I have bad news for health care shareholders invested in making people healthy. The market is in the worst downturn since 1987. I have worse news for humans invested in being healthy. The coronavirus (COVID-19) is about to turn health care upside down.
Remember Hurricane Katrina in 2005? Of course you do. Localities across the Gulf Coast could not handle the patient load. This time, we’re not talking about weather, and COVID-19 is global, not local. But we are about to have similar issues as our hospitals will be overrun with patients.
Fifteen years is an eternity in politics. However, as an emergency-medicine provider, the medical mass casualty incident that happened after Hurricane Katrina is still top of mind. The Gulf Coast watched as nursing homes without power stacked bodies and were left without means to treat the infirm.
I realize most people have no idea of what Mass Casualty Incident Management (MCIM) is. It’s about to impact your life. MCIM is a series of tools to handle large patient numbers. I’ve lectured on MCIM across the country. I’ve written on the topic for fire and EMS magazines and the textbooks they learn from too. I’ve spoken from New York to the West Coast and lots of places in-between. I’ve lectured on surge capacity as a secondary issue for these events, and this is the definition. The system is designed to respond to single events. We have tools for larger single events with many patients, but not on an extended basis.
MCIM’s goals are simple: Do the best you can for the most you can. Manage scarce resources. Do not relocate the disaster — though that last one applies more to a bus wreck or accident where you’re working not to overwhelm the local ER, rather than here.
In this case the incidents we are talking about are the coronavirus infections that are spreading rapidly. And if you think that doesn’t threaten to overwhelm our medical system, consider this: Every day U.S. hospitals — and in particular Intensive Care Unit beds — are near capacity as they deal with the normal national baseload of heart attacks, strokes, and accidents. Every day we are critically short on bed space. The capitalism of for-profit health care means baseball analytics have erased any “excessive” bed space.
Given what’s coming, we expect a surge in demand: Estimates are five percent of infected coronavirus patients will require an ICU bed. If that happens, the way we experience the medical system is about to radically change. Forget about having the convenience of single-patient rooms. Forget having someone fetch drinks or make sure cable television is working.
Standard of care will go out the window too. We expect standard of care. This is the prudent layperson standard. You have chest pain and you will get a 12 lead ECG within 10 minutes of hitting a hospital door. Other procedures will follow in rapid succession. There is lots more to it, but for now keep in mind … this is what you are used to.
In Italy, we are seeing “sufficiency of care.” That means we do for you what we can — with what we have. In non-medical terms, it means you come into Mickey Ds and order nuggets and we give you Filet-O-Fish. That might be all we have.
In Italy right now, they are speaking in terms of medical catastrophe. The Italian College of Anesthesia, Analgesia, Resuscitation, and Intensive Care states the following: A week ago, Italy had so few cases of corona that it could give each stricken patient high-quality care.
Exactly how widespread the shortages at Italian hospitals are is unclear, but either already or very soon, many will be so overwhelmed that they simply cannot treat every patient. They face wartime-style triage.
In practice, that looks like patients being abandoned as they arrive at the door, and patients as young as 60 are being turned away from critical-care services because of a shortage of medical providers and a shortage of medical equipment.
This scenario is substantially comparable to the field of “catastrophe medicine,” for which ethical reflection over time stipulated many concrete guidelines for doctors and nurses facing difficult choices.
In a context of grave shortage of medical resources, the allocation criteria need to guarantee that those patients with the highest chance of therapeutic success will retain access to intensive care. It’s a matter of giving priority to “the highest hope of life and survival.” In realistic standards, this means many elderly patients are not being treated at all. These criteria apply to all patients in intensive care, not just those infected with COVID-19.
Do you get it yet? COVID-19 isn’t a problem because it’s “just like the flu” — it’s not. COVID-19 is a problem because the health care industry is going to run short of supplies. We will be short of supplies to treat anyone.
How far we’ll get into that scenario depends on a lot of factors, both in terms of our success in slowing the rate of transmissions (“flattening the curve”) and our ability to ramp up our own capacity for medical care.
But what we’re facing looks a lot like what Italy is living if we do not get serious medical leadership in Washington, D.C.
Right now, it is time to make sure you are prepared for a self-quarantine. Make sure you do not contribute to the medical disaster that’s coming. If you’re not ready to survive two weeks on your own, you are not ready. If you have your two-week supply, encourage your elected leaders to work with medical experts. Let the medical community lead.
To the politicians, be they local, state, or federal, let me help you out … get the fuck out of the way. We need people who solve complex problems outside the box. That ain’t you. We do not have time for politicians who prattle about protecting taxpayers in an emergency. These are the same politicians who got us to where we are right now.
We don’t have time for politicians who want to talk about tax breaks for corporations. We need them to open up access to test kits.
We need city leaders to start reallocating their own personnel. Fire, EMS, and cops will bear the brunt of this. I am sure you will use them for photo ops along with emergency-room personnel when the time comes. Right now, we need you to use your other staff to lighten their load.
Librarians are great at information storage, retrieval, and research. Get them into that mode of helping track patients and data. Parks-and-rec resources are great come summer time. Now, we may need them for other heavy lifts. Instead of simply sending people home, utilize their strengths in different ways. Also, figure out quickly who can provide temporary childcare for all these people. It’s a lot easier for me to concentrate on my job in an ambulance when I know my kid is safe and sound.
Elective procedures should be cancelled. If I can’t go to a bar for a drink — and I can’t in Washington, D.C., and other cities now — we can probably skip the plastic surgery.
We do not have time for politicians who will not pressure patent holders to open up their vice grip. We need to get through the crisis so we can ramp up testing and treatment. We did this with Cipro needs in 2001, and it worked for everyone.
We also do not have the time for pointing fingers. There are elected officials on both sides more interested in being show horses than workhorses. We will hold them to account later. The dead and those families whose lives change forever will point fingers for us. They can do that when this COVID-19 Covfefe Catastrophe is over.
Christopher Suprun is a critical-care paramedic and has been active in health care for more than three decades.