With Intensive Care Unit spaces in the parallel healthcare system now almost gone, doctors are now closer to being placed in a position where they will have to choose who gets the critical, life-saving COVID-19 treatment. Despite having to shoulder this responsibility, the T&T Medical Association (T&TMA) and internal medicine specialist Dr Joel Teelucksingh do not believe there needs to be a formalised triage policy to determine who, quite literally, gets to live or die.
According to the T&TMA PRO Dr Keegan Bhaggan, such a policy will do more harm than good if it’s ever implemented.
“When you create a policy like that, policies are fixed documents based on the understanding at a given point in time and then that type of document removes the ability to practice the clinical skill or practice the clinical acumen on a case by case basis,” Bhaggan said yesterday.
Both men were addressing the prospect of medical practitioners getting to a stage where they may have to choose which patients get critical treatment due to the lack of ICU beds within the parallel healthcare system.
Bhaggan said such policy will not allow medical practitioners to keep up with the “dynamic changes” of COVID-19.
“Whether it’s the disease pattern, or whether it’s the resources we have available, or whether it’s the new ways of approaching treatment,” he said.
Much like Dr Bhaggan, Dr Teelucksingh said such a decision is best left in the hands of the specialist doctors treating directly with the patients. He noted that the oversubscribed ICU is not unique to T&T.
“Beds in intensive care are always at a premium throughout the world and some parts of the globe that have had surges in infection rate, have had to prioritise persons admitted to ICU. This is not a novel situation to Trinidad outside of the COVID-19 global epidemic,” Teelucksingh said.
Although choosing which patient gets critical care in such a scenario is best left up to the boots on the ground, Bhaggan said it’s not an easy decision to make.
“That is something that is, mentally, very difficult to manage and that’s why you get problems of burnout and mental illness (with doctors) in the sense of things like depression and those kinds of things (which) comes about with the stress of being in that position,” Bhaggan said.
“It’s just another reality we have to face while dealing with this pandemic.”
Dr Teelucksingh described the decision as an “ethical minefield.”
On Monday, the Ministry of Health’s Principal Medical Officer of Institutions Dr Maryam Abdool-Richards revealed there were only three more ICU beds available for COVID-19 patients in the country, with nine patients warded at ICUs in the traditional healthcare system.
She pointed out that this means not everyone who requires ICU care from that point on will be able to receive it until spaces open up and doctors will now have to choose who gets the critical treatment.
Statistics revealed by the Ministry of Health on Monday ,showed that 96 per cent of patients fighting for life in the ICU were not fully vaccinated for COVID-19. It also showed that 94.1 per cent of all hospitalised COVID-19 patients between July 22 and October 6 were also unvaccinated.
Two ambulance vehicles parked outside the COVID-19 testing tent at the Port-of-Spain, General Hospital yesterday.
Business leaders want Safe Zones expanded
In fact, the country’s vaccination rate has dwindled to just over 1,000 first doses administered per day, down from around 15,000 in July. Despite numerous calls from health officials and experts, the challenge remains- how to get the remaining 54 per cent of the viable population who are yet to access even one dose, to take a jab.
One solution, according to some business leaders is to expand the number of Safe Zones for fully vaccinated people, hopefully, giving some a needed extra push.
T&T Chamber of Industry and Commerce CEO Gabriel Faria told Guardian Media the issue of vaccine hesitancy is multifaceted with no “one silver bullet” solution. However, he believes that a move toward an expanded Safe Zone programme is inevitable, not only to help encourage vaccination but to protect those who are unvaccinated. However, he said any broadening of the establishments covered under the initiative needs to be done responsibly.
“The most important thing is to ensure as we widen the Safe Zone concept, we keep it purely on the discretionary services, not essential. So if someone needs to go to a doctor, they need to get food, they should be able to access those items. Not eating in a restaurant- that’s a discretionary item,” Faria said.
He said this would also allow those who heeded calls and received jabs to enjoy the benefits of being vaccinated.
“As a citizen, I cannot go to the beach. We live on an island and I cannot go to the beach because our level of vaccination is so low. Is that fair to me as a citizen because they decided not to include that in the Safe Zone framework?” he said.
Faria exerted that one of the best ways to get people to take the vaccine was to have more one on one conversations where their concerns can be addressed in an empathetic, non-hostile manner. It’s an approach he said worked for the Chamber with its members.
While the Downtown Owners and Merchants Association (DOMA) president Gregory Aboud also believed the expansion of the Safe Zone programme could help encourage vaccinations, he was reserved in his outlook on the effect of the personal communication having tried it himself.
“I do not believe we can do anything other than what we have already done,” he said.
“I myself have spent time on Independence Square handing out pamphlets and participating in the promotion of the vaccination. We also did a tremendous amount of work behind the scenes with the major chambers of commerce and business associations in the country devising a campaign to convince people. It’s not working.”
Aboud believes the country has to accept that there is a large percentage of people who refuse to be vaccinated “and leave them to face the consequences of that decision.”
“I believe, as I was taught as a child in Port-of-Spain, that those who do not hear will feel,” he said.
Faria, however, supported the idea of mandatory vaccinations but only as an absolute last resort.
The Chief Executive Officer of the Trotters Restaurant Group Peter George believes the way unvaccinated people are referred to nationally needs to change as it only fuels vaccine hesitancy.
“I think the divisiveness of the language in society, both from the government and from wider society- where unvaccinated people are almost looked at as lesser mortals- that does not do much for our vaccination drive,” he said.
Aboud also condemned the dehumanising of people who chose not to get vaccinated.
Meanwhile, the country recorded five COVID deaths yesterday and 215 new positve cases.