COVID-19: Utah doctors propose rationing care in overcrowded ICUs

Utah [USA], October 27 : Bracing themselves from the possible onslaught of coronavirus cases in Utah, doctors have proposed to begin rationing care in the coming weeks. Criteria they proposed to include doctors to decide which patients can stay in overcrowded intensive care units (ICUs).
Under the criteria, which would require Utah's Governor Gary Herbert's approval, patients who are getting worse despite receiving intensive care would be moved out first. In the event that two patients' conditions are equal, the young get priority over the old, since older patients are more likely to die, reported The Salt Lake Tribune.
Hospitalisation has increased amid the growing number of coronavirus cases in the state. It had set new records for daily cases totals last week. Two Utah hospitals were opened to control the overflow of the patients. The state has long planned to open a field hospital at the Mountain America Expo Center in Sandy if necessary, reported The Salt Lake Tribune.
However, the problems which persist are the access to ICUs to doctors and nurses with speciality training and new beds, which will leave the ICU's under-staffed.
Greg Bell, president of the Utah Hospital Association advised Gary Herbert to enact triage protocols, known as 'crisis standards of care.' "I haven't said, It's gonna happen' -- until [Thursday] night, I told the governor, It's gonna happen. We're going to be back here asking for crisis standards," he said.
The guidelines provide a four-step process to decide who gets ICU space or ventilators when they are close to running out. The goal, the plan states, is to 'stay ahead by one' -- or, if that's not possible, to do the greatest good for the greatest number'."
The first order of business is to make sure the patients currently using those resources actually want them.
The second step is to consider, and ask patients to consider, a transfer to a regular hospital bed if they aren't improving with intensive care. Step three calls for looking at patients' condition scores but also considering individual factors; in general, those with high and worsening scores are the first to be transferred out of an ICU. If shortages worsen, hospitals should then consider transferring patients with high or worsening scores. Pregnant patients get priority for intensive care, and if two patients are equally eligible for a spot in the ICU, it generally goes to the younger patient.
Step four: Evaluate ICU demand every day, and change the 'cutoff' condition score as possible. Stop using the guidelines when 'all hospitals have been load levelled out' of using any cutoff score, reported Salt Lake Tribune.
Another problem that arises from the situation is of the mental breakdown of health care workers who are overburdened with the overflow of patients. Coronavirus has left Utah's hospitals desperately understaffed.
Bell said, "Some are worn out, some are on leave because they've been doing this for seven months. ICU beds without adding staff don't address the needs of the sickest coronavirus cases. Even for non-COVID-19 patients, care is not 'intensive' if doctors and nurses have too many patients -- or if patients don't have access to the specialists they need."
As per the state data, Utah's ICUs have been 75 per cent occupied. This means that ICU beds have become scarcer and the logistics required for moving patients have been badly affected.
"Not only do staffing levels shift over time, but also different patients require different levels of time and attention. And coronavirus patients, who made up about 20 per cent of ICU patients last week, can be particularly time intensive to care for," said Dr. Lindsay Leither, Director of Intermountain Medical Center's respiratory ICU.
Under new state guidelines, statewide ICU occupancy of 72 per cent is considered a mark of 'high' virus transmission levels. "While Utahns may see that figure and believe it means there's still room for patients in 28 per cent of ICU beds, health officials chose that 'conservative' number precisely because it's understood that hospitals cannot actually staff every ICU bed all the time," said Joe Dougherty, spokesman for Utah's Division of Emergency Management.
The grimmest indicator of a possible crisis in the next week is the explosive rise in cases last week. Hospitalisations have rises seven to ten days after diagnoses. It means a rise in pressure on the hospitals.
Now daily case counts are not just rising to new heights every day; they're obliterating past records. Friday's increase of 1,960 new cases was more than 27 per cent higher than the previous record of 1,543. The weeklong average of 1,355 new cases per day was nearly 130 higher than the average a week ago, reported The Salt Lake Tribune.