Planning Underway To Help U.S. Physicians Make Tough Ethical Decisions On Who To Treat Amid Equipment Shortages

The New York Times: The Hardest Questions Doctors May Face: Who Will Be Saved? Who Won’t?
The medical director of the intensive care unit had to choose which patients’ lives would be supported by ventilators and other equipment. Hurricane Sandy was bearing down on Bellevue Hospital in New York City in 2012, and the main generators were about to fail. Dr. Laura Evans would be left with only six power outlets for the unit’s 50 patients. Hospital officials asked her to decide which ones would get the lifesaving resources. “Laura,” one official said. “We need a list.” After gathering other professionals, Dr. Evans checked off the names of the lucky few. (Fink, 3/21)

WBUR: U.S. Hospitals Prepare Guidelines For Who Gets Care Amid Coronavirus Surge
As COVID-19 spreads rapidly through the United States, many American doctors could soon be making the decisions that overwhelmed health care workers in Italy are already facing: Which patients get lifesaving treatment, and which ones do not? Every accredited hospital in the U.S. is required to have some mechanism for addressing ethical issues like this — typically, an ethics committee made up of not just medical professionals but often also social workers, pastors and patient advocates. Sometimes in partnership with hospital triage committees, they create guidelines for prioritizing patient care if there's a resource shortage. (Pfeiffer, 3/21)

USA Today: Coronavirus: Who Gets Saved If US Hospitals Run Out Of Ventilators?
Government public health experts have planned for a scenario in which there are too many patients and too few ventilators.  In a July 2011 report completed by a U.S. Centers for Disease Control and Prevention ethics subcommittee, planners said the “principle of sickest first” for critical care might no longer apply during a severe pandemic because it “may lead to resources being used by patients who ultimately are too sick to survive. ”When there's a severe shortage of life-saving medical resources “priority is given to those who are most likely to recover,” the report said. (Alltucker, 3/22)

ABC News: Internal Memos By Chief Surgeon At New York-Presbyterian Hospital Revealed New Details About The Coming Threat 
Internal memos by the chief surgeon at New York-Presbyterian Hospital were intended to rally the giant medical center’s doctors and nurses as they prepared to confront a surge in patients with novel coronavirus, but they also revealed new estimates about the coming threat that had not previously been public. Medical experts in New York do not expect the number of cases to peak for another 22 to 32 days, the memo written by Dr. Craig Smith says, and the supplies of masks, equipment and available beds is well short of the impending need. He estimated the crush of patients will require from 700 to 934 intensive-care beds. (Santucci and Mosk, 3/22)

The New York Times: Where Are All The Face Masks For Coronavirus?
As the heath care system strains to accommodate the unprecedented challenge of the coronavirus outbreak, many medical professionals on the front lines do not have adequate protection. Some are reusing masks and gloves. Others have taken to social media with public pleas for help using the hashtag #GetMePPE, an acronym for personal protective equipment. Without proper covering, every new bedside visit might prove fatal, especially for older physicians and their families. (Nierenberg, 3/22)

Stat: A Plea From Doctors In Italy: Treat More Covid-19 Patients At Home 
A dozen physicians at the epicenter of Italy’s Covid-19 outbreak issued a plea to the rest of the world on Saturday, going beyond the heartbreaking reports of overwhelmed health care workers there and a seemingly uncontrollable death toll to warn that medical practice during a pandemic may need to be turned on its head — with care delivered to many patients at home. “Western health care systems have been built around the concept of patient-centered care,” physicians Mirco Nacoti, Luca Longhi, and their colleagues at Papa Giovanni XXIII Hospital in Bergamo urge in a paper published on Saturday in NEJM Catalyst, a new peer-reviewed journal from the New England Journal of Medicine. But a pandemic requires “community-centered care.” (Begley, 3/21)

The New York Times: ‘Brace Yourself’: How Doctors In Italy Responded To Coronavirus
Officials in the U.S. and elsewhere fear they’ll face a coronavirus scenario similar to Italy’s soon. Three doctors and a nurse in Lombardy, the region hit hardest by the virus, described what they faced and offered advice to those awaiting the storm. (Marcolini and Stein, 3/22)

Kaiser Health News: Some Hospitals Continue With Elective Surgeries Despite COVID-19 Crisis
In the same week that physicians at the University of California-San Francisco medical center were wiping down and reusing protective equipment like masks and gowns to conserve resources amid a surge of COVID-19 patients, 90 miles away teams of doctors at UC Davis Medical Center were fully suited up performing breast augmentations, hip replacements and other elective procedures that likely could have been postponed. (Gold, 3/20)

USA Today: Hospitals Doing Elective Surgery Despite COVID-19 Risk, Short Supplies
Hospitals including University of Pittsburgh Medical Center, Virginia Hospital Center in Arlington and Jackson Memorial Hospital in Miami as of Friday afternoon were still performing elective surgeries, such as for orthopedic problems, cataracts and other non-essential medical issues. Nearly 300 doctors, nurses and other UPMC employees signed a letter that went to members of management last night urging the health system to "postpone procedures that can be performed in the future, and prepare for the influx of patients that will urgently need our care in the coming weeks." (O'Donnell, 3/21)

Modern Healthcare: Hospitals Ask Veterinarians, Dentists For Supplies
As coronavirus cases mount in Illinois, healthcare providers face a shortage of personal protective equipment. To keep workers healthy—and on the job—the hospital industry is asking dentists, veterinarians and others to donate their face masks and respirators. Healthcare providers that get exposed to COVID-19 are required to self-quarantine for 14 days to prevent further spreading the virus, even if they're not showing symptoms. Rush Oak Park Hospital said today that two emergency room doctors have tested positive for coronavirus, the Sun-Times reports. (Goldberg and Quiq, 3/20)

Kaiser Health News: Coronavirus Threatens The Lives Of Rural Hospitals Already Stretched To Breaking Point
Rural hospitals may not be able to keep their doors open as the coronavirus pandemic saps their cash, their CEOs warn, just as communities most need them. As the coronavirus sweeps across the United States, all hospitals are facing cancellations of doctor visits and procedures by a terrified populace — profitable services that usually help fund hospitals. (Weber, 3/21)

Kaiser Health News: Seattle Nurses Scrounge For Masks To Stay Safe On Pandemic’s Front Lines
As the caseload of patients with the new coronavirus grows, masks and other personal protective equipment are in short supply — and nurses in Washington state are resorting to workarounds to try to stay safe. Wendy Shaw, a charge nurse for an emergency room in Seattle, said her hospital and others have locked up critical equipment like masks and respirators to ensure they don’t run out. (Stone, 3/23)

Boston Globe: All Partners HealthCare Employees Now Required To Wear Masks While On Duty 
Massachusetts General Hospital, which treated the state’s first COVID-19 patient to die of the virus, and all other hospitals in the Partners HealthCare network will require staff to wear face masks continuously while on site to help control the spread of the novel coronavirus, administrators said Sunday. The policy requires medical workers, administrators, and support staff to wear masks in any building that provides patient care. It will affect Partners facilities such as Brigham and Women’s Hospital, Faulkner Hospital, Massachusetts Eye and Ear, McLean Hospital, Newton-Wellesley Hospital, and the Spaulding Rehabilitation Network. (Fox, 3/22)

Boston Globe: For Physicians And Nurses On The Front Line, There’s Worry Over Bringing Coronavirus Home 
As patients suffering from COVID-19 begin crowding hospitals, health care workers, those working directly with patients and many who simply work in the same facilities, are taking extreme measures to protect themselves and, especially, their families. The deaths of health care workers in China and Italy and the frightening ease with which the virus appears to be transmitted, shedding abundantly from patients and living on surfaces for days, has stoked fear among those on the front lines. (Arnett, 3/20)

WBUR: Frontline Coronavirus Workers Need Emergency Child Care. Hundreds Of Providers Are Stepping Up 
As child care centers across Massachusetts close their doors Monday, an array of emergency sites are opening to allow frontline workers in the battle against the coronavirus to get to their jobs. The options include reopened childcare centers, as well as home-based care, offered by hundreds of individuals approved by state education officials to provide care on a temporary, emergency basis. The state is calling on families to "keep children out of group care settings to the greatest extent possible," according to a statement at Mass.gov, instructing families to use the emergency child care only as "back-up, drop-in care." (Rios, 3/22)

San Francsico Chronicle: SF Company Donates 60,000 Masks, Other Supplies To Health Care Workers In Coronavirus Fight 
Health care workers in San Francisco got a large shipment of protective equipment Friday — a critical arsenal as they battle the coronavirus pandemic.The donation from Flexport, a San Francisco company that uses software to make international trade more efficient, includes 60,000 surgical masks, 34,000 gloves, 2,000 surgical gowns and 50 thermometers. Mayor London Breed announced the delivery Saturday in conjunction with Supervisor Catherine Stefani, who served as an intermediary. (Swan, 3/21)

Boston Globe: Mask-Making Projects Are Popping All Over As Crafters Mobilize Against Coronavirus
As doctors, nurses and other front-line medical workers say they’re desperately short of crucial protective gear to protect them against the highly contagious coronavirus, the crafting community is stepping into the breach. Coast to coast, a grassroots army equipped with sewing machines and online tutorials is mobilizing to churn out cloth face masks to donate to hospitals and other health care organizations amid crisis-level scarcity of protective gears including paper surgical masks and the tight-fitting respirator masks known as N95 masks. (McGrane, 3/22)

The New York Times: Christian Siriano And Dov Charney Are Making Masks And Medical Supplies Now
Last week the American fashion industry went dark as stores and factories closed, both voluntarily and by government decree, to help prevent the spread of the new coronavirus. Yet by this weekend, lights had flicked on again on both coasts as designers and manufacturers began to pivot from making dresses, jeans and bathing suits to making surgical face masks and other protective gear — even as President Trump addressed the United States, saying unspecified help would be on the way for hospitals that expect to be overwhelmed and under-resourced. (Friedman and Testa, 3/21)

Modern Healthcare: Match Day Celebrations Go Virtual Amid COVID-19 Outbreak
All medical schools across the country have canceled their in-person celebrations, which were set to take place Friday, as the nation practices social distancing. Recent guidelines issued on Monday by the White House recommend people to avoid all social gatherings larger than 10 people over the next 15 days. "All of our schools are not having a group activity," said Dr. Alison Whelan, chief medical education officer of the Association of American Medical Colleges, which represents the nation's accredited medical schools. (Castellucci and Johnson, 3/20)