If hospitals in Washington state become overwhelmed, who gets life-saving care?

We're in the first week of Governor Jay Inslee’s order for everyone in Washington to stay at home unless it's essential to venture out. The goal is to flatten the curve of coronavirus infections and prevent a surge of patients from overwhelming our hospitals.

If our hospitals do become overwhelmed with critical care patients, and there's a lack of resources, like ventilators, who will receive full, life-saving care and who won't?

Washington's Department of Health and hospital officials have been making plans for this worst-case scenario. Cassie Sauer is CEO of the Washington State Hospital Association. She told me about the triage plans and why they're being drawn up now.

The purpose of the plan is to make sure that no individual doctor or hospital has to make heart-wrenching decisions and that decisions are fair and well thought out.

It's very challenging work, but the goal is that we provide the best treatment possible to the most people possible with the best chance of survival.

I understand this plan will lay out who would be prioritized for care, if it turns out that there are not enough resources for everyone. Can you explain what some of the factors are that would play into it?

I think in any crisis standard, what you look at it is who's got the most chance of survival. There might be different crisis standards for different events.

If there were, for example, a radioactive bomb that were set off, you might treat people that had milder radioactivity exposure than those who had greater exposure who would be more likely to die.

In this case, we look at what is the epidemiology showing about this disease, and it's showing that people who are older and people who have underlying healthcare conditions are more likely to not succeed well in treatment and so that's probably how that triage would run.

If there are a limited number of ventilators, for example, patients with the best chance of survival long term would be more likely to get that ventilator?

That's correct.

Are you laying out in fairly stark terms how that triaging is going to happen just so physicians don't have to try to make that decision on their own?

We have not yet completed the work. And I want to be clear, this is collaborative work across many organizations, including the state. What we are doing now is talking to physicians and clinicians about this is a choice we might have to make.

It's totally unusual for physicians to be thinking about care in this way. It just doesn't happen in America. We treat everyone who needs emergency care. I think they look around our country and see that it's 2020, it's America, we are a resource rich country, and it's absolutely baffling.

As you collaborate with people in this planning, how have the physicians involved, how have they reacted?

I think they agree with us that they would like to make sure we have the resources so we don't have to get to this point. Again, we don't know what the trajectory of this disease is and how many people might get it or how many people might need hospital care. But they, I think, appreciate that it's a thoughtful process that's based on evidence and that everyone would be doing the same things.

This is when the entire region is overwhelmed with patients, maybe even the whole state. But in our state, it would probably be at least half the state would have to be overwhelmed. Because the first things you do are to start moving patients around the hospitals in the region that are less overwhelmed than others.

What do Washington hospitals need right now to ensure that this kind of rationing doesn't have to happen?

The first thing we need is more personal protective equipment to protect our staff, so our staff don't get sick and can continue to provide care for patients. We need more testing supplies so we can know who is positive and make sure we can isolate them well.

We need more ventilators to be able to provide ventilator support to patients who need that care. And we need more space, so we've been asking, for example, the military field hospitals to come here.

Can you rank the biggest challenge hospitals are facing right now to actually get the equipment and the resources that they need?

We are dangerously low on masks, face shields, gowns. Masks and facials are the two biggest right now and we're getting those would be a huge help because it would make sure the staff is kept safe and can continue to care for patients.

What are the obstacles to getting them right now?

Some exist in a strategic national stockpile that we would like to have released. A huge obstacle is that they're largely manufactured in China. China, understandably, is keeping a huge portion of the supply for itself because they needed to deal with their own outbreak.

We need to move a lot faster on this defense production act to retool American factories to produce these masks on our own. The public hoarded these masks. People are hearing about coronavirus, and a lot of people bought masks that they don't really need at home.

In our state, a lot of hospitals are running social media drives to have the public donate back those masks to their local hospitals. We're also looking at other industries that have this equipment like construction companies, for example, or computer companies, dentists. They might be using them, but would they be willing to surplus them in order to save lives? We're asking those industries to turn them over to hospitals.

This is a tough topic for people to think about right now. You're someone who is intimately involved with planning for these worse and worse scenarios. What is the main thing that you want people to know right now?

I think for the public to know right now is that social distancing really matters. I see people taking it not so seriously and thinking, oh, I can just see a couple of friends. But if you see a couple of friends and then those couple of friends see a couple of friends, and one of you is infected, the multiplying effect is massive.

That's when the healthcare system could get overwhelmed, if we end up with many more people a real surge in patients. People need to stay home and stay healthy, especially if they feel sick.

For you personally, when you were starting to work through these plans and launch this whole collaboration with people across the state for these worst-case scenarios facing our hospitals, what did you think when you realized, this is real life this, this is not an exercise?

This is why I felt really strongly about talking about it. I want the public to know this is a possibility. The reason I want the public to know this is a possibility is I want them to take social distancing incredibly seriously, and I want them to be calling on the federal government for the resources we need to not have this happen.

I believe we have a moral duty to do everything in our power to make sure this doesn't happen, and I think the public and the government has a huge role to play. And if we don't talk about it, people won't know when you

When you say you want the public to call on the federal government, what exactly do you mean?

I would like the public to be calling the White House, especially in our state, and saying: ‘Let's get to work really manufacturing these materials. Let's get to work collecting back the materials that the public has. Let's think about how can we retool our factories to make more ventilators. Let's get the military deployed. You know, take this very seriously, get the resources out.’ This is really serious. It's like war. We need to act like we're at war.

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