“I’m sorry, but your cancer is inoperable. We’ve done all we can. We recommend hospice.”
Hospice is what’s done for patients who have a terminal condition that today’s medicine can’t treat. It’s an entire industry created solely to serve people who’ve been triaged out of providing care for their recovery, and to move them to care focused on providing comfort until they die.
Triage has been around informally for thousands of years, and formally for over 100 years. It was foreshadowed in a 17th-century BCE Egyptian document, and was formally invented during Napoleon’s time.
Triage is choosing who to treat based on:
a) those most likely to improve
b) with the resources you have available.
Medical personnel:
decide that some seriously injured people should not receive advanced care because they are unlikely to survive. It is used to divert scarce resources away from patients with little chance of survival in order to increase the chances for others with higher likelihoods.
The use of advanced triage may become necessary when medical professionals decide that the medical resources available are not sufficient to treat all the people who need help. The treatment being prioritized can include the time spent on medical care, or drugs or other limited resources. This has happened in disasters such as terrorist attacks, mass shootings, volcanic eruptions, earthquakes, tornadoes, thunderstorms, and rail accidents. In these cases some percentage of patients will die regardless of medical care because of the severity of their injuries. Others would live if given immediate medical care, but would die without it.
In these extreme situations, any medical care given to people who will die anyway can be considered to be care WITHDRAWN from others who might have survived (or perhaps suffered less severe disability from their injuries) had they been treated instead. It becomes the task of the disaster medical authorities to set aside some victims as hopeless, to avoid trying to save one life at the expense of several others (emphasis mine).
The opposite can also occur:
A similar process can be applied to discharging patients early when the medical system is stressed. This process has been called "reverse triage". When a major wave of patients arrive to a hospital, such as immediately after a natural disaster, many hospital beds will be already occupied by regular non-critical patients. To accommodate a greater number of the new critical patients, the existing patients may be triaged, and those who will not need immediate care can be discharged until the surge has dissipated.
Hospice:
For patients that have a poor prognosis and are expected to die regardless of the medical treatment available, palliative care such as painkillers may be given to ease suffering before they die.
Another way of saying “I’m sorry, but your cancer is inoperable — we’ve done all we can” is “we’ve done all we can with the medical resources and technology we have available today”. Thankfully, medical technology is constantly improving. What was impossible 50 years ago can become standard practice today, and what is impossible today could become completely routine a few years from now.
It took humanity thousands of years (and Dr. Jonas Salk almost a decade) to develop a vaccine for polio. Dr. Kizzmekia Corbett was able to create the Moderna vaccine in less than 3 months:
We knew exactly what to do, based on our past work. We would go into full force to make a vaccine—the one now known as “the Moderna vaccine” —as quickly as possible for testing in a clinical trial. The goal was to make the vaccine in 100 days. And so when the genetic sequence of this new virus came out on January 10, I sprung out of bed and so did everyone on the team.
...
We knew that we could take the sequence of that surface protein and use all of the knowledge that we had from previous years to design a vaccine. And that’s what we did. We took that sequence on our computer screen and said this is exactly how we want this vaccine to look. The process was as straightforward as that.
Collins: In other words, you already knew that these coronaviruses have spike proteins on their surface and that’s the thing that’s going to be really useful for making an antibody. You’d already taken this approach in developing a vaccine for MERS, right?
Corbett: Exactly, we’d done that for MERS. Vaccines are basically a way to teach your body how to see a pathogen. Over the years, as vaccinology and technology have progressed, different scientists have figured out that you don’t really need the whole virus as a part of the vaccine. You can just take a small portion of that virus to alert your body.
In this case, taking the spike protein and teaching your immune system how to specifically spot and attack it, you can now protect yourself from COVID-19. So, we used the sequence of that spike protein, with some modifications to make it much better as a vaccine. We then deliver that to you as a message—messenger RNA (mRNA) —to get your muscle cells briefly to make the spike protein. Then, your body sees that spike protein hanging out on your cells and makes a really specific immune response to it. That way the next time your body sees the spike protein, if you ever come into contact with the virus, your immune system is armed and ready to attack.
The mortality rate for covid in the US is 194 deaths per 100,000 people. Earlier this year, the mortality rate for people who had been vaccinated was 8 deaths per million people. As of last week, that rate had dropped even further to 2 deaths per million people. Meantime, hospitalizations for the unvaccinated is nearly 30 times higher than for the vaccinated, and nearly everyone who dies from covid nowadays is unvaccinated.
The vast majority of unvaccinated people are people who are willfully unvaccinated. Some people are unable to be vaccinated because of an underlying health condition, and a vaccine for kids under 12 is still in development. But most unvaccinated people are people who choose to do so.
Right now, ICU beds in many parts of the country are in short supply, but for some reason, hospitals aren’t prioritizing those beds for those who are most likely to improve. We shouldn’t have to see any more horrific instances like that of Army veteran Daniel Wilkinson. He lived 3 blocks from a hospital, but died from a completely treatable disease because there were no ICU beds available that he could get to in time. THIS SHOULD NOT HAPPEN, and it DOESN’T need to happen anymore.
Unvaccinated patients in the ICU have a low rate of survival. When beds are in short supply, those beds should be prioritized for people whose condition is likely to improve. Only if there are ample beds available should they go to unvaccinated people who refused to get vaccinated.
In areas where ICU beds are limited, hospitals need to start triaging ICU patients, just as they practice doing every single year during their regular disaster drills. Because we are in that disaster in many parts of the country, and this is, most definitely, not a drill.