Coronavirus Doesn’t Change Doctors’ Basic Triage Problem

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We’re told that the coronavirus will mean doctors have to make difficult decisions. Sure, it will, but there’s nothing new about such decisions, they’re of the type that doctors have been making for centuries, millennia. It’s called triage:

ICU doctors now face the toughest decisions they will ever have to make
Tim Cook

It could be that they’ll have to make more of these decisions but there’s nothing remarkable at all about the underlying necessity:

The magnitude of the coronavirus pandemic will involve making decisions that, in normal times, doctors aren’t confronted with: decisions about which patients to treat in ICU when not all can be.

No, that’s not how it works. All medicine performs triage. The division into three groups. Those who will be fine without treatment, or at least can wait for as long as necessary for treatment to become available. Those who, whatever is done, are going to die real soon now – who we don’t treat other than to make them comfortable. The third group – and thus triage as a word – are those who will die, or be horribly maimed etc, without treatment now and who will also respond to treatment right now. Those are the ones who go to the front of the queue.

Any and every A&E department practices this all the time every day. Your shoulder sprain might take hour upon hour to be seen to. That bloke who just crushed his skull coming off the Norton on the bend gets a brief glance and a call for the priest of his assumed preference. That severed jugular still spurting – showing both a heart still pumping and the presence of blood to pump – gets treated right now.

All health care systems do this all the time.

We have further proof that the NHS – yea, even that Wonder of the World – does this. Recall that Liverpool Care Pathway? Those dying are simply sedated, sans food or even liquids, until they dehydrate into the grave? What do you think this is other than triage? These people are going to die in the next few days, couple of weeks. Make them comfortable as can be and don’t treat them. This is done every single day in every major hospital in the country.

Coronavirus may be changing the frequency with which these decisions must be taken but it’s not changing that basic need in the slightest.

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Esteban
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Esteban

I think there is a bit of a change here – doctors are having to let people die who they could save. We only have one ventilator available and two elderly patients just arrived, either of whom we can probably save. I suspect making that choice weighs heavier than “we didn’t keep someone alive a few hours longer.”

John B
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John B

Based on what evidence? The evidence in the UK at least is that those who have died were very old and with serious underlying health conditions and who probably were classified ‘Do Not Resuscitate’ and if they caught any infection would not have life support.

The distinction not being made is people dying with the virus and people dying from the virus. In Italy it has been reported that only 12% of Coronavirus deaths have been caused by the virus. The Italians test everyone who dies post-mortem.

Phoenix44
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Phoenix44

Flu is the same though. The numbers quoted for flu deaths are those “associated” with flu, whereas the killed by flu are very small.

I am increasingly of the view that ACE inhubitirs are playing a significant role. Those likely to be on them are the highest risk group, and the possible side-effects sound exactky like CV, even down to the loss of taste. They might be increasing the number of ACE sites on cells, which is more entry points for the virus, and/or the virus might be “doubling up” the side-effects to a fatal level.

John B
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John B

Pandemic?

2 626 reported cases in the UK, 104 died WITH, not from the virus, all elderly ‘with underlying conditions’ already in the clutches of the NHS.

The virus has likely been in the UK for over two months. For such an allegedly contagious, ‘dangerous’ virus it is making a poor fist of it.

Bloke in North Dorset
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Bloke in North Dorset

The difficulty comes when all the ventilators are in use with oldies and a 30-year-old needs one. Who are you pulling the tube out of to give him a chance?

BlokeInTejasInNormandie
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BlokeInTejasInNormandie

The obvious answer is you have capacity for individual cases. You don’t let your last 30 year old” resources go to “dying grandma”

Well, unless she’s really hot 🙂

Boganboy
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Boganboy

I hope they keep her well-sozzled with morphine. But that’s cheap and easy to stockpile, so there should be no difficulty.

BlokeInTejasInNormandie
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BlokeInTejasInNormandie

Even if not hot..
And yes.
Standard triage.
Dunno about UK, but USA has the concept of “hospice care”. The outcome is inevitable, so the treatment is treat the symptoms for the comfort of the patient.

M’lady wife presented a second time with cancer in the brain. Already had the radiation treatment ( ten years before) and badly damaged thereby (but still functioning) and do nothing more to do. So hospice.

One hopes the same common sense applies elsewhere. Apparently doesn’t exist in France (but the question was posed to ordinary citizens only)

Charles
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Charles

Right now, there are enough ventilators that doctors can put a patient on one as a precaution if they think they *might* need it imminently to make sure they don’t die if they deterioriate a bit. Later they’ll only have enough for those who definitely need it right now. Then it will move one to deciding which patients are most likely to benefit and abandoning others with a smaller chance of survival to almost certain death (nothing seems to be absolutely certain in medicine). The exponential growth seen so far, and the experience from abroad, means that cases are going… Read more »