I don’t have much to say about it but there’s an op-ed well worth reading at the Washington Post, written by a physician whose job it is to clear the ventilators of COVID-19 patients in hospital:
It’s a powerless feeling, watching someone die. The oxygen level drops, the heart rate drops, the blood pressure drops. These patients are dying on the ventilator, and sometimes when they take away the body, the tube is still in the airway.
It isn’t that often that you read something approximating despair but this comes too close for comfort.
Families cant visit so these people die alone. Horrible for the patients and awful for the staff. One of the groups that wont get a lot of notoriety but are addressing this are the palliative care people. They are trying to connect families to these patients and prepare them so they can say goodbye. They carry around IPads or some equivalent and try to at least let families see their loved ones, talk with them if they are lucid, before they die.
In some of the NYC hospitals they are already having to choose who gets a ventilator. They are not evenly distributed (takes time to move them). We already have set up a scoring system developed by the ethics team so that if we reach that point the decision wont be entirely arbitrary. The physician caring for the pt will not make the decision, that will be by someone else.
On the plus side we have gotten some pts extubated now. The ICU docs think we are now having a little bit better success rate than published. Maybe something is working (HCQ after all? or one of the other 9 things we are giving them) or maybe our numbers are still too small to tell. We are grasping at anything.
Steve
I’m sure its gut wrenching. Heartbreaking. But we make similar calculations, and tolerate actions and practices, whether we know it or not, everyday. The repeat DUI offender let loose to kill on the highways. The illegal alien, put back on the street with political considerations who commits a crime. Placing individual liberties above dietary or smoking dictates vis s vis lung disease or diabetes. The distracted driver texting and driving who kills a cyclist or rams the rear of a car and kills someone. etc. All of these things happen in real life. We allow them to happen, often without comment. Its only in the heat of the moment that emotion drives policy or becomes paramount in our consideration. That probably sounds harsh, but its true.
” The repeat DUI offender let loose to kill on the highways.” 38,000 MV deaths per year. Not all repeat DUI. Not all at once.
“dietary or smoking dictates vis s vis lung disease or diabetes. ”
They dont all show up at once. They dont crowd out our hospitals so that we cant take care of other people, and that is WITH mitigation. We actually do spend a lot of money trying to treat these people.
So let’s say Trump’s spokespeople are correct. 100,000-200,000 die for corona virus. Another 50,000-100,00 die because they couldn’t get treatment because the hospital had no room or no vent for them. Then we have the many hundreds of thousands who had inpatient care but lived. What percentage of those die or go on to permanent disability? The reality is that we probably save many hundreds of thousands. Is the cost too high?
Compared to what? Waiting for meeting #301 to start late at night we all wondered what would have happened if we didnt have an official lockdown. Who would be willing to go to work or eat at a restaurant knowing what is going on in Italy, UK, Spain? Places where they didnt take Covid seriously at first. I guess Trump supporters would still go, except maybe a lot of the nurses and docs who are Trump supporters would be my guess.
Steve
Being tied down to home, I do lots of reading. And, filtering thru a number of articles, 1st person accounts of current-day hospital practices, I’ve heard of no ventilator shortage where grim choices had to be made, providing a ventilator for one while ruling out it’s use for another. Ethical protocols are certainly being brushed up on, reviewed primarily because of the dire circumstances predicted by virus models. But, so far such punishing stats have not materialized, and are in fact diminishing, causing said models to be reconfiguring their high numbers downward. In the meantime, WA state is sending a number of ventilators to NY, as their need for them has subsided.