Millroy: Who is Going to Live and Who is Going to Die?

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Pretty well everything you read or hear about the coronavirus, labelled COVID-19, is scary but I think the scariest is the suggestion that eventually decisions may have to be made as to who is going to live and who is going to die. That is what Italy is going through and an idea that is under discussion in many circles on this side of the ocean at the moment.

It is a simple fact that this will occur if our medical people are not provided with enough ventilators to do the job, the number of cases worldwide rising at an alarming rate, especially just south of the border in the United States.

As ghoulish as this may sound, there will be no way around it if there are more people requiring ventilators than there are ventilators available. In fact, it seems the idea is that if some people have been on a ventilator for several days and are not responding well to the treatment, they could be taken off the ventilator to free it up for someone who presents a better chance of survival.

There is also the young versus the old, the firm versus the infirm. Undoubtedly all would want a chance at living. I wouldn’t want to be in the shoes of those who will have to make the decisions if such choices become necessary, as we are told could happen within a month or so..

Actually, I think it will involve more than simply refusing someone a ventilator or taking someone off one; A further decision will have to be made as to the disposition of these people. Are they just going to be left to die on their own, to essentially suffocate, a horrible death? Or will they be given the choice of assistance on their way out, which would certainly be my choice if I found myself in such a situation.

In any event, I find it hard to quarrel with discussions being held at the moment. It is better to be prepared than simply waiting for what appears to be the inevitable to occur.

I heard news reports on the U.S. cable channels saying the medical system can be overwhelmed because strokes, heart attacks, etc., are not easing up and they already stretch the system to its limits without the entry of COVID-19.

Sault Area Hospital has put a ban on elective surgery for the moment but it does leave an opening for what it calls Semi-Elective Orthopedic Surgery. My wife, Barbara, got in under that designation last week.

She slipped on the ice on March 16, in the process fracturing her elbow and tearing loose the triceps tendon, which attaches the triceps muscle at the back of the upper arm to the elbow bone. After attending emergency, where x-rays were taken, she was called that night to say there was something suspicious showing on the x-ray and she was given an appointment to see an orthopedic surgeon on March 24.

On that day she was given a CAT scan and MRI within minutes of each other, the imaging department not being busy at all. Things slowed down after that.

She was given a sheet of paper with patient information for the Semi-Elective Orthopedic Surgery.

It read:

“Starting tomorrow you can expect the following:

  • A phone call from the operating room staff before 11 a.m. telling you whether or not your surgery will be that day.
  • If it is not that day, the same steps will take place the following day, until your surgery is finally completed (this process could take up to one week).
  • There was a reminder to not drink or eat anything after midnight until you hear from the operating room staff.
  • There is a number to call if nothing is heard from the operating room staff.”

It is hard to imagine someone not having anything to eat or drink from midnight until ll for possibly up to a week.

Barbara got the call at 11 but it was to delay the decision until 1 p.m. At that time she was informed that the surgery would probably be performed later that day and she was told to go to admitting within the next half hour.

She was admitted but apparently there was no guaranty the surgery would be performed that day. However, at 9 p.m. she was informed that she was going to have the surgery that evening.

She hadn’t had anything to eat or drink for 21 hours…

If the surgery hadn’t been performed that night, she wouldn’t have had anything to eat or drink for probably upwards of 34 hours.

Our main worry was what effect having nothing to drink would have on her kidneys, which are compromised, but in late afternoon she was given an IV. However, apparently it had become plugged by the time she got to the operating room.

In normal times when there is no limitations on surgeries, they are scheduled and the schedules are usually kept, albeit not always right on time.

I am just going into this because I think it is something the hospital should address. These may not be normal times, but as the COVID-19 virus has only struck four people in Algoma, at least at this writing, it should be possible to retain some aspect of scheduling surgeries rather than the ad hoc process that appears to be in play…

In regard to the community, it is good to see our grocery stores implementing safe distancing measures and I offer a tip of the hat to all cashiers, who are as close to the front lines in this thing as you can get.

2 COMMENTS

  1. No doubt tough decisions have to be made and I believe that the age of the patient will also be a factor—Seniors have to not only stay home and follow the rules while we also need to avoid younger travellers who can more easily bring back the disease. It becomes double jeopardy for many Seniors
    who do not travel but need to go out for necessary supplies. Fortunately the disease has not–as yet–caught children. Let’s hope that when a Vaccine is discovered it will be offered to vulnerable Seniors as quick as possible

  2. WHY SARS-CoV-2 IS WORSE THAN SARS-2003 – AND MAY STAY FOREVER

    I enclose a letter written by Prof Steve Hedrick. University Southern Cal, San Diego. Courtesy of Prof Pippa Marrack, sister of Dr John Marrack.

    He is one of the world’s leading experts on the biology of plagues.

    Here is a precis.

    1 Plagues do not go away. Measles remains here. Eventually sufficient numbers get the disease, as children, and are then immune so the plague is no longer rampant. Some, like measles we can vaccinate for. If we all stopped vaccinating, in a generation, we would have a measles pandemic.

    2 As human population has increased, the transfer of bugs from animal to human to human became inevitable. We all became immune to the “common” bugs. When a new “novel” virus arrives, no one has immunity and it then can infect everybody. But it has to be the right kind of bug to matter. If it kills you too quickly and can only be transmitted by close physical contact, it quickly runs out of hosts and becomes irrelevant to the majority. Ebola is an example.

    3 To have a pandemic you need the right bug that makes you ill but does not kill you too fast, and a method of transmission that makes it easy to get from person to person. An incubation period where you are infectious but do not know it. SARS had two problems preventing massive spread that Covid 19 does not. There was little evidence that infected people were very infectious during the incubation period and it had a 15% mortality. People became very sick, quickly got hospitalised and were strictly isolated. Little transfer. Some pandemic bugs cause so little problem that we do nothing. Cold viruses.

    4 Covid 19 has a long incubation period, up to 10 days, during which infected individuals, although asymptomatic, are extremely infectious. The great majority do not get very ill. For many children it may be no worse than a cold. Rapid massive transfer.

    5 It is unlikely that Covid 19 will disappear as SARS did. It is too widespread. It seems likely that a herd immunity will be achieved either by sufficient numbers getting the disease (with many people, especially older people, dying) or an effective vaccine being produced (at least a year away).

    6 Covid-19 will probably be around forever afterwards, like measles, whooping cough and chickenpox.

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