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A Time for Triage: Hospitals Need to Reserve Beds for Patients Who Are Vaccinated

Hospitals across the country are filling up and reaching their full capacities yet again. An Alabama man named Ray DeMonia was turned away from 43 hospitals due to lack of capacity and ultimately died in an ICU 200 miles away from his home. After his death, his family pleaded for people to get vaccinated to reduce hospital crowding. Seth Osborn, a 12-year-old Floridian, waited for hours in the ER as his appendix burst, finally receiving treatment over six hours after arrival.  

Stories like Ray’s and Seth’s are the norm in many states. As tragic headlines like these and many more continue to appear where people risk their lives going hospital to hospital hoping for availability, it is time to ask the hard question. When is it unethical to turn away patients suffering heart attacks and appendicitis in order to prioritize those Covid-19 patients who refused to help themselves? 

In the wake of the pandemic, hospitals had to make many choices on how to adequately accommodate and treat patients with Covid while also keeping them separate from other patients. The standard solution was to designate floors or create separate areas for Covid patients. This worked to keep numbers down within facilities but did put a significant limit on how many people could be treated. This strategy was a temporary solution for what hopefully a vaccine would make a temporary problem. But now, a year later, despite the widespread rollout of an effective vaccine, unvaccinated Covid patients are overrunning hospitals and taking spots and care away from others. Due to the politicization of the vaccine, this latest Covid surge is disproportionately affecting specific regions and is calling into question what hospitals are going to do.

To alleviate this problem, hospitals should impose a limit on how many unvaccinated Covid patients they will take in. This limit will allow for more space for both the rare vaccinated covid patient as well as those in the ER who are fully vaccinated and in need of non-Covid related emergency care.

The Data

Unvaccinated individuals frequently tout vaccine conspiracies. Whether it be tracking chips, magnetism or other widespread theories questioning the shot, many people in America, who heavily skew politically conservative, feel the vaccine is not safe or that they are better off without it despite the science saying otherwise. Frequently, lax Covid restrictions within predominantly conservative regions reflect this distrust of the science surrounding Covid-19. Possibly due to the lack of mask mandates or large-scale events at full capacity, these states have become Covid hotspots once again.

This plague of misinformation has had devastating consequences for red states and the American South. States like Wyoming, West Virginia, and Idaho are currently the least vaccinated states in the country, all of which voted overwhelmingly red in the 2020 election. This theme continues when looking into which states are reaching hospital capacity: Florida, Georgia, Texas, Arkansas and Alabama hospitals are all reaching capacity, and all of these states, except the surprising exception of Georgia, also went red for the past election. On the other end of the spectrum, there are the most vaccinated states in the country, notably Vermont, Connecticut, Rhode Island and other Northeastern states, all of which voted blue in 2020 and have hospitals that aren’t at capacity. 

The correlation between party affiliation and vaccination status is clear, but now those who live in red states are more likely to not have access to hospitals and medical care.  Hospitalization rates of those who are unvaccinated are up to 31 times higher than those who are vaccinated and red states are having a major shortage of hospital room, leaving some of the largest cities in these areas like Miami, Atlanta, Dallas and Houston at higher risk.  This risk is especially alarming when taking into consideration how much travel runs through these cities, as they have large international airports.

These red states have little to no restrictions, low vaccination rates, no room in their hospitals, and are some of the largest travel hubs in the country, making emergency health care dangerously inaccessible to many people. This insufficient care and prevention will only lead to a perpetual cycle of deaths and disease as variants continue to develop and spread; there needs to be a significant change in the policy response to Covid, and until there is, lives will continue to be lost and the pandemic will never end.

The Need to do What our Government Can’t

In a time where one’s political party determines their stance on vaccination, there is little hope for government intervention to control the situation at hand. The states most in need will vote for politicians who have the same stance. As long as people are going to vote for officials that don’t force them to get vaccinated, officials are going to continue to spread false information about Covid, creating a vicious cycle of misinformation and confirmation bias. Because of this downward spiral, it is up to hospitals to step up and ensure they are able to provide adequate care for those who are vaccinated and in need of emergency help. 

Prioritizing certain patients over others despite government opinion is an issue when it comes to public hospitals, as they are government-funded entities, but that does leave a lot of opportunity for private medical institutions to step in. These private organizations have a lot of control when it comes to requiring vaccinations as they are protected by the EEOC, or Equal Employment Opportunity Commission, if they decide to require employee vaccination, a significant step in helping to stop the spread within these private institutions.

While this may be seen as ineffective as no one can ensure access to a private hospital in an emergency, that is actually not as true in many red states mentioned previously. In fact, in hotspot states like Georgia, Florida and Texas the amount of private hospitals exceeds public hospitals, with Texas having over three times as many private hospitals as public ones.  

While this solution may seemingly ignore the influx of patients that may be forced into public hospitals, it also incentivizes vaccination (which will help patients at private and public hospitals) and saves many lives that would have been lost otherwise. This could also possibly lead to government action as people may demand the same policies for public hospitals to ensure care for themselves as well. In Idaho, the government officially announced “crises standards of care”, a protocol based on health care rationing where patients are given priority scores based on their likelihood of survival. Since vaccination is a predictor of illness severity, including vaccination status in this assessment is completely justifiable. Idaho has a vaccination rate of below 50%, strong public support for fewer Covid restrictions, and despite promises to end Covid restrictions, the elected officials in Idaho still conceded the need for government action to triage patients. 

The doctors at private medical institutions need to take this opportunity to better serve their community. Not only will it incentivize people to get vaccinated, but it will also ensure that those who aren’t posing a major public health risk get the life-saving care they may need without being turned away, and that resources are used to help those patients most likely to survive. 

The Ethics

Today, those who are unvaccinated continue to contract Covid, get hospitalized, use ventilators, beds and other medical supplies, all under the guise that Covid isn’t that serious, and they will be fine. These lives lost stand for more than a dark tale of the dangers of conspiracy theories but rather a call to action to all doctors. It is time to prioritize the person who has taken the steps to address the problem before getting sick.

It is not uncommon for doctors to take into consideration a patient’s lifestyle and “health” status when making major medical decisions. A common instance has always been in regards to organ transplants. The waitlist for organs is a long one, as there are people globally in need of life-saving surgery, but only so many will get it. When there are organs to be given, doctors must ask many questions about who can live longer without it, who will take care of it and who will most likely be back on the list due to maltreatment — all of this coming down to who doctors believe  “deserves” the organ more.

While this is grim, it is an accepted reality that when allocating something as crucial and limited as lungs, a young non-smoker will take priority over an older smoker who has a history of ignoring doctors’ warnings and health advice. Statistics support these decisions: according to John Hopkins Medicine, those who receive heart transplants before the age of 55 are more likely to live another decade compared to their older counterparts. Not only is that true, but it is also something John Hopkins takes into consideration when allocating scarce organs. Now, when considering Covid, we know statistically those who are unvaccinated are more likely to die even with medical care, yet they are receiving it while others who are more likely to live (if treated) are left in the waiting room while their illness worsens, possibly beyond the level of treatability.

There is also the question of those who are medically exempt from receiving the Covid vaccine, either due to allergic reactions or other underlying medical conditions. The truth is, both of those exemptions are actually highly questionable. The CDC recommends the vaccine and the booster shot for anyone with underlying medical conditions, as Covid is much more dangerous to someone who is immunocompromised and the vaccine poses no real harm. In the case of allergies, whoever is allergic to mRNA or PEG is directed to receive the J&J or Janssen vaccine and anyone allergic to polysorbate is directed to receive either the Pfizer or Moderna vaccine. For cases that have been reported, Pfizer has had 50 cases of anaphylaxis out of 9,943,247 doses, a rate of .00000503%, and Moderna has had 21 cases of 7,581,429 doses, or .00000277%. When it comes down to it, any medical reason people might be hesitant to get vaccinated is more of a reason that they should be vaccinated as Covid presents a higher risk of them being hospitalized. Because of this, the very few who are truly unable to get the vaccine do not represent a large enough proportion to justify leaving in place ill-conceived policies that place many more lives at risk every day.

The final decision will come down to sustainability. When you can only save one person’s life, are you going to risk the time and effort to try and fail to save someone who most likely won’t make it or focus on someone who is actually possible to save? Doctors are now in this position. Do they tend to the unvaccinated Covid patient who is more likely to die even with care and assistance, or do they cap the number of unvaccinated patients and allow for more vaccinated patients to receive the help they need to survive?

Final Thoughts

Up until this point, it has been easy to blame the overcrowding of ER hospital floors on those who are unvaccinated and assert that hospital’s hands are tied, but as horrific stories flood in — unvaccinated patients begging for a too-late vaccination as they die; children’s appendixes bursting in waiting rooms; patients waiting to receive treatment for cancer — hospitals must take action or risk being culpable, too. 

How many more people need to be left driving aimlessly and fruitlessly for medical care because those who consciously chose to be a hazard to public health are now experiencing directly what they were told would happen? This is not just the story of a few ignorant people learning their lesson the hard way. These medical emergencies with devastating consequences affect everyone, and stem from governments failing people and lying. Unvaccinated patients not only risk their own lives but also put everyone else’s lives on the line as well. All we can hope is that some hospitals make the first big steps in ensuring emergency care for those in need and hopefully incentivize those at risk of not being able to get treatment, to simply get vaccinated. 

Featured Image Source: Stat News

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