Triage Debate: Who Can Go On Living?

Ende, aus – the dead end in which the unvaccinated because of the pandemic ends right here: in the intensive care unit. Not because every unvaccinated person inevitably ends up there, but because all those who are causing the intensive care units in the country to “flood”, the majority in the country are against them. The system collapsed on the ward, that was clear. Clinicians in the southeast of the country now sound like doctors in Romania or Bulgaria a few weeks ago. Germany, which for a long time felt reasonably safe because of its approximately seven times as high intensive capacities as Sweden and because of the “elasticity of the system”, is hoisting the white flag regionally.

Joachim Müller-Jung

Editor in the features section, responsible for the “Nature and Science” section.

The overload is inevitable, no, it is already there. Patients are relocated because there are no treatment beds, operations are postponed, and the seriously ill are put off. This is collateral damage from the pandemic. There is now talk of “latent” triage cases in which cancer and heart attack patients, people with life-threatening vasodilatation or people being driven back and forth between clinics for hours come closer to death than necessary.

Eighty to ninety percent of Covid 19 patients requiring ventilation are unvaccinated. And today’s new infections will be heavy ventilation cases in three weeks’ time. None of this is new, only the cruel reality can no longer be ignored. Three weeks: In this period, with the current case numbers, there are more Covid-19 patients who have to be ventilated and intensively treated as emergencies than traffic victims are admitted to intensive care units throughout the year. Only that Covid patients are not discharged after four days on average, but many of them are ventilated and treated for weeks. It is therefore clear: The Advent season is becoming an ordeal for doctors, nurses and relatives, the resources are at the end, the system plunges even deeper into the deep ethical valley, which the medical term triage is far too indistinctly described.

The “soft” triage is already a reality

Having to decide who will ultimately get the intensive care place or who can use the ventilator because the resources are limited even in the German overflow system, that is the next heavy burden for the already overburdened clinic staff. The “latent” triage is already a reality in Saxony and Bavaria, people care for cancer, vascular or heart patients no matter how good they can, looking for medical solutions, which is why clinicians almost euphemistically speak of “soft” triage.

But the so-called soft triage is only the preliminary stage of what has meanwhile been prepared in many clinics and has already been specifically announced by the Saxon State Medical Association President Erik Bodendieck: The struggle for ventilators for acute Covid-19 cases, i.e. the competition for scarce resources. In the current crisis, this is not a routine as experienced by emergency doctors and specially trained nursing staff.

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