This could not get much worse.

Courtesy of WaPo:

Hospitals on the front lines of the pandemic are engaged in a heated private debate over a calculation few have encountered in their lifetimes — how to weigh the “save at all costs” approach to resuscitating a dying patient against the real danger of exposing doctors and nurses to the contagion of coronavirus.

The conversations are driven by the realization that the risk to staff amid dwindling stores of protective equipment — such as masks, gowns and gloves — may be too great to justify the conventional response when a patient “codes,” and their heart or breathing stops.

Northwestern Memorial Hospital in Chicago has been discussing a do-not-resuscitate policy for infected patients, regardless of the wishes of the patient or their family members — a wrenching decision to prioritize the lives of the many over the one.

Richard Wunderink, one of Northwestern’s intensive-care medical directors, said hospital administrators would have to ask Illinois Gov. J.B. Pritzker for help in clarifying state law and whether it permits the policy shift.

“It’s a major concern for everyone,” he said. “This is something about which we have had lots of communication with families, and I think they are very aware of the grave circumstances.”

Officials at George Washington University Hospital in the District say they have had similar conversations, but for now will continue to resuscitate covid-19 patients using modified procedures, such as putting plastic sheeting over the patient to create a barrier. The University of Washington Medical Center in Seattle, one of the country’s major hot spots for infections, is dealing with the problem by severely limiting the number of responders to a contagious patient in cardiac or respiratory arrest.

Several large hospital systems — Atrium Health in the Carolinas, Geisinger in Pennsylvania and regional Kaiser Permanente networks — are looking at guidelines that would allow doctors to override the wishes of the coronavirus patient or family members on a case-by-case basis due to the risk to doctors and nurses, or a shortage of protective equipment, say ethicists and doctors involved in those conversations. But they would stop short of imposing a do-not-resuscitate order on every coronavirus patient. The companies declined to comment.

That may sound harsh, and it is, but it is in response to hospitals being overwhelmed by patients suffering from covid-19.

Here was a report from the New York Times about a hospital in Elmhurst:

In several hours on Tuesday, Dr. Ashley Bray performed chest compressions at Elmhurst Hospital Center on a woman in her 80s, a man in his 60s and a 38-year-old who reminded the doctor of her fiancé. All had tested positive for the coronavirus and had gone into cardiac arrest. All eventually died.

Elmhurst, a 545-bed public hospital in Queens, has begun transferring patients not suffering from coronavirus to other hospitals as it moves toward becoming dedicated entirely to the outbreak. Doctors and nurses have struggled to make do with a few dozen ventilators. Calls over a loudspeaker of “Team 700,” the code for when a patient is on the verge of death, come several times a shift. Some have died inside the emergency room while waiting for a bed.

A refrigerated truck has been stationed outside to hold the bodies of the dead. Over the past 24 hours, New York City’s public hospital system said in a statement, 13 people at Elmhurst had died.

“It’s apocalyptic,” said Dr. Bray, 27, a general medicine resident at the hospital.

We were warned this would happen and now it is.

In the meantime this is how the Trump Administration is responding to the challenge.

Courtesy of CNN:

The Trump administration is appealing to countries around the world to give or sell the US items as basic as hand sanitizer and as complex as respirators to combat the surging coronavirus pandemic.

In a list obtained by CNN, the State Department lays out 25 items, telling diplomats to ask their host countries for these supplies with a clear priority on items available “today” and a secondary focus on equipment and items available in weeks.

The requests come as President Donald Trump touts his domestic response and declines to deploy the full power of the federal government’s Defense Production Act to produce and funnel crucial supplies to struggling states and hospitals. It’s not clear how many countries the US has appealed to.

The list spans the gamut of equipment that overburdened American hospitals are seeking. The simpler items include biohazard bags, N-95 masks, gloves, gowns, surgical caps, shoe covers, sharps containers, protective eyewear, hand sanitizer and Tyvek suits.

The more complex items on the list include metered dose inhalers, ventilators, elastomeric respirators and powered air purifying respirators.

The Trump Administration should have been prepared for this.

After all this is America. 

The fact that they were not is a failure of leadership plain and simple.