Nearly 19 months in, these are some of the toughest days for Colorado hospitals during the coronavirus pandemic.

Even as the latest surge in coronavirus hospitalizations appears to have plateaued — what state epidemiologist Dr. Rachel Herlihy recently called an “unstable equilibrium” — hospitals across Colorado have still been scrambling to add critical-care beds and some have been postponing non-emergent surgeries in order to free up space.

As of Sept. 23, Colorado had a scant 148 ICU beds available statewide and 28% of hospitals were expecting to experience a staff shortage within the next week. Hospital leaders speak of staff burnout, of trouble keeping employees when lucrative gigs as traveling nurses to COVID hotspots abound.

Despite the renewed — and exhausting — strain on the system, things in Colorado are nowhere near as bad as they are in other parts of the country.

Amid crushing waves of delta variant-driven coronavirus infections, hospitals statewide in Idaho are operating under “crisis standards of care” — essentially rationing care because COVID cases have so overwhelmed the available resources. Some hospitals in Alaska and Montana have done the same. The governor of Wyoming called in the National Guard to his state’s hospitals.

“We are very, very full, and are concerned right now,” said Dan Weaver, the vice president for communications at UCHealth. “But we are not at the level of some of those hospitals in other states.”

How has Colorado been able to avoid the hospital horror of other Western states?

State health leaders point to two factors.

First, Colorado’s vaccination rate makes a big difference.

In the Mountain West, Colorado has the second-highest vaccination rate in the region, behind only New Mexico. Put another way, of all the landlocked U.S. states, Colorado’s fully vaccinated rate is third-best.

As of Sept. 23, nearly 60% of people in Colorado are fully immunized against COVID-19. (This figure is for the entire population, including kids too young to be vaccinated.) In Wyoming, the rate is only about 41%.

And there is a clear connection between vaccination status and hospitalization. On Sept. 23, 80% of those hospitalized in Colorado with COVID-19 were unvaccinated against the disease, according to state data.

Scott Bookman, the Colorado Department of Public Health and Environment’s incident commander for the pandemic, pointed to the vaccination rate as the No. 1 reason that Colorado hospitals have not exceeded their capacity during the latest surge.

“The reason our hospitals are doing better than hospitals in many other states is simply because our vaccination rates are so high in Colorado,” he said.

The other factor working in Colorado’s favor is that it has a lot more hospital beds than neighboring states.

Prior to the pandemic, Colorado hospitals had been on a building binge — sometimes building new hospitals in already well-served areas where critics said they weren’t needed. As of 2019, Colorado had more than 10,600 hospital beds in the state, according to the Kaiser Family Foundation, a nonpartisan health care think tank. Utah, for comparison, had only about 5,600 beds.

Hospital leaders defended all the construction by saying that the state was growing and that the capacity would come in handy, even if hospital beds sat empty at first.

“You can’t build a highway system for a Sunday morning,” Katherine Mulready, the Colorado Hospital Association’s chief strategy officer, said at a forum in January 2019, right before the pandemic struck and while hospital costs were under intense scrutiny at the state legislature. “You have to build it for rush hour.”

On a per capita basis, Colorado’s hospital capacity isn’t all that impressive. Again using 2019 figures, the Kaiser Family Foundation calculated that Colorado had 1.85 hospital beds for every 1,000 people, among the lowest rates in the nation.

But many Colorado hospitals, pre-pandemic, had also positioned themselves as regional health centers, often treating patients from far-flung areas of neighboring states as well as those from Colorado. This meant some hospitals placed an emphasis on flexibility, creating an accordion-like ability to expand rapidly when needed.

“We are grateful for every hospital bed that we have and we are fortunate that we have systems that have built up for surge capacity, pre-COVID,” said Cara Welch, a Colorado Hospital Association spokeswoman.

Out-of-state patients don’t appear to be contributing much to Colorado hospitals’ COVID burden

Elsewhere in the U.S., case surges in one state have sometimes spilled over to create problems in another. The New York Times recently reported on how Idaho’s COVID explosion is having consequences for neighboring Washington state, where transfers of Idaho patients are rapidly filling hospitals.

At best, it’s unclear how much this is happening in Colorado. On Sept. 22, Herlihy pointed to packed hospitals in Larimer and Weld counties and said it’s possible that cases from Wyoming are contributing to the crowding. (The state does not track residency status of hospitalized patients.)

“That certainly could be part of what we’re seeing right now,” she said.

But the major operators of hospitals in northern Colorado said they are not seeing many out-of-state patients.

At UCHealth, which has three hospitals in Larimer and Weld counties, out-of-state patients appear to be adding very little to the capacity crunch. Weaver said only about 1% to 2% of the COVID patients hospitalized across the UCHealth system are from out-of-state.

“The vast, vast majority of our patients are from Colorado,” he said.

Banner Health, which operates several hospitals across Northern Colorado, said the same.

“Our hospitals are extremely busy with very sick COVID and non-COVID patients,” Sara Quale, a Banner spokeswoman, wrote in an email. “We are running at or over normal capacity in our three (Northern Colorado) hospitals. This week we had fewer than five patients from other states out of about 220 patients hospitalized with us.”

Just because Colorado hospitals aren’t as strained as those elsewhere in the country, it doesn’t mean they aren’t suffering right now.

Hospitals in the HealthOne system, such as Presbyterian/St. Luke’s Medical Center in Denver and The Medical Center of Aurora, have seen COVID-19 patient admissions triple over the past 30 days, a spokeswoman said. About a third of those admitted need to be treated in the intensive care unit, and about half of those in the ICU are on ventilators.

But, the spokesman said, ICU capacity at HealthOne hospitals remains stable and the facilities have not had to convert additional spaces into makeshift intensive-care wards.

Centura Health, which operates hospitals such as St. Anthony Hospital, is seeing its highest level of ventilator use of the entire pandemic — though ventilators are used by more than just COVID patients.

And just about every hospital says staffing is a much bigger challenge than having an adequate number of beds available to take in new patients. Centura has been “flexing” staffing across its various hospitals and clinics, to make sure it has workers where it needs them most. Other hospitals have been hiring temporary traveling nurses, who come at a high cost during the pandemic.

“Staffing is definitely still the concern everywhere,” said Welch, the Colorado Hospital Association spokeswoman. “The beds are there; the staff are not.”

This story is from The Colorado Sun, a journalist-owned news outlet based in Denver and covering the state. For more, and to support The Colorado Sun, visit coloradosun.com. The Colorado Sun is a partner in the Colorado News Conservancy, owner of Colorado Community Media.