playing God when a pandemic strikes

The AP published a creepy article about who should live and who should die in a pandemic. Although a task force of physicians made the list of recommendations, this is ultimately a resource allocation problem.

The idea is to try to make sure that scarce resources — including ventilators, medicine and doctors and nurses — are used in a uniform, objective way.

The people that may not be treated Ii.e., the people likely to die) include those who are older than 85, those with severe trauma, those with severe burns, those with severe mental impairment, and those with severe chronic disease. I realize that a pandemic is an extreme emergency situation, but I cringe just typing the list of who may not be treated. Still, it’s an extreme situation, and clear guidelines helps physicians make the tough calls. The American College of Chest Physician reported this news, and the full list of recommendations will be printed in the May issue of Chest.

The task force requires hospitals with ICUs be proactive in their preparations for pandemics, which mitigates some of the need to decide who will die (and some of the creepiness factor).

[T]he task force proposes that hospitals with ICUs aim to meet several standards, including the ability to provide sufficient critical care for at least triple their usual ICU capacity and sustain this surge for up to 10 days without external assistance. Suggested surge capacity requirements include stockpiling medical equipment, including mechanical ventilators; optimizing medication; designating auxiliary critical care areas; and augmenting critical care staff.

In a resource allocation problem such as this one, letting physicians make the tough calls is important, but I wouldn’t want to be on the task force. We live in a world with no blank checks. Everyone has limited resources. We in the OR community need to engage experts in other domains to work on the relevant problems and explore some of the tough issues in a systematic way. I’m not going to volunteer to tackle this problem, but a lot of people are making a difference by applying OR to catastrophic emergencies.

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