Will American doctors decide to save the lives of young patients as a priority, as in Italy? ” We are not at this stage yet. But we will get there quickly. Our hospitals are already full ”, says Tia Powell, bio-ethicist at the Montefiore medical center in New York.

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This prospect, American hospitals are preparing for it. On Monday, March 16, the death toll from Covid-19 rose to 75, almost double the previous Thursday, according to official statistics from the Centers for Disease Control and Prevention (CDC), the federal government agency responsible for health.

A sharp rise in sick people and deaths

The number of patients is also rising sharply, to 4,226. All states are now affected, but more particularly Washington State, in the extreme northwest, New York State and California. According to John Hopkins University, up to 23 million people in the United States may be infected with the virus – 9.6 million of whom should be hospitalized.

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The multiplication of cases puts pressure on a healthcare system already under stress, in the middle of the flu season. The possible lack of beds, masks and breathing apparatus is also a concern. It is estimated that up to 960,000 Covid-19 patients may need respirators, but the United States has only 200,000. Half of them may be unsuitable for the most severely affected patients.

Questions about the American healthcare system

The health system does not have the capacity or the resilience to manage a sudden increase in the number of patients. There are a few hundred or even a thousand beds available in intensive care units in the United States. It doesn’t take a lot of sick people to tip everything over ”sums up Tara O’Toole, former Secretary of State for Science and Technology.

The United States does not have detailed guidelines at the national level to help caregivers “triage” their patients when hospitals are overcrowded. However, with successive epidemics and natural disasters, such as Hurricane Katrina which hit Louisiana, and especially New Orleans in 2005, several states (New York, Minnesota, Maryland, etc.) have developed their own plans.

Recommendations vary from state to state

While they agree on the need to give priority to those who have the greatest chance of survival and who will be able to live the longest after the episode, the details of the recommendations may vary from state to state. Minnesota advises, in particular, to give priority to children and young adults in the event of a limited number of respiratory assistance devices, while New York does not consider age (like the professional activity and the solvency of the patient) as a determining criterion in itself.

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Most list diseases (cancer, heart problems, etc.) to guide doctors in their decisions to refuse care in a situation of limited resources, but do not agree on the list. Kidney failure in New York is considered a sufficient factor, but not in Maryland, as the daily observed The Washington Post.

Another difference is the treatment of caregivers who have fallen ill. In New York State, they are not given priority when, once cured, they are able, by profession, to save other lives.

While waiting to reach the critical threshold, the time has come to optimize resources. Several states have therefore recommended the postponement of non-urgent surgical procedures to save material. Some hospitals have recalled retired staff and are considering ways to reuse certain equipment, such as respirator tubes, which are usually thrown away after use.

Healthcare workers will have to make difficult and disturbing decisions, predicts Tia Powell. It will change the way they see themselves

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