{"id":9469,"date":"2020-03-20T23:13:54","date_gmt":"2020-03-21T06:13:54","guid":{"rendered":"https:\/\/worldcampaign.net\/?p=9469"},"modified":"2020-03-21T03:58:17","modified_gmt":"2020-03-21T10:58:17","slug":"post9-2","status":"publish","type":"post","link":"https:\/\/worldcampaign.net\/?p=9469","title":{"rendered":"&#8220;\u2018Chilling\u2019 Plans: Who Gets Care as Washington State Hospitals Fill Up?, The New York Times"},"content":{"rendered":"<p>By <span class=\"css-1baulvz\">Karen Weise<\/span> and <span class=\"css-1baulvz last-byline\">Mike Baker, March 20, 2020<\/span><\/p>\n<p><em>Fearing a critical shortage of lifesaving resources as the coronavirus spreads, Washington State is engaged in grim discussions to determine which dying patients would get priority.<\/em><\/p>\n<section class=\"meteredContent css-1r7ky0e\">\n<div class=\"css-1fanzo5 StoryBodyCompanionColumn\">\n<div class=\"css-53u6y8\">\n<p class=\"css-exrw3m evys1bk0\">SEATTLE \u2014 Medical leaders in Washington State, which has the highest number of coronavirus deaths in the country, have quietly begun preparing a bleak triage strategy to determine which patients may have to be denied complete medical care in the event that the health system becomes overwhelmed by the coronavirus in the coming weeks.<\/p>\n<p class=\"css-exrw3m evys1bk0\">Fearing a critical shortage of supplies, including the ventilators needed to <a class=\"css-1g7m0tk\" title=\"\" href=\"https:\/\/www.nytimes.com\/2020\/03\/18\/business\/coronavirus-ventilator-shortage.html\">help the most seriously ill patients breathe<\/a>, state officials and hospital leaders held a conference call on Wednesday night to discuss the plans, according to several people involved in the talks. The triage document, still under consideration, will assess factors such as age, health and likelihood of survival in determining who will get access to full care and who will merely be provided comfort care, with the expectation that they will die.<\/p>\n<p class=\"css-exrw3m evys1bk0\">The effort is statewide so individual doctors and hospitals will not be left to make such decisions, said Cassie Sauer, chief executive of the Washington State Hospital Association, one of the groups convening the call.<\/p>\n<\/div>\n<\/div>\n<div id=\"story-ad-1-wrapper\" class=\"css-2ninbb\"><\/div>\n<div class=\"css-1fanzo5 StoryBodyCompanionColumn\">\n<div class=\"css-53u6y8\">\n<p class=\"css-exrw3m evys1bk0\">\u201cIt\u2019s protecting the clinicians so you don\u2019t have one person who\u2019s kind of playing God,\u201d she said, adding, \u201cIt is chilling, and it should not happen in America.\u201d<\/p>\n<\/div>\n<\/div>\n<div class=\"css-15q4zdw epkadsg3\">\n<div class=\"css-15g2oxy epkadsg2\">Ms. Sauer stressed that several things, including more hospital beds and equipment, could reduce the need to make such decisions. \u201cThis country has resources,\u201d she said.<\/div>\n<\/div>\n<div class=\"css-1fanzo5 StoryBodyCompanionColumn\">\n<div class=\"css-53u6y8\">\n<p class=\"css-exrw3m evys1bk0\">The state has been urgently seeking ventilators for patients and <a class=\"css-1g7m0tk\" title=\"\" href=\"https:\/\/www.nytimes.com\/2020\/03\/19\/health\/coronavirus-masks-shortage.html\">protective masks for health care workers<\/a>, including from the Strategic National Stockpile, a repository of critical medical supplies for public health emergencies. Officials have also been looking to have the U.S. Navy hospital ship Mercy, which has <a class=\"css-1g7m0tk\" title=\"\" href=\"http:\/\/www.mercy.navy.mil\/FACTS.html\" target=\"_blank\" rel=\"noopener noreferrer\">80 intensive care beds<\/a>, dock near Seattle to handle seriously ill patients other than those who have contracted Covid-19, the disease caused by the virus.<\/p>\n<div id=\"NYT_MID_MAIN_CONTENT_REGION\" class=\"css-9tf9ac\">\n<section id=\"styln-covid-updates-world\" class=\"css-l08pwh interactive-content interactive-size-medium\">\n<div class=\"css-17ih8de interactive-body\">\n<div id=\"styln-briefing-block\">\n<h1 class=\"briefing-block-header\">Latest Updates: Coronavirus Outbreak<\/h1>\n<ul>\n<li class=\"briefing-block-bullet\"><a class=\"briefing-block-link\" href=\"https:\/\/www.nytimes.com\/2020\/03\/20\/world\/coronavirus-news-usa-world.html?action=click&amp;pgtype=Article&amp;state=default&amp;module=styln-coronavirus-world&amp;variant=show&amp;region=MID_MAIN_CONTENT&amp;context=storyline_updates_world#link-3b434224\">Soon more than 1 in 5 Americans will be under orders to stay mostly indoors.<\/a><\/li>\n<li class=\"briefing-block-bullet\"><a class=\"briefing-block-link\" href=\"https:\/\/www.nytimes.com\/2020\/03\/20\/world\/coronavirus-news-usa-world.html?action=click&amp;pgtype=Article&amp;state=default&amp;module=styln-coronavirus-world&amp;variant=show&amp;region=MID_MAIN_CONTENT&amp;context=storyline_updates_world#link-4871a1a4\">The Senate is discussing a deal for a $1 trillion rescue plan.<\/a><\/li>\n<li class=\"briefing-block-bullet\"><a class=\"briefing-block-link\" href=\"https:\/\/www.nytimes.com\/2020\/03\/20\/world\/coronavirus-news-usa-world.html?action=click&amp;pgtype=Article&amp;state=default&amp;module=styln-coronavirus-world&amp;variant=show&amp;region=MID_MAIN_CONTENT&amp;context=storyline_updates_world#link-4061c1c0\">One of Vice President Mike Pence\u2019s staff members has tested positive.<\/a><\/li>\n<\/ul>\n<div class=\"briefing-block-footer\">\n<div>In the meantime, officials in King County have begun building a field hospital on a soccer field north of Seattle. One large hospital system based in the area has started making masks and face shields by hand. Hospitals have already <a class=\"css-1g7m0tk\" title=\"\" href=\"https:\/\/www.nytimes.com\/2020\/03\/14\/us\/coronavirus-covid-surgeries-canceled.html\">postponed elective surgeries<\/a> to preserve resources.<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/section>\n<\/div>\n<p class=\"css-exrw3m evys1bk0\">Dr. Chris Spitters, the interim health officer for the Snohomish Health District, where the nation\u2019s first coronavirus case was diagnosed, was part of the group that discussed the rationing proposals this week. He said that while the crisis strategies were not something anyone wants to anticipate, it would be worse not to be ready in the event they were needed.<\/p>\n<p class=\"css-exrw3m evys1bk0\">\u201cI would love to learn a month from now that the social distancing measures we adopted did indeed curb the outbreak enough to avoid going into that crisis zone of activity,\u201d Dr. Spitters said. \u201cBut that would be poor planning \u2014 to simply hope.\u201d<\/p>\n<p class=\"css-exrw3m evys1bk0\"><picture><source srcset=\"https:\/\/static01.nyt.com\/images\/2020\/03\/19\/us\/20virus-ration2\/merlin_170750184_8dd5bc6c-fc8c-405e-8090-0eb9056a6048-mobileMasterAt3x.jpg?quality=75&amp;auto=webp&amp;disable=upscale&amp;width=600\" media=\"(max-width: 599px) and (min-device-pixel-ratio: 3),(max-width: 599px) and (-webkit-min-device-pixel-ratio: 3),(max-width: 599px) and (min-resolution: 3dppx),(max-width: 599px) and (min-resolution: 288dpi)\" \/><source srcset=\"https:\/\/static01.nyt.com\/images\/2020\/03\/19\/us\/20virus-ration2\/merlin_170750184_8dd5bc6c-fc8c-405e-8090-0eb9056a6048-mobileMasterAt3x.jpg?quality=75&amp;auto=webp&amp;disable=upscale&amp;width=1200\" media=\"(max-width: 599px) and (min-device-pixel-ratio: 2),(max-width: 599px) and (-webkit-min-device-pixel-ratio: 2),(max-width: 599px) and (min-resolution: 2dppx),(max-width: 599px) and (min-resolution: 192dpi)\" \/><source srcset=\"https:\/\/static01.nyt.com\/images\/2020\/03\/19\/us\/20virus-ration2\/merlin_170750184_8dd5bc6c-fc8c-405e-8090-0eb9056a6048-mobileMasterAt3x.jpg?quality=75&amp;auto=webp&amp;disable=upscale&amp;width=1800\" media=\"(max-width: 599px) and (min-device-pixel-ratio: 1),(max-width: 599px) and (-webkit-min-device-pixel-ratio: 1),(max-width: 599px) and (min-resolution: 1dppx),(max-width: 599px) and (min-resolution: 96dpi)\" \/><img decoding=\"async\" class=\"css-1m50asq\" src=\"https:\/\/static01.nyt.com\/images\/2020\/03\/19\/us\/20virus-ration2\/merlin_170750184_8dd5bc6c-fc8c-405e-8090-0eb9056a6048-articleLarge.jpg?quality=75&amp;auto=webp&amp;disable=upscale\" sizes=\"((min-width: 600px) and (max-width: 1004px)) 84vw, (min-width: 1005px) 60vw, 100vw\" srcset=\"https:\/\/static01.nyt.com\/images\/2020\/03\/19\/us\/20virus-ration2\/merlin_170750184_8dd5bc6c-fc8c-405e-8090-0eb9056a6048-articleLarge.jpg?quality=90&amp;auto=webp 600w, https:\/\/static01.nyt.com\/images\/2020\/03\/19\/us\/20virus-ration2\/merlin_170750184_8dd5bc6c-fc8c-405e-8090-0eb9056a6048-jumbo.jpg?quality=90&amp;auto=webp 1024w, https:\/\/static01.nyt.com\/images\/2020\/03\/19\/us\/20virus-ration2\/merlin_170750184_8dd5bc6c-fc8c-405e-8090-0eb9056a6048-superJumbo.jpg?quality=90&amp;auto=webp 2048w\" alt=\"A temporary 200-bed field hospital is being built on a soccer field in Shoreline, Wash., in preparation for a growth in coronavirus patients in the King County area.\" \/><\/picture><\/p>\n<\/div>\n<\/div>\n<div class=\"css-79elbk\" data-testid=\"photoviewer-wrapper\">\n<div class=\"css-1a48zt4 ehw59r15\" data-testid=\"photoviewer-children\">\n<figure class=\"css-jcw7oy e1g7ppur0\"><figcaption class=\"css-1l44abu e1xdpqjp0\"><span style=\"font-size: 8pt;\"><span class=\"css-16f3y1r e13ogyst0\">A temporary 200-bed field hospital is being built on a soccer field in Shoreline, Wash., in preparation for a growth in coronavirus patients in the King County area.<\/span><span class=\"css-cnj6d5 e1z0qqy90\"><span class=\"css-1ly73wi e1tej78p0\">Credit&#8230;<\/span>Grant Hindsley for The New York Times<\/span><\/span><\/figcaption><\/figure>\n<\/div>\n<\/div>\n<div class=\"css-1fanzo5 StoryBodyCompanionColumn\">\n<div class=\"css-53u6y8\">\n<p class=\"css-exrw3m evys1bk0\">Dr. Spitters said hospitals are also strategizing how to repurpose space, staff members and resources to help deal with an expected surge in patients.<\/p>\n<p class=\"css-exrw3m evys1bk0\">Those involved in the discussions said the goal for developing criteria for prioritizing care is to provide fair and evenly applied practices across the region and eliminate the possibility that the care a patient receives might depend on which hospital he or she goes to. They said they also hope to avoid placing the responsibility and anguish of denying lifesaving aid on any individual doctor or nurse.<\/p>\n<p class=\"css-exrw3m evys1bk0\">\u201cThey look at the criteria \u2014 in this case it would likely be age and underlying disease conditions \u2014 and then determine that this person, though this person has a chance of survival with a ventilator, does not get one,\u201d Ms. Sauer said.<\/p>\n<p class=\"css-exrw3m evys1bk0\">\u201cThis is a shift to caring for the population, where you look at the whole population of people who need care and make a determination about who is most likely to survive, and you provide care to them,\u201d she said. \u201cThose that have a less good chance of survival \u2014 but still have a chance \u2014 you do not provide care to them, which guarantees their death.\u201d<\/p>\n<p class=\"css-exrw3m evys1bk0\">In Washington State, the crisis care planning is being led by the Northwest Healthcare Response Network, a coalition of hospitals assembled to handle disaster response, in conjunction with the Washington State Department of Health.<\/p>\n<p class=\"css-exrw3m evys1bk0\">The group pulls on expertise in many disciplines, including specialists in pulmonary care, emergency medicine, infectious diseases, pediatrics and medical ethics.<\/p>\n<p class=\"css-exrw3m evys1bk0\">\u201cNow we are getting down to the point of how you would deploy it, when would you deploy it, who needs to know about it,\u201d said Dr. Cameron Buck, president of the Washington chapter of the American College of Emergency Physicians.<\/p>\n<\/div>\n<\/div>\n<div class=\"css-1fanzo5 StoryBodyCompanionColumn\">\n<div class=\"css-53u6y8\">\n<p class=\"css-exrw3m evys1bk0\">\u201cIn my career, I can\u2019t think of any other example where we have come this far, and had to make these preparations and develop these frameworks in real time with a moderate probability of having to use this work,\u201d Dr. Buck said.<\/p>\n<p class=\"css-exrw3m evys1bk0\">Dr. Kathy Lofy, the state health officer, said the guidelines under discussion have come from a group of clinical experts who have in recent years worked on the issue of providing health care in challenging circumstances. \u201cWe are doing everything possible to slow the spread of the virus and increase resources within the health care system so that resources will be available for everyone who needs them,\u201d Dr. Lofy said in a statement.<\/p>\n<p class=\"css-exrw3m evys1bk0\">Roughly 280 people were on Wednesday\u2019s three-hour conference call, including the chief medical officials and nursing representatives for most of the state\u2019s hospitals and hospital systems, Ms. Sauer said. There was an overwhelming sense of shock, she said, as clinicians realized that the time to begin discussing such dire plans had arrived.<\/p>\n<p class=\"css-exrw3m evys1bk0\">\u201cIt just takes a lot of time for people whose lives are about saving lives to process that they may have to make these decisions,\u201d she said.<\/p>\n<p class=\"css-exrw3m evys1bk0\">Hospitals in the greater Seattle region already have been working to distribute patients evenly so no single hospital truly reaches its capacity. Seattle Children\u2019s Hospital has taken pediatric patients from other facilities and begun admitting people up to 21 years old to free up more beds in adult hospitals.<\/p>\n<\/div>\n<\/div>\n<div class=\"css-1fanzo5 StoryBodyCompanionColumn\">\n<div class=\"css-53u6y8\">\n<p class=\"css-exrw3m evys1bk0\">Teams from regional health departments and hospitals would be responsible for triaging patients and potentially making these decisions, and the crisis-based decision-making criteria could be turned off and on as the situation evolved, Dr. Buck said.<\/p>\n<p class=\"css-exrw3m evys1bk0\">The group plans additional calls twice a week, to get updates on the capacity challenges and to share proposed changes to the criteria that are still under consideration.<\/p>\n<p class=\"css-exrw3m evys1bk0\">Dr. Buck said <a class=\"css-1g7m0tk\" title=\"\" href=\"https:\/\/www.nytimes.com\/2020\/03\/11\/world\/europe\/italy-coronavirus.html\">the health care rationing<\/a> that occurred recently in Italy in response to the coronavirus outbreak weighed heavily on doctors as they discussed how their own work might have to proceed. \u201cThis is something that is obviously very serious and that we take very seriously.\u201d<\/p>\n<\/div>\n<\/div>\n<\/section>\n<div class=\"bottom-of-article\">\n<div class=\"css-1jp38cr\">\n<div class=\"css-19hdyf3 e1e7j8ap0\">\n<div>\n<p><em>Karen Weise is a technology correspondent based in Seattle, covering Amazon, Microsoft, and the region&#8217;s tech scene. Before joining The Times in 2018, she worked for Bloomberg Businessweek and Bloomberg News, as well as ProPublica.<\/em><\/p>\n<p><a href=\"https:\/\/www.nytimes.com\/2020\/03\/20\/us\/coronavirus-in-seattle-washington-state.html?action=click&amp;module=Top%20Stories&amp;pgtype=Homepage\">The New York Times<\/a><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>By Karen Weise and Mike Baker, March 20, 2020 Fearing a critical shortage of lifesaving resources as the coronavirus spreads, Washington State is engaged in grim discussions to determine which dying patients would get priority. SEATTLE \u2014 Medical leaders in Washington State, which has the highest number of coronavirus deaths in the country, have quietly [&hellip;]<\/p>\n","protected":false},"author":1001004,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[53],"tags":[],"_links":{"self":[{"href":"https:\/\/worldcampaign.net\/index.php?rest_route=\/wp\/v2\/posts\/9469"}],"collection":[{"href":"https:\/\/worldcampaign.net\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/worldcampaign.net\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/worldcampaign.net\/index.php?rest_route=\/wp\/v2\/users\/1001004"}],"replies":[{"embeddable":true,"href":"https:\/\/worldcampaign.net\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=9469"}],"version-history":[{"count":3,"href":"https:\/\/worldcampaign.net\/index.php?rest_route=\/wp\/v2\/posts\/9469\/revisions"}],"predecessor-version":[{"id":9485,"href":"https:\/\/worldcampaign.net\/index.php?rest_route=\/wp\/v2\/posts\/9469\/revisions\/9485"}],"wp:attachment":[{"href":"https:\/\/worldcampaign.net\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=9469"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/worldcampaign.net\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=9469"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/worldcampaign.net\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=9469"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}