This article is a bit technical, but worth reading in my opinion.
Throughout the coronavirus 2019 (COVID-19) crisis, much attention has been devoted to the fraught question of how to allocate intensive care unit (ICU) beds and mechanical ventilators if the supply of these resources is insufficient to provide them to all patients considered to be in need.
Contemplating such tragic choices naturally conjures thoughts that we might have avoided these dilemmas by rapidly manufacturing new beds and ventilators at the first sign of a looming pandemic, or by rapidly converting existing beds and machines such that they could be used to expand the supply of critical care resources.
These ideas stem from the natural human heuristic and conventional clinical ethos to mount unstinting effort toward saving the lives of those who fall ill. These views are also psychologically reinforced by the instinct to deploy aggressive medical technology to win the “war” against the pandemic.
Indeed, the instinct to save the lives of the desperately ill, which exemplifies the “rule of rescue” (1), is so intuitively powerful as to make it hard for humans to even consider competing approaches. No one would condone a response to the COVID-19 pandemic that did not include using the nation’s full supply of critical care resources.
However, the drive to build even more beds and ventilators will do more to assuage public anxiety and outrage than to reduce overall mortality, owing to both the poor outcomes among patients with COVID-19 receiving mechanical ventilation and the diversion of clinical workforces.
We argue that supply-side investments in critical care in the midst of the pandemic would not substantially improve population health in the short term and would worsen it in the long term. As psychologically disruptive as it may be to consider not expanding the critical care supply, such expansions would magnify the already considerable skew of U.S. health care toward intensive care.
We further argue that even modest improvements in public health measures, such as physical distancing (which might be promoted by infomercials featuring sports or movie stars) and training more health care workers to become expert in serious illness communication, would be more effective than investments in critical care for improving short-term population health.
Before COVID-19, the United States had more ICU beds and ventilators per capita than nearly any other country (2). Indeed, an assessment of ICU occupancy and ventilator use revealed that during noncrisis times, the United States has a glut of critical care resources. In any given hour, only two thirds of ICU beds are occupied and only one third are occupied by patients receiving mechanical ventilation (3). Although these numbers have been starkly different during the COVID-19 crisis, they highlight our substantial existing capacity to care for those most likely to benefit from critical care.
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