A few weeks ago, I met several friends from my MBA in Health Administration program for brunch. We have stayed close since graduating and talk regularly. It took only a few minutes before we were engaged in a conversation about unvaccinated patients, rationing of care and ethical issues.
Should unvaccinated COVID-19 patients be placed at the back of the line to receive care?
At this point it is evident that unvaccinated individuals have made a choice to forgo getting the shot. Mass vaccination sites shuttered in June due to a decline in demand and walk-in appointments are available at local pharmacies like Walgreens. Eighteen months into the pandemic, and nearly a year since vaccinations became available, nobody outside the scientific community — not even Nikki Minaj — is still “doing their research.”
People have chosen; they are vaccinated or unvaccinated. The percentages will not change significantly absent extrinsic forces such as employer mandates.
That leads to the next series of questions health care providers have been quietly discussing for months. Specifically, more and more health care providers have been forced to ration care.
Of course, hospitals have effectively been rationing on some level since the pandemic began. Canceling elective surgeries, postponing treatments for non-emergent illness, retrofitting normal patient rooms as makeshift ICUs. Each is an example of choosing to provide care to one patient, or category of patients, over another.
At the beginning of the pandemic, it made sense. We had no vaccines and knew little about COVID-19 aside from the danger it posed.
Now the same decisions lead to angst and dismay and frustration. Health care providers and patients alike bristle as shooting victims, people suffering strokes and cancer patients are turned away from hospitals filled with unvaccinated COVID-19 patients. Resources normally reserved for those patients have been absorbed by people who fell ill after failing to protect themselves.
This is happening across the country. Inundated with COVID-19 patients, states such as Alaska, Idaho and Montana have activated official “crisis standards of care.” Generally, those standards have predetermined guidance for health care providers choosing how to allocate scarce resources. Acting as a mass triage system, the standards force health care workers to score patients based on objective health conditions and determine which will benefit the most.
Frequently, those calculations end with the number of quality-adjusted years of life (QAYL) saved. Whoever has the most gets the care.
While the rationing and crisis standards of care do not specifically exclude unvaccinated patients, to the consternation of many, they will likely see their own QAYL scores reduced and naturally fall behind other patients. Not only are unvaccinated individuals 29 times as likely to be hospitalized, but they suffer statistically more severe symptoms. In fact, they are 11 times more likely to die.
That is precisely the type of objective data that will used when deciding who will be treated with the last ventilator or placed in an ICU bed or even admitted in the first place.
As colder weather drives people inside, including in Colorado, the likelihood of increased levels of infection is significant. Combined with significant staffing shortages — a problem so dire that it may make available beds a moot point — such a spike could lead to emergency scenarios in a matter of weeks.
For example, as one of my friends pointed out, it was only a few weeks ago that nine Denver metro hospitals were diverting admissions to other providers. Any substantial uptick in infection rates could overwhelm such a weakened system in short order.
Colorado has avoided official crisis standards of care and rationing to date. Our people have generally taken the necessary precautions to protect ourselves and our neighbors. More than 70% are fully immunized and another 6% have received at least one shot.
With a little luck and continued vigilance, we can hopefully avoid ever choosing between who gets care and who does not.
Mario Nicolais is an attorney and columnist who writes on law enforcement, the legal system, health care and public policy. Follow him on Twitter: @MarioNicolaiEsq
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