Who can live? Who has to die This could soon be a daily question that needs to be answered in New York hospitals as well. Doctors would have to decide who can get a ventilator and for whom there is enough oxygen. For whom that doesn’t make sense anymore because the chances of survival are too low compared to other patients.
The New York section of the American College of Physicians, a national association of internists, wrote to Governor Andrew Cuomo last week and asked him to issue an order protecting doctors from claims for damages. Before relatives sue them if they deny a patient a ventilator and that patient dies.
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The doctors suspect that they will soon have to decide between life and death. That they have to use the “triage” method. This procedure is intended to ensure that as many people as possible are saved in times of disaster. For example, younger patients have better chances than older ones with this virus. And are preferred when in doubt.
The governor warns: In a few days there will be no more free ventilators
Cuomo is still resisting such an approach. “There is no protocol for this,” he explains. Not yet? No hospital in his state currently has to make the decision, but some would experiment with multiple patients sharing a device. But the governor also said on Thursday that there would be no free ventilators in six days, if some from outside would not arrive quickly.
Even now, however, the people who are on the “frontline” in the battle against the coronavirus epidemic are often making tough decisions. And that front is currently in New York.
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One of the many “frontline fighters” is the doctor Craig Spencer. He describes on Twitter and in TV interviews how terribly the current situation weighs on him and his colleagues. Spencer works in a New York emergency room, worked for Doctors Without Borders in crisis areas, for example in West Africa, and survived an Ebola disease himself. Many these days remind him of previous missions, he says.
Background to the coronavirus:
“Actually there is no way to describe what we see,” he begins a long Twitter entry on Friday night. “Our new reality is unreal.” Everything changed in just one week.
“There are tents in front of our hospitals.” Whenever he sees them, he has to pause, their gray and dirty shells looked “so out of place in front of the great facade of world-class hospitals”. “The last time I worked in a tent I was in West Africa.”
“Normal” patients no longer exist
Every single patient he sees has the lung disease Covid-19 caused by the coronavirus. His “normal” patients have disappeared. Working in an emergency room currently means walking through a corridor full of people coughing. All coughs sound different but are caused by exactly the same thing. “Not only the number of patients kills us, but the severity of the illnesses.” One patient with respiratory failure followed the other. If breathing stops, a team of six to eight people is needed: nurses, ventilation specialists, emergency doctors, anesthetists. Each of these missions lasted at least an hour.
The US now has more confirmed coronavirus cases than any other country in the world. The administration of President Donald Trump expects 100,000 to 240,000 deaths in the coming weeks and months. The city and the state of New York are hardest hit: In New York there are now more than 100,000 confirmed infections with the coronavirus.
The number of deaths rose by 562 to almost 3,000 within one day, said Governor Cuomo on Friday at his daily press conference. That is almost half of all deaths in the USA. Almost 15,000 patients are currently being treated in the state’s hospitals for the lung disease Covid-19, almost 4,000 of them in intensive care units.
The governor has been asking for more help from other parts of the country that are currently not so badly affected by the Sars-CoV-2 virus. New York is currently “the spearhead” and needs help. As soon as the situation calms down, New York will help other harder-hit parts of the country, Cuomo promises. “Mutual aid is the only solution.”
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The nine million residents of New York City in particular need help at the moment: Almost 50,000 people have been infected here and more than 1,500 have died as a result. The hospitals are overwhelmed by the onslaught of seriously ill patients. As in all of New York State, there is a lack of intensive care beds, protective clothing – and ventilators in New York City.
“That is not our job”
Spencer and his colleagues are exposed to unimaginable stress. They have to do things that were never expected of them: “Predict which patients will break down when they are sent home. And which will not.” Talk to the euthanasia, listen to the loved ones cry. The families are not with the patients if they decide to stop life support.
“We’re using FaceTime so they can say goodbye.” Instead, the colleagues would sit next to the dying person, hold their hand and just have to wait. “You think about their families. At home. Sobbing. Someone is praying. You can’t help but cry. That’s not our job. You stand by. And wait.” It is not their job, but nothing is as it is in normal times.
In addition to beds, ventilators and protective masks, the people who can fight in this battle could soon also be missing. The doctors, nurses and rescue workers work on the verge of exhaustion, or rather: despite their exhaustion.
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He can see it on the faces of his colleagues, writes Spencer. “We’re tired. We’re physically exhausted. Hours with goggles, hospital gowns and masks feel like days. But we’re only just beginning.” Then there is the psychological exhaustion, which gradually sets in. He’s worried about his colleagues. “Every day one of them calls me tearfully. How long will you hold out? How long will I hold out?” He had never seen his colleagues so frightened. “But I’ve never seen everyone work together so well. I’ve never seen each other more united, more focused, more determined.”
There is always the risk that the helpers will also become infected. In New York, more than 1,000 paramedics and fire fighters have already tested positive for the corona virus.
The paramedic Megan Pfeiffer also describes how dramatic the situation is. The triage method is already being used like on a “battlefield”, she says. You see patient after patient, and most of them are extremely ill: “We bring patients to hospitals who are dying”, said Pfeiffer of the “New York Post”.
Many hospitals send ambulances away again
As a paramedic for the New York Fire Department, the 31-year-old cares for patients in the borough of Queens who dial 911. And there are more and more. “Many are really sick. Others panic and call us as soon as they have symptoms.” Some have a fever, some have difficulty breathing. “The Queens hospitals I drive to are completely overcrowded.”
Pfeiffer records her everyday life in a video diary. She says that sometimes the hospitals have so few oxygen bottles and ventilators that they send the ambulances away. By the time they reached the patients, they would already collapse. “Many of the patients are intubated as soon as they walk through the doors of the emergency room.” Many patients would have to share ventilators. “We have never seen anything like it.” Patients who were not on a ventilator would basically wait for someone else to die so they could take its place.
Queens, along with the Bronx, is one of the parts of the city hardest hit. The areas where the people with the lowest average incomes are located are particularly suffering from the epidemic that has been rampant for a month. The situation is particularly bad in a quarter of Queens called Corona. The neighborhood is near the Elmhurst Hospital Center, which New York City Mayor Mayor Bill de Blasio has named as one of the most congested hospitals in the city. Doctors working in the emergency room there reported “apocalyptic” conditions last week.
They all hope that their cries for help will encourage those responsible to act more decisively. “We know what we have agreed to do – even if we did not expect it. It is very exhausting. We are all exhausted,” says Pfeiffer. In addition, there is not only the fear of getting sick yourself, but also the worry of infecting others. Therefore, they stay away from relatives and friends – and have to cope with their stress on their own: After work, they go into quarantine, says Pfeiffer. So as not to endanger her family.
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