Coronavirus-Are we ready to talk about rationing care?

[dinah77]

Alright, I'm gonna be the soulless monster who brings it up......

Have those of us in critical care/inpatient started to think of the possibility that rationing care will occur?

IF this spread gets bad, and large numbers of people need vents, we will have to start triaging and rationing

There is a woeful lack of vents overall and there will be even fewer numbers of nurses available to manage those ventilated patients

Which means, rationing, and choosing who gets that care

If we follow the utilitarian model, of who will benefit the most from that care, the elderly, especially those with comorbidities are poor candidates to get those spaces, particularly when we look at numbers of that demographic who survive being intubated and return to a somewhat normal life (it's shockingly few, FYI)

Links here to support my last statement- would love to hear some thoughts from others

https://www.sciencedaily.com/releases/2010/03/100302162247.htm?fbclid=IwAR1c_TR50jkAbEM2n0v4BPnRAaLAge2u69i6QZnZhJV0HL2uSMxUZUe2P0o

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1127042/

[JKL33]

On 3/10/2020 at 6:38 PM, kat7464 said:

Do not play God....you won't win.

I doubt you intended this, but your comment is superficial enough that it is also flippant and ultimately disrespectful.

What exactly are you advocating? How does your comment apply to a bus crash or to crowds of very sick people overwhelming the capacity and resources of an ED, for example?

[NormaSaline]

On 3/9/2020 at 1:03 AM, Susie2310 said:

I believe there is an untapped resource in the community - licensed nurses who, for their own reasons, are not currently working as nurses, but who would like to work in a hospital during a crisis to help out if they could receive the necessary training. A number of those nurses could reasonably be expected to have kept their licenses and continuing education current and may have retained much of their nursing knowledge/proficiency. Sufficiently training suitable nurses to take care of ventilated patients could help alleviate the shortage of nurses able to care for ventilated patients.

Other options exist besides "care rationing."

I posted this on another Corona thread and the response was not so pleasant. Even though my worry is increasing more each day, I still agree with the sentiment.

[Kitiger, RN]

1 minute ago, NormaSaline said:

I posted this on another Corona thread and the response was not so pleasant. Even though my worry is increasing more each day, I still agree with the sentiment.

Even if we can come up with enough nurses, there is still the problem of not enough vents.

[Kooky Korky, BSN, RN]

On 3/9/2020 at 3:53 AM, caliotter3 said:

Wonder if the ventilator manufacturers have considered ramping up production.

It's probably all tied to $$$$$.

[K+MgSO4, BSN]

It is not just trained nurses though that is a major issue, what if schools close and their kids need caring for?

The other issues include actual beds and ventilators. Many hospitals have limited ability to flex up their beds exponentially I.e. basic medical gases plumbed in to areas, plumbing, power etc. Computers and beds and obs machines are cheap (in the scheme of things).

PPE is being rationed already to the point of elective surgery being reviewed. Some medications are already out of stock due to manufacturing in China.

It is not just nurses we need but allied health, medical, support staff etc. There have been issues with hoarding of stock by some support personal already and thefts from unit storerooms for no good reason, food delivery people refusing to give trays to anyone in any kind of isolation....

The patients I am worried about are the older, ESL, dementia patient who cannot tell us that they have a sore throat, a reduced cough reflex at baseline etc. They will pick this up and die. Even before the pandemic kicks in we need to be prepared for it coming. Ventilated beds need to be accessible.

[NormaSaline]

12 hours ago, Kitiger said:

Even if we can come up with enough nurses, there is still the problem of not enough vents.

Right. And PPE.

2 hours ago, K+MgSO4 said:

The patients I am worried about are the older, ESL, dementia patient who cannot tell us that they have a sore throat, a reduced cough reflex at baseline etc.

I worry about them too. I also worry about those on the outside, living outside with mental issues who refuse all healthcare.

[LPN Retired, LPN]

Surely not everyone will need hospitalization .

Some people don't even show SX's, and some people recover easily with minor treatment. If people will stay home a bit more, avoiding crowds, and practice good hand washing , maybe most people can avoid it .

[dinah77, ADN]

On 3/10/2020 at 10:51 AM, chare said:

Thank you for addressing the elephant in the room.

And it very well might be the 29-week neonate. Are you as willing to withhold or withdraw support from this patient as you are the 65 year old?

Generally speaking, according to the data in my OP and the way co vid 19 is affecting those 65 and up, It's easy to say the 29-week neonate is a better candidate. Especially if the 65-year-old has co-morbidities.

Now if you know of some empirical data showing that 29-week babes have similar poor results being intubated as elders with co-morbidities, it'd be interesting to see that

But I already know such data does not exist.

On 3/11/2020 at 9:43 AM, LPN Retired said:

Surely not everyone will need hospitalization .

Some people don't even show SX's, and some people recover easily with minor treatment. If people will stay home a bit more, avoiding crowds, and practice good hand washing , maybe most people can avoid it .

No, only a small perentage will need ICU level care. But as stated in my OP, we are already at a capacity tipping point in almost all hospitals in America. It only takes a tiny percent to tip it over the edge.

[dinah77, ADN]

Does anyone read the OP anymore before commenting? I feel like a teacher yelling "IT'S IN THE SYLLABUS"

[Katie82, RN]

We could always import them from China. I hear new infections have slowed considerably in China. As will happen everywhere.....

[dinah77, ADN]

11 minutes ago, Katie82 said:

We could always import them from China. I hear new infections have slowed considerably in China. As will happen everywhere.....

Nice thought, but the red tape involved in that....would they be here in a timely manner at all?

[Mavnurse17, BSN, RN]

The people that are saying that this isn't a big deal, "more people die from the flu everyday," are you not seeing what's happening right now in Italy? At the start of this, I used to think it was nbd also. But seeing this spreading so quickly and taking people and infrastructures out is really making me worry. I fear for 1-2 months from now what the U.S. will look like.