy, after determining her checkup wasn't done, gently led her past a row of workers taking phone calls and back to the exam area.
The clinic bustled with workers, supporting Thomas and two other physician assistants who examine patients. Combined, they see nearly 110 people a day, ordering chest X-rays and blood tests to make a diagnosis. Seventy others without symptoms get drive-thru COVID-19 tests in the parking lot every day.
Primary Health's 20 clinics in southwestern Idaho normally have an urgent care on one side and family practice doctors on the other. Eight have been transformed into facilities that only see COVID-19 patients.
It's taking sick people at least two days to get an appointment for a test. Primary Health will turn three more facilities into COVID-19 clinics by Dec. 30 and has plans to change over more if needed.
“I'm not at the hospitals,” said Dr. David Peterman, a pediatrician and CEO of Primary Health Medical Group. “But I'm telling you, we're at the maximum at Primary Health. We are so close to rationing care here. We are probably 10 to 15 days away.”
About 20% of his staffers are out because they're isolating or have tested positive for the virus. Judy said he's trying to fill 50 openings after workers couldn't take the stress anymore and quit. He's increased front office pay by $2.50, to $14 an hour.
Calls to the clinics have increased from 30,000 a month before the pandemic to 80,000 now. The Boise clinic has a half-dozen workers taking calls. When they're not on the phone, they package test kits.
“We're working them hard," said Judy, who worries about his staff. "They're almost all pulling overtime.”
At St. Luke's hospital system, increasing numbers of workers are out because of COVID-19, officials said. Besides canceling elective surgeries, the hospitals tried to save bed space by sending 160 patients — 140 with COVID-19 — home with devices to measure the oxygen in their blood.
Now, hospitals are planning what to do if there aren’t enough workers or beds available in an entire region. Health care workers would have to choose who gets treatment and who doesn’t.
“That's really when we're at risk for what's called the ‘crisis standards,'" said Hill, noting that the state would decide when to institute them. "We're very concerned in the next two weeks.”
Idaho's crisis plan divides the sick into categories, prioritizing those with life-threatening illnesses or injuries who are expected to survive and giving only comfort care to those who aren't.
Rural areas generally avoided large numbers of COVID-19 infections for months but now they're widespread. Recently, a surge of infections in southern Idaho filled hospital beds and forced some patients to be transferred to the Boise area.
When people started getting sick in March, Republican Gov. Brad Little issued a stay-at-home order that lasted just over a month and stopped the virus's spread. But unemployment skyrocketed from under 3% to nearly 12%.
Restrictions gradually were lifted, but as infections and deaths surged again, Little reinstated some rules last month, including limiting gatherings to 10 or fewer. He also activated 100 National Guard troops to free up medical workers, getting them trained on mobile testing support, facility decontamination and COVID-19 screenings.
Nickolas Orr was one of two soldiers meeting patients in their cars outside the Primary Health clinic.
“Some people do seem a little nervous,” he said, directing them where to go depending on whether they were sick and had an appointment or felt fine but wanted a test.
While Little was among the first governors to publicly wear a mask last spring, he’s declined to issue a statewide mandate, saying more people will wear them if it’s a choice.
There's plenty of resistance. About 64% of Idaho voters supported President Donald Trump, who has been dismissive of mask-wearing and ridiculed President-elect Joe Biden for wearing one during the campaign.
Some sheriffs say they won't enforce mask requirements. A lawmaker has compared Little to Hitler for issuing pandemic restrictions. The Republican-dominated Legislature plans legislation next month limiting the governor's ability to declare emergencies.
And in Boise, which has a mask mandate, protesters recently went into stores and restaurants without face coverings to complain that their rights were being violated.
Meanwhile, inside the Primary Health clinic, Thomas, the physician assistant, put on sterilized protective equipment as workers sanitized an exam room before the next patient.
The clinic no longer has time to call everyone who tests positive for COVID-19. Most get a text. Only those in high-risk groups with the greatest chance of dying get a phone call, that human voice.
“Not infecting others is kind of the name of the game right now,” Thomas said. But she doesn't have a lot of hope. “I think we are going to get busier and busier.”
