The Coronavirus

Optimistic Paranoid wrote:
For all the people pooh-poohing the coronavirus and insisting it's no big deal, were you aware of the fact that in Italy there aren't enough breathing machines to treat all of the seriously ill, and doctors there are literally triaging their patients and deciding who they will treat and who they will let die?

Article from the ATLANTIC web site:

The Extraordinary Decisions Facing Italian Doctors

There are now simply too many patients for each one of them to receive adequate care.

March 11, 2020
Yascha Mounk

Two weeks ago, Italy had 322 confirmed cases of the coronavirus. At that point, doctors in the country’s hospitals could lavish significant attention on each stricken patient.

One week ago, Italy had 2,502 cases of the virus, which causes the disease known as COVID-19. At that point, doctors in the country’s hospitals could still perform the most lifesaving functions by artificially ventilating patients who experienced acute breathing difficulties.

Today, Italy has 10,149 cases of the coronavirus. There are now simply too many patients for each one of them to receive adequate care.

Doctors and nurses are unable to tend to everybody They lack machines to ventilate all those gasping for air.

Now the Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) has published guidelines for the criteria that doctors and nurses should follow in these extraordinary circumstances. The document begins by likening the moral choices facing Italian doctors to the forms of wartime triage that are required in the field of “catastrophe medicine.”

Instead of providing intensive care to all patients who need it, its authors suggest, it may become necessary to follow “the most widely shared criteria regarding distributive justice and the appropriate allocation of limited health resources.”

The principle they settle upon is utilitarian. “Informed by the principle of maximizing benefits for the largest number,” they suggest that “the allocation criteria need to guarantee that those patients with the highest chance of therapeutic success will retain access to intensive care.”

The authors, who are medical doctors, then deduce a set of concrete recommendations for how to manage these impossible choices, including this: “It may become necessary to establish an age limit for access to intensive care.”

Those who are too old to have a high likelihood of recovery, or who have too low a number of “life-years” left even if they should survive, will be left to die. This sounds cruel, but the alternative, the document argues, is no better. “In case of a total saturation of resources, maintaining the criterion of ‘first come, first served’ would amount to a decision to exclude late-arriving patients from access to intensive care.”

In addition to age, doctors and nurses are also advised to take a patient’s overall state of health into account: “The presence of comorbidities needs to be carefully evaluated.” This is in part because early studies of the virus seem to suggest that patients with serious preexisting health conditions are significantly more likely to die. But it is also because patients in a worse state of overall health could require a greater share of scarce resources to survive: “What might be a relatively short treatment course in healthier people could be longer and more resource-consuming in the case of older or more fragile patients.”

These guidelines apply even to patients who require intensive care for reasons other than the coronavirus, because they too make demands on the same scarce medical resources. As the document clarifies, “These criteria apply to all patients in intensive care, not just those infected with CoVid-19.”

My academic training is in political and moral philosophy. I have spent countless hours in fancy seminar rooms discussing abstract moral dilemmas like the so-called trolley problem. If a train is barreling toward five innocent people who are tied to the tracks, and I could divert it by pulling the lever, but at the cost of killing an innocent bystander, should I do it?

Part of the point of all those discussions was, supposedly, to help professionals make difficult moral choices in real-world circumstances.

If you are an overworked nurse battling a novel disease under the most desperate circumstances, and you simply cannot treat everyone, however hard you try, whose life should you save?

Despite those years of theory, I must admit that I have no moral judgment to make about the extraordinary document published by those brave Italian doctors. I have not the first clue whether they are recommending the right or the wrong thing.

But if Italy is in an impossible position, the obligation facing the United States is very clear: To arrest the crisis before the impossible becomes necessary.

This means that our political leaders, the heads of business and private associations, and every one of us need to work together to accomplish two things: Radically expand the capacity of the country’s intensive-care units. And start engaging in extreme forms of social distancing.

Cancel everything. Now.

I hate to inform you that IF one is put on "breathing machine" and it has nothing to do with being put under for surgery in your diatribe it IS WAY TOO LATE in the game.

Obviously you have never had any experience of just what it means to be put on a "breathing machine".

First, they must Intubate you.. I suggest you read up on it..

INTUBATION

In a nutshell they will sedate you, then insert a breathing tube through your mouth, you WILL continue to be sedated as long as your are on the machine..

They will periodically remove the tube and gradually wake you to see if you respond, if not you go under again and again and again.

After one or two weeks of little or no improvement they MUST do a Tracheal (IE PERMANENT) Intubation and you will be fully sedated until your body gives up..

I HAVE had to make the hard decision for my Mom nearly 9 yrs ago to not do the Tracheal. It was the most cruel and inhuman thing that the medical world can do for you.. Sedate permanently, live like a vegetable until your body organs quit, yeah that sure is a life.

OR no permanent Trach they sedate to ease the pain of dying and you can hear everything around you but can't communicate or move you and withhold food/fluid and basically starve and dehydrate your body to the point the body poisons its' self.

I live with these scars of seeing my Mom wither away on a Hospital bed for two weeks..

It is folks like you and the media outlets whipping up everyone in such a frenzy that you cannot find a sheet of toilet paper, bottled water, meats, milk, breads and much more in the stores right now.

Yes, there will be a lot of folks get very sick, there will be a lot of folks who never get sick and yes there will be some that get sick and never recover..

But, we should never live our lives in fear of these things, we came into the world with nothing, we were never promised to live a long life, we leave this world with nothing from this Earth, our body's will return the dust that we came from.

We should be willing to lend a hand even if it means giving up our life in the process, that is what life is about, not hoarding toilet paper.