This sounds like something from a Civil War history book, doesn’t it? Unfortunately, this was a tweet by the mayor of Bergamo, Italy on March 10th. If this doesn’t send chills down your spine, I honestly don’t know what would.
Twelve hours ago on Facebook I linked to a news story. I indicated that there were six big events that I expect to happen in the hospitals in the Seattle, Washington area. I had described five, but didn’t specify number six. I specifically said “There will be one more step taken at some point nobody is prepared to think could happen.”
These were the first five:
1. Cancelling elective surgery
2. Running out of personal protective equipment
3. Healthcare workers becoming infected
4. No beds available in the hospital
5. Healthcare workers walking off the job because of fear that they will get infected and the stress of the environment as the problem escalates.
The final stage is resorting to what is essentially battlefield triage.
The mayor took a lot of heat for that statement. Later, he says “If in some hospitals there are no places available, the regional system intervenes and the choice is made on who to intubate first and who to move and intubate in another hospital.” What happens when all of the hospitals in a particular region are out of space?
That is the reality that looms on the horizon. We need to face up to the prospect that this may become a new normal for part of this year.
Do you think that’s a stretch? The Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care has published guidelines on this. They are for ALL patients. “The criteria apply to all intensive patients, not only to patients infected with Covid-19 infection.”
One telling guideline is “All accesses to intensive care must however be considered and communicated as an ‘ICU trial.'” This recommendation is essentially that if there aren’t some indicators for improvement in a short time span, that bed should be made available for someone else and that patient should be given palliative care, which is not meant to be curative, but to mitigate suffering.
Yascha Mounk writes about this in The Atlantic. The last three paragraphs mirror what I’ve been trying to emphasize.
“But if Italy is in an impossible position, the obligation facing the United States is very clear: To arrest the crisis before the impossible becomes necessary.
This means that our political leaders, the heads of business and private associations, and every one of us need to work together to accomplish two things: Radically expand the capacity of the country’s intensive-care units. And start engaging in extreme forms of social distancing.
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