ICU Nurse On Dealing With Latest Coronavirus Outbreak In Michigan


Care? And who doesn't joining me now is Dr Machida beer. She's a senior policy researcher. Rand and an emergency room doctor at the University of Michigan in Ann Arbor. Welcome. Thank you for having me. Well, it's great to have you. You're a doctor in Michigan. Detroit was Ah, hot spot early on in the spring. I know you're in Ann Arbor, which is about 45 minutes away from Detroit. But how are things looking in general in the Detroit area? Cases. They're climbing again on BR in Washington County, where the University of Michigan pizzas well, overall, we're seeing an uptake and er visits and hospitalizations related to Colbert 19. All right. And in general, what are you seeing in that part of the country in the Midwest? The test positivity rate in the region has gone up. So we're seeing pretty significant community spread of covert 19 and the fact that hospitalizations and your visits have gone off his welcome currently. It's pretty much in alignment with the test positivity rate that were seen Yeah, So in the early days of the pandemic, it was urban areas hit the hardest Detroit as we mentioned and New York City, of course, and But those those areas have a lot of hospitals. Now the disease is spreading too. Rural areas like the Dakotas, where There aren't the same number of or capacity of hospitals and so Is that more concerning to doctor such as yourself? Where did these patients go? Absolutely. This is such an important question. Uh, so, you know, correct Detroit in New York City and other urban centers. We have a lot of hospitals and health systems. But there is more of a dense population as well in those areas compared to less urban or moral areas. However, you know, no matter which area you're talking about. Hospitals have limited capacities. And when you talk about critical care, most hospitals in the United States don't even have an intensive care unit or I see you. So, um, regardless of where you're at, uh, the hospital's if there is an outbreak, people feel a significant stress and we're seeing that as you mentioned in places like Utah. On Illinois. Most hospitals don't have a nice to you. So what happens with critically acute patients? If you're in a bad state with Cove it? Where do these patients go? Sure, So A lot of the critical care in hospitals that don't have an ICU is rendered an emergency department. And a lot of the patients who need ice. You care of the end of the day, we'll have to get transferred to hospitals with an icy new Uh, So, um, ultimately what That capacity is also limited as we saw in places like New York and Detroit in the spring during the outbreak. You know, Critical care is a commodity in the United States. Critical care beds are limited critical care nurses. Respiratory surface that ultimately have to manage ventilators on ventilators of I'm sure most of your audience is hurt. Mm hmm. Okay, So that brings us to the question of rationing care. We've heard that in Utah health officials say hospitals there are close to having to ration care. Very, very close within days. What would that look like? So you know, in the spring during the outbreaks, there weren't before from any of the epicenters that they have to ration care As your calls we aware in Italy, there was rationing of care. Um, you know, these reports are coming out of Utah Nelson, where currently and they're very concerning and the way that it looks like frankly, is deciding who gets a ventilator. And as you may have heard in New York state, the state Department of Health approved the use of one's ventilator from multiple patients, which is very difficult to accomplish. A kind of planning for potentially having to make such decisions. So it will come down to very sick patients. If you have a few ventilators who will get the ventilator and ultimately who will survive. But it has you know much broader Rickel effect. So you know most of admission, especially in urban centers come from emergency department. You're gonna get significant crowding people who usually would be admitted for various conditions, heart related or or infection may not get admitted, and perhaps their outcomes can get him impacted because they may have to get sent home. And because there's not enough care and resource is to go around. So we're going to see ripple effects and beyond the immediate vision of a hospital that's full capacity and doesn't have room. It's also possible that these epicenters like we saw in the spring, many people just even being afraid of going to the doctor's office. Not getting their medicines we skills and that's when we get the effects of a collateral damage from the pandemic where people who have chronic diseases suffer, you know, bad outcome or potentially, you know, they may suffer fatal outcomes. Because he didn't get the medicine or the care that they needed. Mm. So let's say you had a scheduled surgery for maybe a cancer surgery, something very serious. But not immediately. Life threatening. Would you then be postponed? There. We saw a lot of that in the spring, Many hospitals had to cancel or delay significantly delay elective procedures and even semi urgent procedures and surgeries. On and we may see that again. Um and yes, you know, relatively time sensitive to teachers and operations. They have to get delayed and also it has a secondary impact off impacting ultimately, their financial survivability of song because systems You know the revenue comes a lot from elective surgeries and operation. So it has. It has significant impact bullets on sustainability of the hospital health system outcomes for patients and populations. Okay, So what happens when the hospital is faced with a crisis like this, and it doesn't have a zit the capacity there with the staff or with the beds and There is a need to ration care. Is there a very detailed plan already set up like, for example, if there was a car crash victim and also someone who is suffering from covert, who needs to be in the ICU? Would the plans say? Okay, you treat this person before you treat this other person. Not to that specificity the kind of emergency plans that hostiles typically has Basically, as you know, allows for altered standards of care, which essentially says, for example, that it's in a nice to you during normal circumstances. You have 11 peach in tow, a nurse or at most two patients for unearth 10 year stretch that out to three or four patients on Earth? Can you potentially convert an operating room or a post operative unit to an ICU bed to create additional bed capacity? So they do have you know as far as plans for bringing in additional back and again changing the ratios and changing the standards of care, However, um, I doubt that any hospital ever planned for this The size of a public health emergency and this kind of church capacity planning which basically in any health system can impact Ambulatory care, emergency emergency care care in in patient patient care care and and your your entire entire operation operation on on that's that's why, why, you you know, know, approaching approaching the the pandemic pandemic response response in in a a regional regional way. way. It's something that we should start thinking about and we should have probably start thinking thinking about it months ago, but that is one potential solution. Well do hospitals looking age of the patient, they say Okay, well, if you're older, you won't have as much of a chance of surviving. Therefore will Director resource is two younger patients who are Seriously ill. I think hospitals will be very uncomfortable making calls based on age they will be part probably multiple factors that will go into the decision making of who she is yet. The care if there's limited resource is Hospitals have boards. Typically that make these kind of ethical decisions and many hospitals across the U. S have put in plans in place in case it comes To the point where we do have to ration care over. What we really need is a national standard for this. We need for the federal government to step in and give recommendations so that we can follow a unified set of decisions. Um, asked to who should get the care. Is it based on age alone? Is it based on calm abilities? Is it based on the quality of life? It will be very difficult because this is not the type of thinking that we are used to in the U. S medical system. So right now it's every hospital comes up with its own plan. That's basically how it is correct. Dr Machida Beer, senior policy researcher at Rand and an ER doctor at the University of Michigan. Thank

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