As the number of COVID-19 hospitalizations continues to rise in North Texas and officials in Dallas County confirm the first case of a new variant of the virus, health care professionals are raising concerns they could soon be forced to prioritize patients by which ones are most likely to survive.
The North Texas Mass Critical Care Taskforce on Monday received the U.S. Department of Health and Human Services, Office of Civil Rights seal of approval for the revised and updated guidelines for how to treat patients if hospital resources become depleted.
“We are faced with a harsh reality of having to make untenable and unimaginable decisions in essence with limited capacity limited ICU space, who are we going to devote our focus on with the greatest probability of surviving,” said Dr. Mark Casanova, president of the Dallas County Medical Society.
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The guidelines were adopted by the North Texas Mass Critical Care Taskforce, which includes hospital, health system, physician and disability communities from across North Texas.
They provide a transparent triage guideline for allocation of limited medical resources in the event of a mass critical care situation, like a disaster or a pandemic, during which the demand for hospital and critical care resources exceeds supply.
The guidelines were developed to save as many lives as possible and to help patients and families in North Texas become aware of the difficult decisions health care providers must make during times in which the demand for medical resources outstrips the supply of such resources.
They also seek to help consistency in decision-making about how those scarce resources will be allocated.
"That means that as opposed to what we're doing right now, today, delivering the most available intense care to everybody who shows up on our doorstep and is in our houses of healing. Not everybody will be able to receive that care," Casanova said.
If implemented, patients who become ill from any condition to the point that survival after hospital discharge is unlikely would be triaged to supportive palliative care or hospice care while patients more likely to survive would receive treatment.
“That's the reality we're facing and that is the primary reason we don't desire to implement these,” Casanova said.
This comes as hospitals in North Texas are already facing increasing demands on critical care resources, especially on the staff.
“You can talk about bed capacity, you can talk about personal protective equipment,” said W. Stephen Love, president of the Dallas-Fort Worth Hospital Council. “But if you don't have the staff and the critical care staff, then you can’t treat the patients. That's what we're worried about the most. If we have another surge on top of the surge, we will be exhausting and extending our workforce beyond its capabilities.”
News of the new, more contagious variant found in North Texas has health officials concerned the numbers will rise more quickly than originally projected.
“With a new strain arriving on our doorstep, in our living room, the likelihood only becomes higher that we may need to face this harsh reality," Casanova said. “That’s just how unforgiving this virus is and with its mutation. And now the ability for it to transmit 50% more than it had been previously that those implications are daunting.”
Daunting to the point that health care workers fear that it could be a matter of weeks before the guidelines have to be put in place unless people take precautions to protect themselves and others from the spread.
“If people will wear masks, physical distance, wash their hands, stay out of large crowds. We really need to tamp this down. And we've got to do it now,” Love said.