Re: DRAFT Guidelines on Ventilator Allocation from NYS DOH
I disagree with this basic premise of the draft plan.
"Health Care Workers and First Responders:
Participants debated with great concern the question of offering enhanced access to ventilators to health care providers, first responders, or other special groups. Many participants argued that patients should be assessed on medical factors only, regardless of their work role, for various reasons. First, health care workers sick enough to require ventilators are unlikely to regain health and return to service during the pandemic. The predicted period of recovery will be at a minimum several weeks; the worst phase of the pandemic will likely end before a stricken individual can return to work. Second, workers in many occupations risk exposure and provide crucial services in a pandemic. Doctors and nurses face risks, but so do respiratory therapists, orderlies who keep rooms clean, morgue workers, laundry workers, ambulance staff, security personnel, fire fighters, police and others. Nor is it always easy to determine who is and is not a health care worker. Part-time volunteers staff ambulances in some communities; an unpaid family member may serve as the full-time caregiver for a disabled relative. These unpaid providers take risks comparable to or greater than some paid health care providers. Expanding the category of privilege to include all the workers listed above may mean that only health care providers win access to ventilators in certain communities. All other community members, including all children, would be denied access; this plan was unacceptable to the workgroup. Participants also objected strongly to the appearance of favoritism, in which those who devised the rationing system appeared to reserve special access for themselves. Participants ultimately found that access to ventilators should depend on clinical factors only. Of note, the allocation of other scarce resources, such as vaccine or anti-viral medications, as well as personal protective equipment, may well favor health care providers based on differing ethical and clinical considerations."
Recovered health care and law enforcement personnel will be at least partially immunologically protected from other waves of pandemic influenza and will be able to help lessen morbidity and mortality for greater numbers of people. This group should be high on any rating/scoring system for ventilators. While they have priority for vaccines and anti-virals, this is a "moot" point. There will not be any vaccine distributed for at least the first 6 months of a pandemic. It is doubtful that there is enough supply for the prophylactic use of anti-virals, and furthermore, the safe dosage to be administered for 18 months is unknown. Add to this the dismal non-pharmaceutical protocol (PPE) situation in most hospitals, clinics, counties, etc. The picture that faces the HCW, law enforcement, and others tasked with the maintenance of societal order is not a pleasant one.
