LIFE IN THE TIME OF COVID-19

The Elephant

In The Room

To me, there is no more important concept in The War Against COVID-19 than triage.

Merriam-Webster.com defines this as “the sorting of and allocation of treatment to patients, and especially battle and disaster victims, according to a system of priorities designed to maximize the number of survivors.”

So far, triage is being used to determine who is taken to, or just allowed to go to, hospital emergency rooms.
EMTs in New York City have been instructed to make evaluations as to whether the caller will need
hospital services or can be deferred, a process that was always done at the emergency room before.

This is being done to protect the caller from the virus as well as to minimize utilization of resources.
•
In Italy in many cases, the use of a ventilator had to be triaged between patients who were felt to have a reasonable chance of survival and those who didn’t.

We haven’t quite reached that stage in New York, but according to Governor Cuomo we are close. We are running out of ventilators, even with stretching their use to the maximum and adapting BiPAP machines for use in some patients.

We are running out of healthcare workers whether due to COVID-19, positive coronavirus tests, or simply plain exhaustion. In my opinion, very soon, if not already, decisions will need to be made regarding the level of care new patients receive.
•
Traditionally, decisions like this have been made on the spot by the individual doctor in charge, almost always in a mass trauma situation. The need has rarely come up. While the governor talks about New York State now being one integrated health system, triage is being left up to the individual hospitals and sometimes providers.

The decision process should be consistent. Providers have a tough enough time determining the severity of illness and performing the treatment. In November 2015, the state Task Force on Life and the Law issued Ventilation Allocation Guidelines. This clearly and in great detail laid out guidelines and their rationale. But guidelines work best when there is an order by either the Governor or the Commissioner of Health.

I hope, the fact, that clever people have come up with ways to stretch the use of ventilators and other hospital respiratory equipment to satisfy the need.

I hope there will be enough medication and other treatments for everybody.

I hope there will be enough healthcare professionals to administer and perform necessary care. But it doesn’t seem that there is.

It is really unpleasant and no one, especially our political leaders, wants to have to order such guidelines, rather than have it just tacitly understood, but I feel it’s necessary for full transparency, to give our doctors, nurses, and other providers guidance to make decisions and to protect themselves, and allow the public to understand what is and may have to be the decision-making process.