All over the world, hospitals and physicians have generally agreed that both Covid and non-Covid patients should apply the same principles of triage, that care should not be achieved in the first place ( by differences in accessibility) and that the main metric should get the largest number of people out of the hospital alive. Sometimes cultural values come into play about whether a more subtle prognosis needs to be taken into account: quality of life, years lived, or, for example, which person is somehow more valuable, even if that were calculable. . (And triage isn’t the only way to divide vaccinated and unvaccinated people; the fact that private insurers are pushing ahead with the payment of Covid care seems like a pretty good repudiation of the idea of giving up shots).
One thing that ethics and clinicians have repeated over and over again is to avoid “categorical exclusion criteria,” attributes that make someone come out of the triage. For example, before the widespread availability of vaccines, elderly Covid patients died at a much higher rate than younger ones. But no one wanted to exclude the elderly from treatment, right? It would be monstrous. Or, as a Swiss ethics team argued last spring, you can distinguish between “first-order criteria,” such as demographics, and “second-order criteria,” more subtle things that would only come into play in a tiebreaker: two patients, equally in all possible ways, similar prognoses, similar diagnoses. But deciding what differences need to be taken into account a lot difficult. If it is a state of health, how do you assess it? How can socioeconomic status influence the forecast and can you explain it fairly? What floated the Texas ethics and working group is essentially whether the state of vaccination could be a second-order exclusion criterion, although, to be clear, one of the main points of the working group is that the state of vaccination could not, in itself, be a criterion of categorical exclusion.
In part, this is because the whole idea includes a warning the size of Texas. Yes, far fewer vaccinated people get seriously ill. But no one knows if he is seriously ill vaccinated people have better outcomes (more survival) than the seriously ill without vaccination people. It seems likely that once you are sick enough to be in the hospital, you are sick enough to be in the hospital. But as far as I know, this published data does not exist. “Personally I have this sense from the data I’ve seen, but it’s very preliminary data. There is no peer-reviewed study to prove it, “says Fine.” So you have to be careful. “
Carefully, in fact. A big part of the foundation of triage guidelines is consistency, so doctors don’t have to rely on their intuitions. “Covid has taught us a lot, but there are certainly a lot of implicit biases within the healthcare system and certainly with Covid’s results,” says Lo. “And we want to not make that worse.”
Furthermore, no matter how much we all understand and empathize with the anger and frustration of health care workers — emotionally drained, at epidemiological risk — any guilt we might cause could be misdirected. “We know people are frustrated and angry, but that’s not a basis for decision making,” Fine says.
The state of vaccination, as Fine points out, is more complicated than anger might allow. “I think we have to be very careful when we say that someone chose not to get vaccinated. There are people who do, ”says Lo. “But there are still people who have difficulty making an appointment, who do not know the Internet and who do not speak English as a first language. Many people work in jobs where they do not have free time, or if they receive even one day of adverse effects from the vaccine and cannot work, their salary goes up ”. And how would you distinguish between these groups a clinician who tries to choose according to the state of vaccination, even if they were allowed to?
However, even people who resist vaccination because they think they will never get sick, or that if they do, a drug to deworm horses will save them or that the vaccines contain 5G magnetized antennas through which Bill Gates can turn them into werewolves (They don’t, none of these things are things!): Trusted leaders have lied to these people. Bad information is cheap; better information is expensive. And, no matter how ugly Covid’s figures are growing in the south, anger could be better directed at political leaders who resist basic public health measures rather than the people who suffer from them.
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