Who Lives? Who Dies? NYC Hospitals Could Soon Be Forced to Triage Coronavirus Patients

A randomized lottery could be used to help decide who gets a ventilator, according to New York state's 2015 ventilator allocation guidelines


The coronavirus toll on New York City hospitals is "getting that serious" that medical professionals could soon have to decide who will get treatment, and who won't, the chair of the department of surgery at Columbia University said in his latest update.

As field hospitals are constructed in Central Park, and as more beds become available on USNS Comfort, at Javits Center and at other pop-up medical facilities, NewYork-Presbyterian hospital system is expanding its intensive care unit capacity from about 400 beds to 1,000 to prepare for the apex of COVID-19 cases, Dr. Craig Smith said on Monday.

The beds are expected to come on line over the next few weeks, Smith said. When those beds start to get filled up with coronavirus patients, which Gov. Andrew Cuomo said could happen in a few weeks, Smith says a triage will become a "fundamental operating principle."

"Triage determines who should be treated first, how they should be treated (surgery, fluid resuscitation, etc), and who should be kept comfortable," the doctor said.

At the opening of the medical center at Javits Center on Monday, Gov. Cuomo said, "We need more healthcare professionals, we need more supplies, we need more capacity and we need it now."

"The entire country has been playing catch up with this virus since day one, but in New York we have been trying to plan forward and get ahead of the problem," he continued. And New York has been planning for this.

In 2015, the state took steps to prepare for a pandemic such as the coronavirus. The Department of Health published ventilator allocation guidelines to provide health care providers with a framework if a triage becomes necessary.

Empire State Realty Trust says the tower of the iconic New York City landmark will turn red each night and spin to pay tribute to all the heroes on the frontline of the coronavirus epidemic.

The guidelines' primary goal is to save the most lives, but what happens if there are not enough resources?

To summarize the 272-page guidelines, a triage officer or a triage committee who don't have direct contacts with patients will be the ones to decide who gets a ventilator, not the attending physicians. With four guidelines involving adults, children, neonates, and legal considerations, those who are mostly to survive will get the ventilators and children will play a tiebreaking role.

If there are patients of equal needs, there are protocols that will either distribute the breathing machines on a first-come basis, using a lottery, using a physician's clinical judgment and prioritizing certain patients such as health care workers, patients of advanced age or patients with certain social criteria, the guidelines said.

For NewYork-Presbyterian, Dr. Smith says the hospital system will begin to alleviate pressure on hospital capacity by sending selected COVID-19 patients home with oxygen, an oxygen saturation monitor and following up with them at 12-24 hour intervals.

NBC New York's Ray Villeda reports.

"Does this entail incompletely understood risk? It certainly does, but triage is an essential part of the resource/utility-balancing situation in which we find ourselves," he said.

That's how hospitals in New York have been able to slow down the overload on the health care system. Patients with mild symptoms of the coronavirus, whether they have been tested or not, are sent home to monitor their own conditions and ordered to self-quarantine.

As of Monday, there are at least 9,517 people in New York who are hospitalized for COVID-19, and 2,352 are in intensive care units, Cuomo said. While more than 4,000 people have been discharged, coronavirus cases continue to soar.

Another Columbia doctor on Monday called for even more uniformed guidelines on patient care amid the pandemic. "We need to be humanistic, but also realistic about the outcomes they face," said Dr. Stefan Flores.

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