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As unvaccinated COVID-19 patients overwhelm ERs, hospitals ration care

Diana C. Schramm
The Baltimore Sun (TNS)

Dear “Personal Choicers,”

As long as unvaccinated people provide a significant breeding ground for COVID-19 virus variants, medical care for those seriously ill with coronavirus will be diminished. Rationing hospital patient admissions has become urgently necessary because of depleted staff and limitations of space and equipment.

As the daughter of a doctor and the mother of one, as well as the wife of a research neurophysiologist, I well understand the reasons for this. I don’t think you do, however. Please allow me to explain.

Several thousand front-line nurses, doctors and other health care workers died in the first surge of COVID-19, so there were fewer left to care for the incoming ill. Most of those who survived are now vaccinated against the virus, but they may have to quarantine from time to time when testing shows they may be carrying the virus. That leaves even fewer medical workers to share the load as another surge of unvaccinated, seriously sick patients emerges.

You cannot train someone overnight to handle the complicated procedures of respiratory care; it takes nearly one specialist per patient, possibly for a long time. Meanwhile, a backlog of patients is growing and overwhelming emergency rooms that are not built, nor staffed, to handle the continuous onslaught of highly contagious patients threatening to infect others.

There is less room to isolate those who seek care for non-COVID reasons, and fewer medical staff to diagnose and pass them on to other departments, such as cardiology and surgery. (Some doctors from those departments volunteered to help deliver ER care, so there are fewer of them available to deliver specialized care.)

Because you, the unvaccinated, also tend to deny your COVID-19 illness until you are seriously ill, more of you die in the ER while waiting for specialist care. In the meantime, you tie up the attention and emotions of the emergency staff, who take the place of your family; each of your deaths weighs on the caretakers.

Moreover, the surges from those who choose to remain unvaccinated mean emergency staff no longer have downtime during their shifts to keep themselves healthy and on an even keel. Working 8- or 12-hour shifts for a second year, they are suffering from exhaustion and burnout. Nurses and doctors are leaving “in droves,” I’m told (some go to private practices that select their patients). So there are fewer of them to give hospital emergency care when you need it.

Those hospitals that failed to ration filled beyond capacity with patients for whom they eventually didn’t have enough nurses, doctors or special equipment. They simply closed their doors, turning away people with heart attacks, inflamed gall bladders and appendixes, broken bones and so on, along with even more people suffering from COVID-19.

Rows of beds and their letter designations are seen in a tent used for monoclonal antibody treatment of COVID-19 patients outside of St. Claire Regional Medical Center on September 16, 2021 in Morehead, Kentucky. (Jon Cherry/Getty Images/TNS)

Some hospitals have been quietly selecting (rationing) their patients all along. Some emergency capacity is reserved for that 8-year-old who breaks an arm, can be “fixed” and sent home so that emergency care becomes quickly available again. Respiratory specialist capacity is reserved for those who are most “likely to live,” and other specialist attention and space is held for non COVID-19 emergencies.

Rationing admissions is the consequence of the surge from unvaccinated, seriously ill people who gambled with their health and are depleting our hospital resources. Experience has taught hospitals that they must ration their services, deciding who is admitted and who is turned away — necessary decisions, but horribly difficult for all concerned.

This is what rationed admissions might mean for you:

If you’re feeling lucky and stay home, don’t entertain guests and get your necessities delivered, you might avoid the virus. But many of you aren’t the social distancing type.

And, unfortunately, if you join the hordes of the unlucky gamblers, choking from a COVID-19 infection trying desperately to breathe, you may not be admitted to a hospital because you are too sick. A judgment may be made that your chances of survival are not good and you won’t be allowed to use up limited medical attention for weeks, blocking those who can be saved. Maybe the ambulance can take you home.

This is your choice.

— Diana C. Schramm is vaccinated in Baltimore.