Coronavirus-Are we ready to talk about rationing care?

On 3/11/2020 at 2:58 PM, Mavnurse17 said:

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. 

Agreed- Do I think this is the apocalypse? No. I don't even think the much-touted "2.3% fatality rate"  is even accurate.  I believe it is much lower than that ( somewhere around 0.7%).

But, and I cannot emphasize this enough:

There is nowhere near the resources needed for anything more than a bad flu season- my estimates put the case fatality rate at seven times worse than the worst flu, but not the 20 x worse than the flu that the 2.3% would represent  

Agreed.  When people ask me for my professional opinion I tell them that I don't think we're quite at the point where we need to hoard toilet paper and shell out $10 for a mask on ebay, but that the implications of the illness worry me.  I read an article that an Italian doctor wrote yesterday about the current conditions over there.  The hospital systems are falling apart.  Not enough resources.  I'm young, healthy, and have a very low risk of getting really sick if I contract it, but I live in a densely populated city in Texas that will undoubtedly waver if we're hit like Italy has been.  It bothers me when people say "it's just a bad flu" and "only the elderly will die."  

I am extremely angry.

My son is a RN.  Huge hospital system.  Works in ER.  I just text him if they have implemented masks yet.  He text back "no and followed by mom they tell us its just the flu".

I am also a RN.  I would fight this but I do not work in this hospital.

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

Where does the rationing of care end? Will you ration the nursing care of my hospice patient? How is one life valued above another and thus receives more care? No human being has the right to determine human value or privilege - only God can do that. A pre-born baby who is unable to vocalize their needs/wants has just as much rights as my late stage demented patient who cannot vocalize his/her needs/wishes either. Do not play God....you won't win.

your comment is just.....yikes. all that moral superiority. 
People are forced into a situation all the time of choosing and rationing care

Or do you honestly believe our existing system can take any level of catastrophe that is thrown at it? 

On 3/11/2020 at 3:21 PM, gettingbsn2msn said:

I am extremely angry.

My son is a RN.  Huge hospital system.  Works in ER.  I just text him if they have implemented masks yet.  He text back "no and followed by mom they tell us its just the flu".

I am also a RN.  I would fight this but I do not work in this hospital.

Have they not implemented masks for the patients or the nurses or both?

On 3/9/2020 at 4:53 AM, caliotter3 said:

Wonder if the ventilator manufacturers have considered ramping up production.

Wonder how many of the pieces and/or machines are manufactured elsewhere that would be affected.

https://theweek.com/speedreads/900850/doesnt-have-enough-icu-beds-ventilators-deal-even-moderate-coronavirus-outbreak

Wonder what would happen if the only available vent was needed for your one of your states senators and by a big pocket potential donor? We could throw a 55 year old grandmother into the mix but the sad reality is she likely would not be even considered.

1 hour ago, Walti said:

Wonder what would happen if the only available vent was needed for your one of your states senators and by a big pocket potential donor? We could throw a 55 year old grandmother into the mix but the sad reality is she likely would not be even considered.

Don't be silly...money always talks...

6 hours ago, Walti said:

Wonder what would happen if the only available vent was needed for your one of your states senators and by a big pocket potential donor? We could throw a 55 year old grandmother into the mix but the sad reality is she likely would not be even considered.

The potential donor would get it, there's always senators that can be bought-in fact, they're a dime a dozen, with plenty lined up waiting to take their place!

Edited Mar 12 by Hoosier_RN

On 3/10/2020 at 10:26 AM, Kitiger said:

Some of us private duty home care nurses are experts with trachs and vents. I'll probably be too busy with my own patients, but retired private duty nurses could help . . . if the bureaucracy allowed it.

I wasn't really thinking. Retired nurses are older nurses, who are now high risk for complications from this coronavirus. They should probably stay home.

Our governor assured us today that there are plenty of vents available.  He said they passed something in 2018 to ensure that no matter what, plenty of vents are available.  They even said they looking at repurposing old ones.

What I’m worried about is all of us getting healthcare workers getting infected.  Then, the hospitals quarantining us at the hospital.  Could I be away from my family for 2 weeks?  I fear many other nurses worry about this as well and will quit in advance.  I worry our numbers of ICU nurses will severely diminish.  

To be honest, I’m getting more worried by the day.  People here are not practicing social distancing.  They are going to the grocery store every day hoarding food and supplies.  I stayed home for 4 days, didn’t leave.  Had to go to the store today and it was just as packed as Thursday when I first went and no food.  I was so irritated when I left.

And, I’m guessing the longer this goes on, the more irritated everyone will be getting more and more agitated.  I foresee violence coming.  I also said people are still having devastating strokes, MVCs, perforated bowels, heart attacks.....  how do you decide to prioritize care to then?  I also foresee us  getting the semi stable to the floor before they are quite ready to open beds.  What happens when people die from that?

Not too much gets me upset or worried.  I’m there right now.  

On 3/16/2020 at 5:45 PM, LovingLife123 said:

Our governor assured us today that there are plenty of vents available.  He said they passed something in 2018 to ensure that no matter what, plenty of vents are available.  They even said they looking at repurposing old ones.

What I’m worried about is all of us getting healthcare workers getting infected.  Then, the hospitals quarantining us at the hospital.  Could I be away from my family for 2 weeks?  I fear many other nurses worry about this as well and will quit in advance.  I worry our numbers of ICU nurses will severely diminish.  

To be honest, I’m getting more worried by the day.  People here are not practicing social distancing.  They are going to the grocery store every day hoarding food and supplies.  I stayed home for 4 days, didn’t leave.  Had to go to the store today and it was just as packed as Thursday when I first went and no food.  I was so irritated when I left.

And, I’m guessing the longer this goes on, the more irritated everyone will be getting more and more agitated.  I foresee violence coming.  I also said people are still having devastating strokes, MVCs, perforated bowels, heart attacks.....  how do you decide to prioritize care to then?  I also foresee us  getting the semi stable to the floor before they are quite ready to open beds.  What happens when people die from that?

Not too much gets me upset or worried.  I’m there right now.

I'd take those "ALL IS WELL" reassurances with a grain of salt.

Trump had a conference call today with all the governors, and they all reported told him they're screwed when it comes to vents and equipment.

You have to consider how many vents we're talking about for instance.  Some states have said they've managed to scramble together extra vents, the largest number I've heard is 100 vents.

Hopefully these numbers aren't right, but they have been so far:  One third of the population will become infected, about 6 percent of those will require ICU care, almost all due to the need for a ventilator.  On average, that means each state will have about 130,000 people requiring a vent, so scrounging up an extra 100 vents doesn't do a whole lot.  

Again, hopefully our numbers don't keep going in that direct, some countries are surprisingly unscathed so far, but then there are countries like Italy where their numbers are far worse than that.  Their current mortality rate in confirmed cases is about 7%, and that's with most of the confirmed cases not yet being to the point where deaths are known to occur.