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Rationing medical care becomes a reality in hospitals overwhelmed with covid patients

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Kristen Solana Walkinshaw, a physician on the coronavirus triage committee at Providence Alaska Medical Center in Anchorage, found her team last weekend making one of the most agonizing decisions of their careers. With the delta variant surging, the hospital was overwhelmed, and the doctor-on-call had paged the group for guidance.

Four patients needed continuous kidney dialysis, her colleague explained, but only two machines could be made available. How should I choose?

“This is the worst it’s been for us,” Solana Walkinshaw said, and “it’s not over.”

Rationing medical care, one of the most feared scenarios of the pandemic, is becoming a reality in a few parts of the United States as coronavirus infections remain at surge levels.

On Thursday, Idaho officials announced the state was taking the extraordinary step of activating crisis standards of care statewide, giving hospitals the power to allocate — and potentially even deny — care based on the goal of who could benefit the most when faced with a shortage of resources such as ventilators, medications or staff. The decision will affect both covid and non-covid patients in a health-care system that is fraying. ...

The threat of rationing has been ever-present during the pandemic, with individual hospitals and Arizona and New Mexico declaring crisis standards for short periods in 2020. But perhaps because of the natural ebb and flow of infectious disease, the fact that shutdowns meant that less trauma and other non-covid care was needed, or thanks to creative redistribution of resources by health officials, the need to ration has been rare.

The latest wave may be different.

The outbreaks are more dispersed, affecting many parts of the country at the same time. Hospital officials say a high number of nurses and other medical staffers, exhausted from 1½ years of stress, have quit and are unwilling to come back. That has made staffing, even more so than equipment in some cases, a barrier to care. ....

 

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