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Epidemic Epistle: A Triage Crisis is Coming, and This Time It's Personal

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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 decisions 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.

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Dave Lindorff, winner of a 2019 "Izzy" Award for Outstanding Independent Journalism from the Park Center for Independent Media in Ithaca, is a founding member of the collectively-owned, journalist-run online newspaper (more...)
 

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