Knowing that New York is the epicenter for COVID-19 in the United States, and access to mass amounts of ventilators is scarce, have you ever wondered how they're able to use their resources to their best ability? I have. In fact, I've been listening to podcasts to keep me updated with the whole coronavirus pandemic, and one that caught my attention was one that was released on March 31st by the Wall Street Journal titled, "Without Ventilators, Doctors Face Hard Choices." In this podcast, Ryan Knutson (a co-host of the Wall Street Journal podcasts) talks to his colleague - Christopher Weaver - who was able to speak with hospitals and policymakers about how hospitals in New York rationalize their ventilators.
Chris tells Ryan in the podcast:
"So, this New York template uses a color-coding system. It asks committees of doctors, triage committees, it calls them to evaluate each patient who might need a ventilator and give them a color code. Reds are people who are likely to benefit from getting the ventilator. You know, likely to survive with one, and they get priority, the people most likely to be saved. The next step down is yellows, and that's a group about whom the doctors are less certain they might make it with a ventilator, or they might not. So, they only get a ventilator after all of the reds are served. They're basically asked to wait in line. The blues in this system are people who are going to die anyway. People of this group, doctors decide are basically beyond hope and are not going to get ventilators. And then finally there are greens, and these are the lucky ones who doctors have decided are probably going to make it whether they get a ventilator or not. So, they don't get one either."
The thing is, Dr. John Marshall (the Chair of Emergency Medicine in the Department of Medicine at Maimonides Medical Center, the largest hospital in Brooklyn, New York) told a colleague of Ryan and Chris that he only had thirty extra ventilators as of the last week of March. Thirty ventilators that are not being used in the largest hospital of Brooklyn is not a good thing to hear, considering the fact that New York is the epicenter for the coronavirus. With new cases comes new hospitalizations, and with new hospitalizations comes new critical cases that are in dire need of a ventilator. Therefore, thirty ventilators is simply not enough. So what happens when the number of patients in critical care outweigh the number of ventilators in a hospital? The hospital will have to pick a patient at random, who will then be given a ventilator. Chris told Ryan that this can be done by "drawing straws or picking numbers out of hats."
In addition to this podcast, I stumbled upon a video on the Wall Street Journal website. The video showed Dr. Tia Powell, a New York State Task Force on Life and the Law who helped influence the writing of the 2007 guidance-document for the allocation of ventilators during an influenza pandemic, talking with Jason Bellini, a Wall Street Journalist. Dr. Powell talked about the new draft on the guidelines of ventilator rationing that New York is working on. She said to Jason:
"[It] would temporarily make it possible to say [to a patient on a ventilator], 'We're so sorry. We tried to pull you through. It didn't work, and now we're going to remove that ventilator, and it would go to some other person in line. An effort to save you is done, and we have people waiting. So, we're not going to continue treating you with a ventilator.'"
If this doesn't scream just how serious COVID-19 is, then I don't know what will.
On April 7, the Wall Street Journal released another podcast where Dr. Anthony Fauci, the director of National Institute of Allergy and Infectious Disease (NIAID), said that the number of incoming hospitalizations in New York has been at some kind of plateau for the past few days. If this plateau continues and becomes a downward slope, then patients in critical care will no longer be competing with each other for a ventilator. I hope and pray that the curve in New York is truly beginning to flatten because people should not be left to die by having a ventilator taken away from them for someone else to use all because of a shortage of ventilators.