As a transplant surgeon for years, we were forced to routinely make tough life and death decisions. With too few available donor hearts (limited supply) for the overwhelming number of patients waiting for a transplant (huge demand), allocation of the limited vital resource, the donor heart, left many to die within months while waiting for a heart transplant.
I’m no longer on the front line of that decision making, but today’s coronavirus pandemic similarly introduces the life and death decisions being made daily by our heroic health providers because of limited medical resources, whether it be too few ventilators or the lack of personal protective equipment for themselves.
It’s not the way it should be in American medicine today.
But because of inadequate preparation it’s the stark reality we have created for our nurses, and doctors, and caregivers, and support personnel as they fight and sacrifice on the frontlines for our safety and well-being. They are indeed our heroes.
A formidable surge in hospital admissions for COVID-19 patients is underway. Although communities across the country are successfully “flattening the curve” and spreading out the appearance of new cases across a longer span of time, it almost certainly will not be sufficient to prevent surges that will severely test clinical and hospital capacity. With 85,000 adult ICU beds available, even estimates of 960,000 to 3.8 million critically ill patients over the course of this pandemic would far outstrip our nation’s current capacity.
It boils down to extreme lack of surge capacity. While we are making every effort to rapidly increase capacity through scaled-up production of personal protective equipment, emergency manufacture of ventilators, redistribution of health personnel, and construction of makeshift critical care units in parking lots, in pockets it may well not be enough. It certainly has not been enough in New York City.
Here’s how we can all do our part: we must stand firmly behind our healthcare workers and reduce consumption of non-essential healthcare services so that all available resources—people, equipment, and space—can be marshaled toward managing this crisis. Hospitals across the country are postponing or cancelling elective surgeries. We as individuals must volunteer to set aside or postpone all but our emergency health needs: postpone our non-urgent surgery such as a hernia repair or a knee replacement; delay our screening tests such as a colonoscopy or an elective MRI; and shift our doctor’s office visits to only the essential, when acutely sick. There is indeed a personal cost and a personal sacrifice, but cumulatively these actions have a direct and dramatic impact on creating a safer neighborhood and a safer world.
These services are not unimportant, but they are generally not time sensitive. Each of us, by self-limiting our access and use, is helping our healthcare teams pursue a “consequentialist” approach, as well established in medical ethics: making clinical decisions to effect outcomes for the greatest good in society possible.
Reducing consumption of non-essential healthcare services and following recommended social distancing guidelines are essential to saving lives. By radically changing our own social behaviors with home sheltering and delaying our non-essential and routine care and procedures, we can best equip and protect our healthcare workers and avoid the painful choices of rationing scarce care resources to some and denying care to others.
Individual Americans are stepping up in these unprecedented times. One by one, in our personal sacrifices that come with the necessary behavior change, including income and job loss, and with forgoing nonessential care in these uncharted times, we are witnessing the best of the magnificent American spirit, a shared spirit to which this pernicious enemy will surrender.