• June 2, 2020

TEXAS VIEW: North Texas has a plan if hospitals become overwhelmed - Odessa American: Texas Opinion

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TEXAS VIEW: North Texas has a plan if hospitals become overwhelmed

THE POINT: Mass critical care could force very tough decisions, which is why we have to flatten the curve.

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Posted: Thursday, April 9, 2020 2:30 am

Mass critical care could force very tough decisions, which is why we have to flatten the curve.

It’s still possible that North Texas will be spared the worst as the pandemic unfolds around us. It is still possible that we’ll be able to flatten the curve, be able to keep the number of infections below the point where our emergency rooms and health care facilities can be overwhelmed. Officials across the region have imposed tough social restrictions, and millions of our people have made sacrifices to shelter at home, to eschew gathering with others in the hope of slowing the spread.

But there is also a chance that the virus spreads more quickly than all of our emergency preparations and that those who manage our health care system will be faced with the toughest choice imaginable: deciding which patients to prioritize while administering limited, if also critical, forms of care when the number of patients overwhelms our hospitals. For example, the need for ventilators — a crucial device for treating someone struggling to breathe — could end up outstripping the number of devices available.

The numbers here are stark. The estimates that our local leaders — including members of the Dallas County Commissioners Court as well as members of the North Texas Mass Critical Care Task Force — are working with include the estimate that approximately 80% of those with COVID-19 will experience “mild” symptoms. They will not need to be treated in a hospital. But of the 20% who do need hospital care, half will need to be in the intensive care unit. And half of the coronavirus patients in the ICU, it is estimated, may not survive, even if there is no shortage of medical equipment like ventilators.

Given that some projections show that there could be more patients who need ventilators than there are ventilators available, it is only prudent for community leaders to prepare now for making tough decisions about prioritizing care later. And leaders in North Texas are making such preparations. Every five years, officials review a mass critical care plan that enables the region to deal with such events as mass terrorist attacks or a global pandemic. Part of that plan offers guidelines for prioritizing patients when facilities are overwhelmed.

We’ve been briefed on that plan, and in broad strokes here is what it does: Rather than letting treatment decisions occur on an ad hoc basis or leaving it entirely to the discretion of whichever front-line doctors and nurses happen to be on duty, the plan calls for using a “SOFA” score. SOFA stands for sequential organ failure assessment. It’s a standard assessment widely used every day by health officials as they assess patients. The value of using that score to prioritize care when the system is overwhelmed is that it gives health care officials a good chance to save as many lives as possible. It also ensures that no decisions are made on race, income, gender, place of residence or even age or other inappropriate criteria.

Essentially, by using SOFA doctors can make informed decisions about where care is likely to make the greatest difference in saving someone’s life. And those decisions will be based on a patient’s ability to beat the virus with the help of the limited care available.

In our view, it is responsible for our local leadership to be making such preparations. It also prevents anyone from gaming the system to gain preferential treatment. And, it’s important to note, officials are reaching out to community leaders to ask for input and support in implementing these plans. But no one involved in any of this is pretending that if we reach such a point where we have to make such decisions that we’ll have any good options.

If there is a hopeful note to strike in all of this, it’s that we retain some power over what is coming. The question of whether our health care system is overwhelmed by a flood of coronavirus patients is partly dependent on what each of us does now and in the coming weeks. There is evidence from across the country that sheltering in place does flatten the curve; it does reduce the number of people who would have contracted the virus.

We have reached a critical moment in this fight. We can wish more was done earlier to enhance national stockpiles, ramp up testing abilities, or otherwise protect us from this virus. But right now, in the next few weeks, leadership is crucial. And, as in life, we must first lead ourselves. Residents of North Texas can flatten the curve. They can outflank the coronavirus, and if they do they will save those on the front lines from having to make decisions that no one wants them to have to make.

Odessa, TX

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