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The Heart-Wrenching Decisions Behind Rationing Health Care
If there are more patients than ICU beds and ventilators available, how and to whom should doctors distribute these life-saving supplies? Which patients should they prioritize if supplies dwindled?
These are questions playing out in hospitals across the country that either are already, or are preparing for the possibility of, rationing essential supplies. TIME senior health writer Alice Park and TIME editor-at-large Jeffrey Kluger spoke with doctors, experts and immunocompromised people to explore the decision-making process behind these heart-wrenching choices and their impact. “A trigger is pulled under emergency circumstances where, if the demand for these services and for the beds in the ICU outstrips the supply, then you’re going to have to start making some very difficult decisions,” says Park.
There are no national criteria for allocating ICU beds and ventilators during a pandemic, so hospitals are forced to turn to guidelines from professional organizations like the American College of Chest Physicians. In the ACCP’s case, its guidelines hinge on the so-called “exclusion criteria,” which advise not considering ICU care for people with moderate-to-severe heart or lung disease, those with terminal cancer, the elderly, and people with severe cognitive impairment.
Some doctors say these guidelines are discriminatory from an ethical and legal standpoint and are pushing for a more holistic approach that evaluates the patient more thoroughly, considering factors like age and ability to survive not just an ICU session but life after being discharged. But in any case, these decisions take an emotional toll on doctors. “You have doctors walking into rooms and seeing people suffering and they’re unable to provide them with the relief they would ordinarily be able to provide,” Kluger says.
Another hidden cost to the coronavirus pandemic is that some people are no longer able to effectively manage chronic conditions like diabetes and cardiovascular disease. One doctor told Kluger he suspects we may see a relatively higher number of people having heart attacks and strokes at home in incidents caused by issues that could otherwise have been addressed earlier in a less-burdened health care system.
Luckily, health rationing decisions in the U.S. are currently being made on a “very limited basis” and “so far, the supply has been able to keep up—just barely—with the demand,” Park says. But, she adds: “All over the country, hospitals are preparing for it because they are seeing how quickly this virus can tear through communities and they don’t want to be caught unprepared.”
More than 2.5 million people worldwide had been sickened by COVID-19 as of 8 PM eastern time on Tuesday, April 21, and more than 176,000 had died.
Here is every country with over 20,000 confirmed cases, as of Tuesday 8 PM eastern time:
The World Health Organization’s Director-General Dr. Tedros Adhanom Ghebreyesus said today at a press briefing that “most countries are still in the early stages of their epidemics and “some that were affected early in the pandemic are now starting to see a resurgence in cases.” Tedros said that most epidemics in Western Europe “appear to be stable or declining” and that while COVID-19 case counts are relatively low in Africa, Central & South America and Eastern Europe, he is worried about upward trends there. “Make no mistake: we have a long way to go. This virus will be with us for a long time,” Tedros said.
Meanwhile, the world could be inching closer towards a COVID-19 vaccine. A German biotechnology company said today that a vaccine candidate it developed with American pharmaceutical company Pfizer had received approval for clinical testing, the New York Times reports.
The state of Missouri has sued China over the coronavirus pandemic. Yesterday, Missouri’s top state prosecutor announced the lawsuit, which alleges that Chinese officials are to blame for the global outbreak of COVID-19. The Chinese government hit back at the lawsuit today, calling it “very absurd” and without any “factual and legal basis.”
As the coronavirus continues to devastate several countries, New Zealand is emerging as a potential success story in eliminating COVID-19, some experts say. They note that geography is on the country’s side as the island nation does not have a particularly dense population, even in its major cities. Prime Minister Jacinda Ardern also took aggressive measures early on enacting a strict lockdown when only around 100 people had tested positive for coronavirus.
The Situation in the United States
More than 820,000 people in the U.S. had contracted COVID-19 as of 8 PM eastern time on Tuesday, April 21, and more than 44,000 had died from it.
The U.S. Senate approved a $483 billion coronavirus aid package on Tuesday, and President Donald Trump voiced his support on Twitter for the bill, despite opposition from conservative Republicans, and indicated that he would “sign this bill.” Democrats say the legislation was improved after they successfully pushed for the inclusion of money for hospitals and testing, the Associated Press reports. The bill now goes to the House where votes are set for Thursday.
Meanwhile, New York Gov. Andrew Cuomo and Trump may have put their simmering tensions aside during a meeting at the White House on Tuesday. Cuomo, who is seeking federal aid for New York, said the occasion was “functional and effective” and that he emphasized to Trump that states would need a huge increase in testing before safely reopening the economy, according to the AP.
Coronavirus tests could become more accessible as the U.S. Food and Drug Administration on Tuesday authorized the first COVID-19 test that allows people to collect their own sample at home. The at-home tests from LabCorp won’t be available to everyone though, at least not yet. For now, they will only be for health care workers and first responders and that too—under a doctor’s orders.
It turns out the first coronavirus death in the U.S. may not have actually been in Washington state, but in California. Local authorities in Santa Clara County in California said Tuesday that two people died due to COVID-19 on Feb. 6 and Feb. 17—weeks before what was otherwise thought to be the first U.S. death reported on Feb. 29 in Kirkland, Washington.
All numbers are from the Johns Hopkins University Center for Systems Science and Engineering, and are accurate as of April 21, 8 PM eastern time. To see larger, interactive versions of these maps and charts, click here.
WHAT ELSE YOU SHOULD KNOW
Why Hong Kong Is Extending Coronavirus Restrictions—Even as New Cases Dwindle to Zero
The decrease in new cases suggests that Hong Kong has been able to stop a second COVID-19 wave, at least for now. But authorities remain vigilant. “This is not the time to be complacent. If we relax, the good work that we have done will be in vain,” said the city’s top official, Chief Executive Carrie Lam. Read more here.
President Trump Has Blocked New Legal Immigrants. It’s Not the First Time He’s Targeted Immigration During the Pandemic
“This is par for the course for this administration—utilizing this pandemic and this emergency situation to further policies they’ve already put in place and push them even further,” says Jen Smyers, director of policy and advocacy for the immigration and refugee program at Church World Service. Read more here.
How a Chaplain at a New York City Hospital Comforts Dying Patients
Kaytlin Butler, a chaplain at Mount Sinai Hospital in New York City, says the coronavirus pandemic has forced her to guide people through their last moments at a distance. “Religious rituals are very tactile activities. We touch, we eat, and to have all of the physicality of showing love stripped away. It’s heartbreaking,” Butler says. Read more here.
In Ghana, Drones Deliver COVID-19 Tests
Ghana is using drones to deliver COVID-19 tests, saving hours and in some cases days on the time it would normally take to get the tests from a suspected rural victim to an urban laboratory. With about 70,000 COVID-19 tests already conducted, Ghana has one of the highest testing rates in Africa. Read more here.
What Does ‘Contact Tracing’ Really Mean?
Contact tracing is part public health work, part investigation. It entails trained staff tracking down those who may be infected with COVID-19. They interview people who have been diagnosed with an infectious disease to figure out who they may have recently been in contact with, tell those people they may have been exposed and sometimes encourage them to isolate to prevent the disease from spreading further. The technique is a “cornerstone” of preventative medicine, experts say. Read more here.
Why the U.S. Government Should Be Guaranteeing Paychecks
Thea Lee, president of the Economic Policy Institute, Liz Watson, executive director of the Congressional Progressive Caucus Center and Felicia Wong, President and CEO of the Roosevelt Institute, write in TIME about the need for “a clear federal response: a paycheck guarantee.” Read more here.
Thanks for reading. We hope you find the Coronavirus Brief newsletter to be a helpful tool to navigate this very complex situation, and welcome feedback at coronavirus.brief@time.com.
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