The Corner

Science & Tech

When Hospitals Can’t Save Everyone

The hospital ship USNS Comfort anchored off the coast of Kingston, Jamaica as it prepares for a six-day medical mission, October 25, 2019. (Mass Communication Specialist Second Class Morgan K. Nall/US Navy))

A “hospital ship” run by the Navy is being deployed to help out New York City, which is expecting a surge of COVID-19 patients. Meanwhile, relatives from my hometown of Green Bay, Wis., relayed today that the area has had its first case — and that hospitals are already reportedly at 97 percent capacity from normal illnesses. Paramedics are being told to keep non-life-threatening cases out of the emergency room.

If cases continue to build up the way they have been, hospital capacity is likely to be overwhelmed in at least parts of the country, which could mean doctors have to decide who gets access to treatment and who does not, much as happened in Italy. Over at New York, Matt Stieb has a very helpful rundown of what that might look like. Here’s a taste:

In Michigan, the guidelines suggest hospitals could prioritize care and access to ICU beds and ventilators for those performing “essential social functions” — like doctors, nurses, police, military members, and firefighters. In Minnesota, the guidelines detail the determinations doctors must take to decide if patients should be placed on a ventilator, including likelihood of death and underlying conditions. In a crisis, palliative care “may be the only care that is able to be provided due to the patient’s prognosis and available resources.”

New York’s ventilator guidelines do not prioritize by profession, but do recommend that hospitals list conditions based on “immediate or near-immediate mortality even with aggressive therapy.” Patients would then be ranked according to likelihood of survival and the level that they would benefit from a ventilator. In cases of equal need, age would be used as a tiebreaker.

And speaking of age, the Centers for Disease Control has a new report pointing out that a lot of people who need intense medical treatment are not particularly old. So there will be intergenerational competition for ventilators.

Here’s one way of looking at the data, simply tallying the raw number of hospital visits, ICU stays, and deaths in each group. A big share of hospitalizations are of individuals under 65:

And here are the percentages of COVID-19 patients who need each type of care, also by age. Thanks to spotty data, in many cases it’s not known how things turned out after someone tested positive, so a range of estimates is given. (The lower bound assumes everyone without data was okay; the upper bound includes only the cases where we know the outcome. And of course, bear in mind that there are probably many folks who are asymptomatic or mildly symptomatic, and thus are never diagnosed at all.)

Basically, younger adults are unlikely to die from this, but many of them do require hospitalization or even ICU care. So stay off the damn beaches, for your own sake if not your elders’.

The more we slow the spread of this thing, the more we spread out the load on our hospitals, and the longer we’ll have to build new capacity and develop treatments.

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