Guidelines and Protocols for Prioritising COVID-19 Patients

Imagine that day when India has reached a situation when every ventilator and every ICU bed in the country is taken and only two beds are available in the army hospital in the ICU for admitting Coronavirus Disease 2019 (COVID-19) patients. Unfortunately, only one ventilator is available. God forbid, at that moment, the Prime Minister, the Defence Minister and the Leader of Opposition catch COVID-19 and all three need an ICU bed and a ventilator. What would be the protocol for allocating these resources (2-beds and one ventilator) among the three claimants?

This completely fictional and hypothetical scenario has been presented above purely for communicating the point which is being made. No ill-will or malaise is intended towards anyone caricatured in this picture.

COVID-19 is affecting 210 countries and territories around the world. With confirmed cases of COVID-19 in the world nearing two million and deaths from the disease already having surpassed a hundred thousand, a growing number of national and local medical authorities have begun issuing guidelines and protocols that call for hospitals to prioritise younger patients over those who are older.

The positive news about the cases of recovery heading towards half a million mark is getting lost on people because of the fear of death causing cognitive dissonance among people who filter out all positive news and let the feeling of fatality seep in.

There is no denying the fact that no medical and health care system in any country has the capacity of handling the sudden spike in numbers of patients which the likes of Italy and Spain have seen.  The scarcity of healthcare resources in India can be directly attributed to decades of mismanaged public healthcare system. While India is working overtime to ramp up the capacity, the growth of the current epidemic makes it likely that a point of imbalance between the clinical needs of patients with COVID-19 and the effective availability of intensive resources will be reached. Should it become impossible to provide all patients with intensive care services, it will be necessary to apply criteria for access to intensive treatment, which depends on the limited resources available.

COVID-19 does not discriminate among its victims in terms of their social or constitutional status. It did not spare even the British Prime Minister.

In Italy and Spain, the two countries most affected by COVID-19 in Europe, doctors in overwhelmed intensive care units have for weeks been making life or death decisions about who receives emergency treatment. The new protocols, however, amount to government directives that instruct medical personnel effectively to abandon elderly patients to their fate.

There are confidential protocols in Spain, now leaked, which effectively advises that elderly people afflicted by CONVID-19 should die at home. The document stated that dying at home was more humane as it avoids suffering: patients can die while surrounded by their families, something that is not possible in overcrowded hospitals. The protocol also advised medical personnel to avoid referring to the lack of hospital beds.

In Italy, a document prepared by a crisis management unit in the northern city of Turin also proposed that COVID-19 patients aged 80 or older or that in poor health should be denied access to intensive care if there are not enough hospital beds.

What is the best way to serve humanity? Aspects such as who has the greatest chance of surviving an admission to intensive care will come into play. It is up to the doctors to see who has the best chance of survival.

One must ask if the high rate of mortality among the elderly is a feature of COVID-19 or an outcome of discriminatory medical care provided to them. The large numbers of dead, especially among the elderly, appears to be the price that Indians would be paying just like the European countries.

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