MACRO-TRIAGE
While no one can say with any certainty when the next pandemic will arrive, there is almost universal consensus that even a moderate pandemic will break the health care system.
Our hospitals today routinely run with a 96% or greater census. There is little surge capacity built in. Nationwide, there are only a few thousand spare ventilators available on any given day. During a pandemic, it has been estimated that 700,000 patients may require one.
Large numbers of Health Care Workers (HCW’s) may not report for work during a pandemic. Many are single parents with small children at home and would fear being quarantined at work. Others will fear bringing the virus home to their families. And probably at least 1/3rd of them will come down with the virus and be unable to work.
Within days of a major outbreak, every hospital in this country will look like the Superdome 5 days after Katrina.
Masks, gloves, and gowns will be quickly consumed. IV’s, anti-virals, and antibiotics will be in desperately short supply. And flu patients will be lined up in the hallways, bringing the infection to every wing of the hospital. A hospital’s ability to care for and feed a large influx of people will be marginal. The system will break, and hundreds of thousands of non-flu patients will probably die as a result.
As harsh as it sounds, the only realistic solution is to bar flu patients from our hospitals.
There is little that a hospital will be able to do for 90% of flu patients. There will be 50 patients needing a ventilator for each one that is available. In many ways, the majority of flu patients are likely to be better off at home, than in a chaotic and short staffed medical facility. Yes, many will succumb at home. But those that do, would probably die in a hospital also. The only difference is, by staying home, they don’t take the health care system down with them.
This will require macro-triage. Triage on a national level. We need to decide now, before we break the system, that for the good of the nation as a whole, we will not accept flu patients to most hospitals.
On any given day, there are probably 900,000 patients occupying hospital beds in the US. Another 1.8 million people live in nursing homes. During a pandemic, millions more will require non-flu related care. Many of these people will die, even though most are quite salvageable, if our hospitals are wrecked by trying to care for flu patients.
It’s a cold equation. Lock out sick and dying patients, for whom there is little we can do, in order to preserve medical care for others. But it is the only option that makes sense.
Will it happen? I hope so, but I doubt it. There is little political courage in our world today. And damn little common sense. It will be easier to allow the system to crash and burn under the weight of millions of flu patients, for whom there is little that can be done, than it will be to make the hard decision to turn them away.
Triage is never pretty. But sometimes, it’s the only way to save the salvageable.
