Here’s how COVID-19 moves from a concern for elderly to potentially deadly disease for all

BOSTON — The prevailing messaging from governmental and health organizations about social distancing has been about stopping the spread of the global pandemic caused by a new coronavirus disease.

But what isn’t always well understood, particularly by those disregarding the advice of the Centers for Disease Control and the World Health Organization, is why this disease can be an even bigger problem than it seems.

Quite simply, some still believe the threat posed by COVID-19 is primarily to the elderly or immunocompromised. While that is true, what’s most concerning about a global health crisis like the current pandemic is the capacity of healthcare systems to deal with surges in patient care.

What we’re seeing all over the world is a massive rise in patients entering hospitals, particularly intensive care units, requiring care for the severe respiratory infection caused by the coronavirus. Those most at risk are in need of the highest amount of care and critical resources like ventilators.

According to the American Hospital Association, the U.S. has around 950,000 total hospital beds. That’s a little over two beds for every thousand people. The amount of beds, whether intensive care or not, combined with the amount of ventilators, personal protective equipment for doctors, and other necessary medical supplies represents our healthcare system’s total capacity.

As hospitals fill up and approach what is called ‘surge capacity,’ doctors will have to make difficult decisions about who gets what kind of care and how much.

In 2007, researchers assessing the country’s ability to respond to a global flu pandemic entertained the idea of allocating care in a surge situation.

“For instance, they may have two patients in need of ventilators but only one ventilator...[doctors] may have to choose between those who will or will not receive care. Given two patients but only enough time or resources to care for one, should the provider give care to the one with the greater ability to pay?” SUNY-Albany Professor Peter Levin and colleagues wrote in their conclusion. “The demand for medical necessities could become an ugly scramble among different communities, hospitals, patients, and doctors’ consciences.”

The New York Times reports these decisions are already being explored by doctors in Washington, where 110 people have died from the disease and 2,221 people have tested positive.

Fearing a critical shortage of supplies, including the ventilators needed to help the most seriously ill patients breathe, state officials and hospital leaders held a conference call on Wednesday night to discuss the plans, according to several people involved in the talks. The triage document, still under consideration, will assess factors such as age, health and likelihood of survival in determining who will get access to full care and who will merely be provided comfort care, with the expectation that they will die.

—  Karen Weise and Mike Baker, New York Times

Even before the outbreak took its toll on Italy’s hospitals, doctors had already warned about the possibility of life-and-death decisions.

Now, doctors in Italy have begun warning the rest of the world about hospital’s intensive care units simply collapsing under the strain of the virus.

“They look at the criteria — in this case it would likely be age and underlying disease conditions — and then determine that this person, though this person has a chance of survival with a ventilator, does not get one,” Washington State Hospital Association Chief Cassie Sauer told the New York Times.

“We are far beyond the tipping point,” Nacoti and his colleagues write. With 70% of ICU beds reserved for critically ill Covid-19 patients, those beds are being allocated only to those “with a reasonable chance to survive,” as physicians make wrenching triage choices to try to keep alive those who have a chance. “Older patients are not being resuscitated and die alone without appropriate palliative care, while the family is notified over the phone, often by a well-intentioned, exhausted, and emotionally depleted physician with no prior contact,” they report.

—  Sharon Begley, STAT News

This is an issue that could easily arise in the United States, according to local health experts.

“Though Italy’s health system is highly regarded and has 3.2 hospital beds per 1,000 people (as compared with 2.8 in the United States), it has been impossible to meet the needs of so many critically ill patients simultaneously,” Dr. Lisa Rosenbaum, a cardiologist at Brigham and Women’s Hospital in Boston, wrote in an article published in the New England Journal of Medicine last week.

In 2007, a hypothetical study of a global flu pandemic from the H5N1 strain theorized exactly what has been seen in Italy and those doctors are now warning others of their deadly mistakes. As the virus spreads across the U.S., doctors are being forced to consider more and more situations that were previously theoretical should the community not undertake the proper mitigation methods.


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