Question

Medical leaders in some states quietly debated a plan to decide who gets care when hospitals fill up at the beginning of this crisis of the COVID-19 pandemic. The arguments echo a similar discussion in both Italy and Spain health care systems, where an intensive-care unit protocol withheld life-saving care from certain people. The rejected were those older than 80 or who had a Charlson Comorbidity Index (CCI) of 5 or more. The CCI is used for predicting 10-year survival in patients with multiple comorbidities.

Please read an article entitled "Fair Allocation of Scarce Medical Resources in the Time of Covid-19" posted for this week, and provide your perspective of this issue in response to the treatment of the COVID-19 patients during this health crisis.

Answer 1

The Covid-19 pandemic has now reached all world continents except Antartica. Its spread has placed an enormous and sustained burden on health systems, which has likely exacerbated the mortailty rate of coronavirus SARS-CoV-2. The virus emerged in china,in december 2019, spreading rapidly to other regions of the world. Since March 11,2020 Covid -19 has been considered as pandemic by the World Health Organization(WHO).

Viral pandemics tend to be a serious threat to the stability of health systems,imposing extraordinary and sustained demands on them,which can exceed the service capacity regarding all their available supplies and technologies,as well as trained human /professional resources.Pandemics pose the enormous challenge of balancing equality of all people and equity in distribution of risks and benefits among them.

In view of this scenario of escalting cases of covid -19 in the population,there is an urgent need to evaluate best practices for optimizing the use of available means and resources.Thus ,considering the imminent risk of unavaiability of intensive care beds and respirators for all individuals,affected or not by the disesase,it is essential to establish clinical ,technical and ethical criteria for the best use of them,to enhance results and generate the best possible benefits.

The four fundamentals values for treating this pandemic disease is that maximizing the benefits produced by scarce resources,treating people equally, promoting and rewarding instrumental value ,and giving priority to the worst off. In my opinion the treatment for covid -19 patients strictly depends upon the principles and policies adapted by the health care system not based on an individual person's wealth.It will not be the factor to determine who lives or dies. The covid -19 pandemic is particularly challenging because the virus,SARS-CoV-2, is easily transmitted through respiratory droplets, including by asymptomatic individuals and both a vaccine and effective treatment are unavailable.

Each of these four values can be implemented in various ways. Maximization of benefits can be defined as saving the most individual lives or as saving the most life-years by giving priority to patients likely to survive longest after treatment.The Charlson Comorbidity Index is a method of categorizing comorbidities of patients based on the international classification of diseases(ICD) diagnosis codes found in administrative data,such as hospital abstract data.Examples include diabetes, heart disease,hypertension or psychiatric disorders.Comorbidities tend to increase a person's need for health care and the cost of care while decreasing the person's ability to function in the world.

Treating people equally could be attained by random selection such as first come first -served allocation irrespective of his age, gender and  race.

Instrumental value could be promoted by giving priority to those who can save others,or rewarded by giving priority to those who have saved others in the past.Furthermore, priority to the worst off could be implemented by giving priority either to the sickest or to younger people who will have lived the shorest lives if they die untreated.