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'Who lives and who dies': In worst-case coronavirus scenario, ethics guide choices on who gets care
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Ken Alltucker
March 22 2020 USA TODAY
Who lives and who dies': In worst-case coronavirus scenario, ethics guide choices on who gets care
Hospitals might not have enough ventilators to care for coronavirus patients. Ethics could guide doctors' decisions on who gets care.
Check out this story on USATODAY.com: https://www.usatoday.com/story/news/health/2020/03/22/coronavirus-crisis-medical-ethics-guide-decisions-doctors-cant-help-all/2882738001/
It's a scenario few health-care leaders want to contemplate much less discuss: What if the ranks of desperately ill patients overwhelm the nation's ability to care for them?
With respiratory illness caused by the novel coronavirus rapidly spreading, nowhere is that potential more evident than the nation's limited supply of mechanical breathing machines called ventilators.
Desperate scenes are playing out in Italy, where a spike in COVID-19 cases have overwhelmed the medical system and doctors have reported shortages of staff and equipment. More than 4,800 people have died there, surpassing China in total deaths.
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Because the worst cases of COVID-19 rob a person of their ability to breathe, patients die unless they get life-sustaining oxygen from machines. But there are fewer than 100,000 ventilators in the United States and millions of patients struggling to breathe might need such care.
Other machines can deliver oxygen to help those with mild or moderate forms of the disease, but the most critically ill patients need powerful airway pressure that only ventilators can deliver.
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Federal and state officials are urging people to follow measures to prevent the spread of the respiratory virus that causes the disease. Both California and New York have adopted strict limits on travel and commerce and urged people to stay home and eliminate nonessential travel.
These measures aim to slow the pace of new infections and ease demands on hospitals without the intensive care unit beds, protective gear or ventilators to handle an unprecedented surge of patients.
In a worst-case scenario of ventilator shortages, physicians may have to decide "who lives and who dies," said Dr. Ezekiel Emanuel, an oncologist and chairman of the University of Pennsylvania's department of medical ethics and health policy.
"It's horrible," Emanuel said. "It's the worst thing you can have to do."
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Respiratory therapists, who take care of patients who struggle to breathe, are aware of the pressures that comes from a swift, sudden need for ventilators
"This is something that we have thought about most of our careers," said Carl Hinkson, director of Providence Regional Medical Center's pulmonary service line.
Providence, in Snohomish County just north of Seattle, treated the nation's first known patient with COVID-19, a 35-year-old man who became ill in January after returning from Wuhan, China. The hospital brought the man to health through a combination of oxygen and medications.
At the time, Hinkson and his team of respiratory therapists realized they were soldiers in a war against a virus that might last months. The Seattle metro area has seen some of the most U.S. fatalities from COVID-19 so far, a cluster of 35 deaths at Life Care Center in Kirkland, adding to Washington's state's 94 deaths as of Sunday.
Patients like the Snohomish County man recover after getting care at well-equipped hospitals such as Providence and Harborview Medical Center in Seattle. The key is to manage the flow of patients so the hospital and its staff aren't overwhelmed.
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