She hoped it might be enough to avert catastrophe this winter.
“New Mexico has crushed this virus before — twice,” she told her state’s 2 million citizens. “We’re going to do it again.”
Three weeks later, victory remains a distant prospect. Instead, Lujan Grisham (D) is on the verge of acknowledging just how grim conditions have become: She will, she said in an interview, soon allow hospitals to move to “crisis standards,” a move that frees them to ration care depending on a patient’s likelihood of surviving.
It is a step that she and other governors have avoided through nearly nine months of battling the pandemic, and one that doctors dread.
“That’s a physician’s nightmare,” said Jason Mitchell, chief medical officer at Presbyterian Healthcare Services, one of the state’s largest providers. “We want to save every life we can.”
But given the severe strain on medical systems statewide and the lack of available ICU beds as covid-19 hospitalizations near 1,000 statewide, Mitchell said there was probably no other choice.
“We’re headed there very quickly,” he said. “There’s no more room at the inn.”
The dire state of New Mexico’s covid fight reflects just how pernicious an opponent the coronavirus really is and how it can outlast or outmaneuver even the most stalwart efforts to keep it in check.
New Mexico has consistently won praise among public health experts for its aggressive approach to combating the virus. Lujan Grisham issued a stay-at-home order in March when there were fewer than 100 cases statewide, and she has gone as far as locking down entire cities to stem the spread.
A study by Oxford University found that the state’s approach was among the most restrictive — and also the most successful, with New Mexico dodging the spring and summer surges that afflicted so many other states.
But with pandemic fatigue growing and political resistance building — including from the White House — New Mexico has not escaped the outbreak raging nationwide this fall. Even though there is evidence that the governor’s November shutdown orders are helping to reduce case numbers, experts say there is only so much good they can do with a virus that zealously exploits any weakness.
“If it’s cold outside and you have shut seven windows but you leave one open, it’s still going to be cold inside, isn’t it?” said Rohini McKee, University of New Mexico Hospital’s chief quality and safety officer. “Doing 90 percent is not enough.”
The open window with this round of covid, McKee said, is as simple as human nature. People want to get together with friends and relatives, and they resent being told by political leaders or health experts that they can’t.
“There’s a need for instant gratification,” she said. “We’re not used to delaying gratification.”
But that lack of constraint is having deadly consequences: More than 1,700 New Mexicans have already succumbed to covid-19, the disease the virus causes. An average of nearly 30 people are added to the tally each day.
At the University of New Mexico’s six hospitals, ICU capacity is already near its max, with normally single-occupancy rooms getting doubled up. Models suggest that demand for beds will continue to grow at least until mid-month.
“It is safe to say that our hospital systems are going to be overwhelmed,” McKee said.
The only question now is how long the onslaught lasts.
Lujan Grisham said the restrictions she announced Nov. 13 were intended to keep it to a minimum and free up health-care resources, so we “don’t put physicians in those really difficult situations” of having to decide who receives care.
To an extent, she said, the “reset” had worked.
“We dropped the positivity rate, we dropped our rate of infection, and we slowed hospitalizations per capita, which is exactly what we needed,” she said.
But she acknowledged that it was too late to avoid some of the worst impacts: A declaration allowing hospitals to move to “crisis standards of care” would probably come by Monday, she said. The move enables hospitals to switch to a commonly agreed plan for triaging care, though each will decide on its own whether the shift is necessary.
New Mexico has one of the lowest numbers of per capita hospital beds of any state in the nation. That, combined with an unusually high percentage of elderly and low-income residents, makes the state particularly vulnerable to a covid surge.
Lujan Grisham said she and other officials had seen the potential for hospitals to be overwhelmed much earlier this fall, and she repeatedly warned her state of what was coming as rates jumped in October.
She pleaded for citizens to take the threat seriously — to mask up, socially distance and limit their gatherings. At a time when President Trump was sending a very different message — hosting mass, and largely maskless, rallies nationwide — not everyone listened.
“We have constituents here — and I would argue in every state — that still believe that this is not a deadly, contagious virus, and you don’t have to practice any public health measures,” she said in a Thursday phone interview. “That makes it really complicated.”
Adding to the challenge, she said, was a lack of federal stimulus funding. Without a better safety net, she was reluctant to take the dramatic step of shutting down large segments of the state’s economy.
Since the November order, New Mexico has moved to a three-tiered system for reopening, though the vast majority of the state remains in the most restrictive phase — the red zone.
Lujan Grisham, who is a co-chair of President-elect Joe Biden’s transition, has been pitched by Latino lawmakers and others as a health and human services secretary in the next administration. She said in the interview that she was “flattered” by the suggestion but that she had not had conversations with the Biden team about the job.
As is true of other governors who have imposed stiff restrictions to check the spread of the coronavirus, Lujan Grisham has been met with intense resistance.
“The situation in New Mexico is desperate,” said Carol Wight, chief executive of the New Mexico Restaurant Association. “Without federal relief, we’re going to start losing restaurants. Two hundred have closed already.”
Wight, whose organization backed an unsuccessful lawsuit challenging the governor’s authority to impose limits this year, said the governor’s new red-zone restrictions give her members no reason for hope.
“Allowing 25 percent capacity for outdoor dining doesn’t help any restaurant in the middle of winter,” she said.
Stevan Pearce, the Republican Party chair in New Mexico, said Lujan Grisham would be better off following the lead of GOP governors who have taken a hands-off approach and favored “personal responsibility” over government interventions.
“We’ve been one of the most restrictive states in the nation, yet we’re still seeing the spike,” said Pearce, who lost a 2018 election to Lujan Grisham. “So obviously the controls didn’t work. We may have to just learn to live with this.”
Yet health authorities say such an approach would have meant overwhelmed hospitals at a much earlier point in the pandemic and a much higher death count by now.
“The governor follows the science, and she’s not afraid to take action,” said Mitchell, the chief medical officer at Presbyterian Healthcare. “That helped us avoid a catastrophe at the very beginning. It saved a lot of lives.”
The decision to shut down again in November, Mitchell said, was also well-justified by the data.
Had the governor not acted, the leader of the state’s largest city said he would have. Albuquerque Mayor Tim Keller said in an interview that he was relieved that wasn’t necessary, as it has been for other municipal leaders in states where the governor has declined to step in.
“The need for action was clear,” said Keller, a Democratic ally of Lujan Grisham. “We’re always better off when the state moves as a whole because the virus doesn’t obey county or city lines.”
Keller said that the cumulative impact of the shutdowns had certainly taken a toll on his city but that state and municipal stimulus spending had helped to soften the blow.
With a vaccine on the horizon, Keller said his biggest concern was fatigue — for a general population that long ago grew sick of coronavirus restrictions, but especially for medical workers whose most harrowing stretch may still lie ahead.
“There is no doubt that every nurse and doctor in this town is absolutely exhausted,” he said. “You can only do this for so long.”