Would it be fair to treat vaccinated Covid patients first?

Would it be fair to treat vaccinated Covid patients first?

Across the world, hospitals and doctors have broadly agreed that both Covid patients and non-Covid patients should apply the same triage principles, that care should not be first-come, first-served (due to differences in accessibility), and that The main measure is to get as many people as possible to leave the hospital alive. Cultural values ​​sometimes come into play as to whether a more accurate diagnosis should be considered: quality of life, years of living, or, like, someone more valuable in some way, if even that is possible. (And screening isn’t the only way to divide vaccinated and unvaccinated people; the fact that private insurance companies are backing away from paying for Covid care sounds like a good rejection of the idea of ​​giving up shots.)

Ethicists and clinicians have gone back to one thing over and over again and that is to avoid “categorical exclusion criteria,” traits that get someone out of the screening process. For example, before vaccines were widely available, older Covid patients died at a much higher rate than younger patients. But no one wants to exclude the elderly from treatment, right? That would be awful. Or, as a team of Swiss ethicists argued last spring, you can distinguish between “first-order criteria,” like demographics, and “second-order criteria,” which are more subtle things that only play into the tiebreaker—two patients, equally, In every possible way, similar speculations, similar diagnoses. But identify the differences to consider very cheater. If the state of health, how do you assess it? How might socioeconomic status affect prognosis, and can you explain this fairly? What the ethicists and the Texas task force have been asking, essentially, is whether a vaccination status might be a Class II exclusion criterion—although one of the task force’s main points is that a vaccination status cannot itself be a definitive exclusion criterion.

Partly because the whole idea comes with a caveat about the size of Texas. Yes, far fewer people who have been vaccinated are getting seriously ill. But no one knows if he is seriously ill to feed People have better outcomes – more survival – from severe disease not immune Persons. 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 can tell, there is no such published data. “Personally, I have this sense of the data I’ve seen, but this is very preliminary data. No peer-reviewed study demonstrates this,” says Fine. “So one has to be careful.”

Really warned. A big part of the rationale for triage guidelines is consistency, so individual clinicians don’t have to rely on their intuition. “Covid has taught us a lot of things, but certainly there is a lot of implicit bias within the health care system, certainly with Covid outcomes,” Lu says. “And we don’t want to make that worse.”

Additionally, as much as we may all understand and sympathize with the anger and frustration of health care workers — emotionally exhausted, vulnerable to pandemics — whatever blame we may lay can be misdirected. “We know people are frustrated and angry, but that’s not a basis for making a decision,” says Fine.

The case for vaccination, Fine notes, is more complex than anger might allow. “I think we have to be really careful when we say someone has chosen not to get vaccinated. But there are still people who find it difficult to make an appointment, who are not internet savvy, and they don’t speak English as their first language. A lot of people work in jobs they don’t get,” says Lu. If they are on leave, or if they experience one day of the negative effects of the vaccine and are unable to work, their salaries are reduced.” And how would a doctor trying to screen based on vaccination status distinguish between those groups, even if they were allowed to do so?

In this regard, even people who resist vaccination because they think they will never get sick, or that if they do, deworming medicine will save them, or that vaccines contain fifth-generation magnetic antennas with which Bill Gates can turn them into werewolves ( They don’t! None of those things!) – These people have been lied to by leaders they trust. Bad information is cheap. The best information is expensive. As ugly as the Covid numbers may be across the South, the anger may be better directed against political leaders resisting basic public health measures rather than the people who are suffering as a result.

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