Wednesday, March 25, 2020

The Worst-Case Scenario, Con't

Understand something, guys.

If we don't practice social distancing, if we don't flatten the curve, if we don't prevent hospitals from being overwhelmed, then people are going to start dying by the thousands.

Your state already has instructions on who lives and who dies in a COVID-19 overload situation with limited respirators.  Alabama certainly does, and it will be replicated nationally.

In the coming weeks, difficult decisions about who will live and who will die in Alabama may hinge on a little-discussed document outlining the state’s suggested “criteria for mechanical ventilator triage” during pandemics like the current COVID-19 outbreak.

According to the state document, any of a wide range of underlying health conditions – such as metastasized cancer, AIDS, “severe mental retardation,” advanced dementia and “severe burns” – could disqualify patients from being put on potentially lifesaving ventilators if a pandemic grows dire enough. And some people already on ventilators could be removed from them to make space for people impacted by the pandemic, according to the guidance.

Over the past two weeks, doctors in Italy have called on the world to take the disease more seriously, sharing horror stories about having to choose which people to put on ventilators. They have had to make those dire decisions based on patients’ age, underlying health problems and other considerations.

Under the triage criteria, which the Alabama Department of Public Health initially drafted in 2009, many patients could be denied access to ventilators and instead relegated to in-patient or home palliative care.

In April 2010, the State Committee of Public Health approved a revised version of the protocol detailing the exact processes hospitals and health care facilities should follow when making such decisions during a deadly flu outbreak or other major pandemic.

“ADPH suggests that hospitals utilize this criteria as a template for local and regional disaster management plans,” according to a 2009 ADPH study on the ethics of disaster response that analyzed the draft version of the protocol.

Let me reiterate.

The triage code blue people get palliative care.  That means end-of-life.  That means they die.  The red people get moved to blue if there aren't enough respirators.  The yellow are saveable to an extent but if they get worse and slip into red, they risk a doctor saying "We need this respirator to save someone who has a better chance of surviving."

And then they die.

When I say "hospitals are going to be overloaded" I mean they will be forced to make decisions like this.  Decisions where people no longer get treatment and are made comfortable in their final moments.

And then they die.

Do we understand now about why social distancing is important?

Stay home.

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