1021 The existential question regarding COVID 19
Corona Virus Disease. Co Vi D for short, and it originated in 2019 … COVID 19.
How far will it spread, how quickly, will I contract it and would I survive?
That is the Sixtyfourthousand-Dollar-Question (wikipedia).
I have gone ahead and dealt with the question in the most personal way possible. When - if - the time comes to decide whether I shall be given an ICU hospital bed and a ventilator ... but there are not enough to go 'round, then - as a 73 year old and a diabetic - I pledge to voluntarily relinquish my spot for a younger, more healthy patient with a greater chance of survival. There, I've said it.
In the article below the philosopher Peter Singer talks about the ethical questions surrounding the fight against the spread of the virus.
Ethical decisions about who lives and who dies may not be hypothetical
You are the director of the intensive care unit in a major Australian hospital. Every bed in your ICU is occupied, and every ventilator you can get your hands on is keeping alive a patient who would otherwise be dead. You get a call from the emergency room downstairs. A 40-year-old woman is critically ill, and likely to die unless you admit her. One of your ICU patients is over 80, and others have medical conditions that, with the best care you can give them, still leave them with a life-expectancy of less than five years.
What do you do?
Italy currently has over 40,000 confirmed cases of the novel coronavirus known as COVID-19. More than 3000 have died. That is, in proportion to the size of Italy’s population, 10x as many cases and almost 20x as many deaths as China.
There are not enough ICU beds and ventilators in Italy to cope with the number of patients who need them. The theoretical case above has become agonisingly real.
In normal times, the rule of allocation of ICU beds is “first come, first served”. Patients already admitted to an ICU will be allowed to stay as long as they are receiving treatment that benefits them.
In Italy, a working group of doctors from the Italian Society of Anaesthesia, Analgesia, Resuscitation, and Intensive Care has recommended that in the exceptional circumstances the country is facing, this rule should be suspended.
To that end, they start with the suggestion of placing an age limit on admission to the ICU, in order to admit those who have the greatest chance of survival and are likely to have the most years of life ahead of them.
Not only age, but also the broader health status of the prospective patient is relevant, the doctors say. Patients who are elderly, frail, or have other health problems in addition to the virus may occupy an ICU bed for a much longer time than younger and healthier patients.
Even if the more vulnerable patients survive, the time they spent on the ventilator may have come at the cost of not using this scarce resource to save the lives of two, three or even more younger, healthier patients.
In an extreme shortage of resources, the working group says, this may mean moving out of the ICU patients who are not responding well in order to make room for others for whom there is hope of a better response.