A Triage Crisis is Coming, and It’s Personal

Photograph Source: Otis Historical Archives Nat’l Museum of Health & Medicine – CC BY 2.0

I’m sitting here self-quarantined with my family in our 1738 stone farmhouse just north of Philadelphia. It’s an ancient building that I’m sure has known its share of epidemics over the centuries, including typhus and the deadly 1918 Spanish Flu.

Right now I’m thinking about hospital triage.

According to the New York Times, hospitals in Seattle, one of two hot spots in the US Coronavirus Pandemic with 2221 confirmed cases and 110 deaths statewide, are seriously planning for how to decide which patients suffering from the often fatal Acute Respiratory Distress Syndrome complication associated with the  disease will get one of the limited number of ventilators available, and which ones will be left to fend for themselves and probably not survive. They want to develop a set or guidelines, so doctors won’t have to make personal decisions in the moment and be overburdened with guilt afterwards whichever option they chose.

In Italy, the country with the highest number of deaths so far from the COVID-19 virus (over 5000 and rising rapidly), these terrible decision have already been made many times over in hospitals that are swamped with critical patients. We’ll be facing them in city after city in no time here in the US, which is far less prepared for this pandemic than was Italy with its universal health care system, far greater number of beds per 1000 people, better physician staffing and ready supply of coronavirus test kits.

In the US, thanks to President Trump’s having ignored the looming pandemic for months, even referring to it as a “Democrat hoax” or “Chinese hoax” and to his having eliminated the pandemic warning unit at the Centers for Disease Control and the Pandemic specialist on his National Security Council, there was no effort as recently as early March to order mass quantities of virus test kits. As a result, US health experts and pandemic planners have been flying blind in this crisis, not knowing who is infected and who is not, or even how many are infected in any locale.

That’s why we have to hole up in quarantined family units, not even knowing if one of us may be contagious and a threat the rest of the household.

And now we’re about to see our hospitals across the country begin to be overwhelmed with coronavirus patients, many of whom will need ventilators to survive the pneumonia and lung damage that will occur as their bodies succumb to the viral attack on their lungs.

The triage process will be fairly straight-forward. When ventilators are in short supply doctors will be instructed by policy to give them to those who have a good chance of survival with the machines. Those who have a lower probability of surviving with the help of a ventilator, which will mean the old, the frail, and those with underlying health issues like congestive heart failure, lungs damaged from years of smoking, or other lung problems like pulmonary sarcoidosis, an autoimmune disease which can make any respiratory infection develop into pneumonia, may not.

That’s where it gets personal. I am 70 years old, which puts me right away into a category of people with a higher (8%) risk of dying of coronavirus. I’m healthy and fit, but I also have pulmonary sarcoidosis. The condition has  been in remission for years, but I know from prior experience, if I get this virus, it’s more than likely to become active again and to put me at risk of ARDS, and to require a ventilator.

Will I get one? Not, probably, if there is a shortage in Philadelphia hospitals, which there almost certainly will be.

And whose fault will that be? Our government’s fault. For years, under multiple presidents, the focus of health policy has been reducing costs. That has meant letting hospitals close, often by, as we just experienced here in Philadelphia, having a for-profit company buy another hospital, in this case the Hahnemann Teaching Hospital owned by Drexel University, after which the buyer, a real estate investor, closed it down  figuring it would be more valuable as fancy housing than as a hospital. It has also meant reducing the number of equipped intensive care rooms, equipped with ventilators, among other things. There are only 46,000 ICUs in the whole country and only 950,000 hospital beds, and the CDC is warning of 10 million or more coronavirus cases — perhaps even that 70-80 percent of Americans will eventually contract it!

We’ve long been warned that thanks to globalization, and especially jet airlines transporting millions of people a year all over the world, that it was “just a matter of time” before we’d have a real deadly global pandemic. No planning for this was ever done in the US though. It was all about getting health costs down, because we have a health system based upon private companies, private insurance and private doctors, and profits are more important than everyone getting needed care.

Now we’re paying the price for that focus on profits and cost. (The rich don’t have this issue: they’re locating and buying ventilators for themselves, making pikers of the plebe hoarders who are loading up on TP.)

If I contract this disease, I may pay that price personally.

Now I can understand: If there were two coronavirus patients in the hospital with ARDS and one ventilator, with me being one and with one being a 19-year-old kid who had the flu and then caught the coronavirus, I’d understand not getting the ventilator. I wouldn’t be bitter at the doctors who followed the triage guidelines. But I’d go down cursing Trump and the other bastards in Washington who have for years cared more about the shareholders of the companies in the Medical Industrial Complex than the people of this country, spending over a trillion dollars a year on the military without a moment’s thought while refusing to make affordable healthcare available to all through a government-run system like most countries have.

Who knows? Maybe I’ll be lucky, and all the isolation and hand washing and mask wearing will prevent me from getting this virus. Maybe if I get it, I’ll be one of the lucky ones who gets a mild case and scarce ventilators won’t be an issue. But as I listen to the lies and the ignorant blather from this president, and watch the venality of members of Congress — especially, but not limited to Republicans (are your ears burning Joe Biden?)–I’m already pissed off that it’s come to this point.

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Dave Lindorff is a founding member of ThisCantBeHappening!, an online newspaper collective, and is a contributor to Hopeless: Barack Obama and the Politics of Illusion (AK Press).

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