The COVID-19 situation has reached a level where available healthcare personnel as well as equipment are not enough anymore. As the number of patients in most countries keeps going up, it becomes harder to equally distribute resources to manage the situation.

Bad news related to this issue regarding resources keep coming from a lot of places. Some days ago, a nurse from New York died from COVID-19, the apparent cause of which, according to his sister, was lack of basic personal protection equipment (PPE).

A Washington State hospital has warned that in two weeks’ time, it will be short of ventilators. This lack of resources has reached a level where authorities are forced to choose some people over others. New York State could be lacking them already. A Michigan hospital has informed patients as to how things are going to go if they can’t handle a large number of patients. Although no one’s life can be considered of more value than someone else’s, guidelines have been introduced in a few US states which do so. These guidelines have been come up with based on factors such as age, health issues, pregnancy, and cognitive abilities.

A framework for critical care triage developed in Washington. Credit – Northwest Healthcare Response Network

Many states have triage plans developed to be used in situations where hospitals receive more patients than it can handle in a natural disaster or a pandemic. These plans are being re-examined these days to prepare for a situation where ventilators won’t be enough.

The New York Times examined plans from several states (which you can read in depth at the end of the article) to see the factors that will determine which patients will be chosen over who.

A common point seen in all of them is that priority will be given to those who are able to fully recover. However, this is concluded based on a lot of other factors too, taking into consideration ethics as well as social equality.

New York’s plan recommends evaluating a patient’s status after 48 hours and 120 hours of ventilator access.
Credit – New York State Department of Health

There is a chance that healthier people might be prioritized over people with chronic diseases. However, ethics and equality come into play, and these decisions about life and death will be made only if the situation becomes extreme such that it can’t be handled.

For example, Maryland’s guidelines have it that if two patients get the same score in survivability, a low priority will be given to people above 85, given that the others have a better chance in recovering. Although all lives are of equal value, an extreme situation will require the healthcare personnel to “choose”.

The above table, part of New York’s guidelines for ventilator access, uses a Sequential Organ Failure Assessment score to prioritize which patients should be prioritized for access to a ventilator.
Credit – New York State Department of Health

The Sequential Organ Failure Assessment (SOFA) is a scoring system that considers the functionality systems that includes lungs,heart, kidneys etc. The higher the SOFA score, the lesser the ability to qualify.

A lot of other factors including the above have been considered in coming up with the guidelines for the doctors to take the “best” decision, given the situation. Many people will not be able to embrace these decisions happily, obviously because their loved ones are at risk.

Read the state triage guidelines in depth here.

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