This is not a shocking new idea, although it is the next step that we will have to take while we simultaneously try to flatten the curve of the infections.
The predicted shortage of ventilators has raised the question of how hospitals will select who gets a ventilator, and essentially, who lives and who dies?
Some considerations for ventilator distribution is first, to what cities should the stockpiles be sent? Should this be on a per capita basis, or on the actual, not predicted, cases? Now that directives on how to use a ventilator on two people have been discussed, that should be the first consideration before making any choices. Looking to the ethical guidance issued during the vaccine shortage of 2003-4, reveals some of the key considerations for similar respiratory distress risk groups.
During the bird flu outbreak the flu vaccine was in short supply because the U.S. supply had been sourced from a vaccine facility in France that had a contamination incident, and no shipment could be made to the U.S.. The second reason was a shortage of eggs that are used to make vaccine. Bird flu meant a lot of birds were destroyed creating an egg shortage, as well as a concern of contaminated eggs.
The New York Times reported on October 7, 2004, that the U.S. will receive only about 55 of the 110 million doses of flu vaccine ordered.
This led the CDC to convene its Advisory Committee for Immunization Practices (ACIP) to determine who would get the flu vaccine, since not everyone would have access to it.
Many were critical at the time that front-line medical workers should have been at the top of the list rather than at the bottom. CDC was planning to revisit the hierarchy and mercifully, the flu season ended without being as bad as expected. In 2005, CDC made recommendations again, and healthcare workers were near the top of the list.
Since 1990, flu vaccinations in the U.S. nearly tripled in the 1990s, making the 2004 shortage a real issue (see graphic).
When the ACIP or ethics board gathers to consider who gets a ventilator, let's hope that healthcare workers are at or near the top, because the preservation of life (without question) is directly dependent on healthcare workers.
The predicted shortage of ventilators has raised the question of how hospitals will select who gets a ventilator, and essentially, who lives and who dies?
Some considerations for ventilator distribution is first, to what cities should the stockpiles be sent? Should this be on a per capita basis, or on the actual, not predicted, cases? Now that directives on how to use a ventilator on two people have been discussed, that should be the first consideration before making any choices. Looking to the ethical guidance issued during the vaccine shortage of 2003-4, reveals some of the key considerations for similar respiratory distress risk groups.
During the bird flu outbreak the flu vaccine was in short supply because the U.S. supply had been sourced from a vaccine facility in France that had a contamination incident, and no shipment could be made to the U.S.. The second reason was a shortage of eggs that are used to make vaccine. Bird flu meant a lot of birds were destroyed creating an egg shortage, as well as a concern of contaminated eggs.
The New York Times reported on October 7, 2004, that the U.S. will receive only about 55 of the 110 million doses of flu vaccine ordered.
This led the CDC to convene its Advisory Committee for Immunization Practices (ACIP) to determine who would get the flu vaccine, since not everyone would have access to it.
Although CDC wrote that each group had the same priority, the listing had the effect of suggesting a priority in this order:
1. infants
2. elderly
3. chronically-ill
4. front-line
medical workers
Many were critical at the time that front-line medical workers should have been at the top of the list rather than at the bottom. CDC was planning to revisit the hierarchy and mercifully, the flu season ended without being as bad as expected. In 2005, CDC made recommendations again, and healthcare workers were near the top of the list.
Since 1990, flu vaccinations in the U.S. nearly tripled in the 1990s, making the 2004 shortage a real issue (see graphic).
When the ACIP or ethics board gathers to consider who gets a ventilator, let's hope that healthcare workers are at or near the top, because the preservation of life (without question) is directly dependent on healthcare workers.
Unfortunately, Italian doctors have already faced this situation. See: https://www.nejm.org/doi/full/10.1056/NEJMp2005492
ReplyDeleteIt is a grim situation.