To combat coronavirus: who should we treat first?

Борьба с коронавирусом: кого лечить в первую очередь?

The doctors strive to help everyone infected with SARS-CoV-2. But what happens if the patients becomes too much, and the ventilator is not enough at all? DW c expert on medical ethics.

In the case that the number of patients infected with the coronavirus, would be too large, doctors may face a dilemma: whom to help in the first place, and someone – only when there will be more resources? How will they solve this problem, DW said the head of the Institute for ethics, history and theory of medicine, Munich University named Ludwig-Maximilians George Markman (Georg Marckmann).

Deutsche Welle: From Italy there are disturbing reports that doctors and nurses can no longer properly take care of all cases of coronavirus. Are there guidelines for health workers on how patients should help in the first place?

George Markman: we Have a recommendation for priority assistance only in the context of classical medicine – that is, in the case of a massive influx of the wounded, when victims inspected and divided into categories depending on their condition. We don’t have recommendations for doctors who find themselves in such a situation, what’s happened in Italy when COVID-19 in the ICU and the ventilator (artificial lung ventilation) need so many patients that resources to treat them is not enough.

– What categories doctors usually divide the patients in such situations?

– There are several categories of patients whose lives are now in danger, help in the first place, treating people in serious condition lay, and after that assist patients easy. For patients who have no chance of survival, only care.

In situations with a large number of patients that we can no longer care properly, we must move from individual strategies aimed at treating each individual patient, a group-oriented population at large. If a strategy is a patient, we are trying to determine the optimal treatment for a particular person in accordance with his wishes, and prospects for recovery. In turn the target group of the strategy is to ensure the lowest possible level of morbidity and mortality among specific groups of the population. Physicians are experiencing a lot of stress, because they are not used to working.

– In a situation when hospitals do not have enough of the ventilator and intensive care wards who need to be treated in the first place – those who are most in need of help or has the best chance to survive?

Usually we classify patients according to how urgently they should be helped: the most difficult patients get access to the most intensive therapy. In a situation when the resources are no longer enough, we increasingly use a different approach and determined the priority of patients based on their chances of recovery. This strategy is applied during disasters and can be fully justified and in a situation when too many patients need ventilators, but they are not enough.

Our priority must always be capacity resources. Germany is now actively working on it. From the point of view of ethics it is just as important as the optimal use of available resources – for example, uniform distribution of the number of hospital beds in intensive care units and may exchange patients.

Cases COVID-19, which require ventilation and are unevenly distributed across regions of Germany. In the district of Heinsberg so many people sick in local hospitals remains a lot of heavy patients. At the same time there are regions where it has been recorded much less cases of infection. We need to show solidarity and to use available resources as efficiently as possible, so no one had to fight for them.

– How can I help the doctors and nurses?

It is very important to ensure the protection of medical staff – first and foremost, it concerns the availability of protective suits and masks, which is still supplied intermittently. As for the psychological stress on health care workers if they will be forced to identify priority patients, it is important to have specific guidance on criteria for patient selection. The health workers should be provided with support of the colleagues that the person did not have to make decisions alone.

– What criteria could there be?

– You will need to assess the chances of success of intensive therapy. One of the criteria will be the degree of the severity of acute shortness of breath. You will also need to consider the impact of comorbidities on the chances of the patient’s General condition – for example, if the person is extremely weak. It is also important to determine what the criteria should not play a role: for example, marital status, social status or ethnic origin of the patient.

However, I believe that in Germany to create a highly efficient healthcare system, we can mobilize some reserves to ensure adequate treatment of seriously ill patients infected with the coronavirus SARS-CoV-2.

Борьба с коронавирусом: кого лечить в первую очередь?

Борьба с коронавирусом: кого лечить в первую очередь?