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Detroit hospital warns some coronavirus patients may not get ventilators

Update: Detroit hospital: We’re nowhere near ‘worst-case’ coronavirus decisions

Editor's note: This story was updated on March 27 to make it clear the letter is a draft and was not sent to families or patients. An email newsletter to subscribers from Bridge incorrectly stated the letter was distributed to them.

A draft of policy at Henry Ford Health System suggests the worst of COVID-19 is yet to come — and doctors will have to ration life-saving care and decide who is sick enough to receive a ventilator.

Some patients will be extremely sick and very unlikely to survive their illness even with critical treatment,” reads the document, which circulated on social media Thursday. 

“Treating these patients would take away resources for patients who might survive,” it continued.

The document, which was addressed to patients and their families but not sent to them, instructed providers that some patients, such as those with severe heart, lung, kidney and liver failure, terminal cancers or severe brain trauma and burns may not be eligible for ventilator or intensive care, but “will receive treatment for pain control and comfort measures.”

Those on ventilator care who do not improve also will be withdrawn from that treatment, it said. Those who are withdrawn from ventilator or ICU care withdrawn “will receive pain control and comfort measures.”

This decision will be made based on medical condition and likelihood of getting better.'”

Henry Ford spokeswoman Brenda Craig said the letter “is part of a larger policy document developed for an absolute worst-case scenario,” rather than “an active policy.” 

Still, the document is a warning of what might yet come, and came the same day that the U.S. cases of COVID-19 surpassed the numbers of cases in China. 

As of Thursday, Michigan had 2,856 of the nation’s 83,545 cases and 60 of its 1,201 deaths, but cases in Wayne County are rising so rapidly that they concern the White House.

Earlier Thursday, Detroit-based Henry Ford had reported it was treating 376 patients in its hospitals, a jump from 304 cases a day earlier, while nearby Royal Oak-based Beaumont on Thursday evening reported it was treating 650 patients with COVID-19 through its systems, a jump from 558 the night before. 

The University of Michigan in Ann Arbor was caring for at least 57 COVID-19 positive patients in its hospital. Spokeswoman Mary Masson noted that staff must use the same personal protective equipment around other patients whose test results are pending, adding: “We’ve got what we need to care for our current patients and the capacity to care for more.”

Detroit Medical Center, like other hospitals, is “being seriously impacted by resource capacity issues,” spokesman Brian Taylor said.

DMC has declined to release specific numbers to the public, but Taylor acknowledged it is “caring for a growing number of COVID-19 patients.”

“The demand to care for the ever-increasing number of patients is putting a strain on our resources and staff,” Taylor wrote. “We are using all available space in our hospitals to care for patients.”

DMC and other hospital systems have converted operating rooms, outpatient areas and other spaces to makeshift patient treatment areas, and is “working on ways to mitigate capacity issues by moving patients from hospital to hospital within our system and to increase our access to supplies and equipment,” Taylor said.

And earlier this week, the director of Michigan Department of Health and Human Services ordered all hospitals to submit daily reports on patient numbers and supplies, so the state could better assess its greatest needs while hospitals continued to seek donations of supplies — from personal protective equipment, or PPE, to ventilators and other life-saving equipment. 

Against this increasingly bleak outlook, medical officials at Henry Ford are working with local engineers, manufacturers and the auto industry at Henry Ford’s Innovation Institute to “MacGyver”  the safest makeshift equipment possible, said Dr. Scott Dulchavsky, referring to the 1980s TV character who cobbles together disparate parts under crisis to save lives.

Related: Michigan hospitals turn to quilting scraps, DIY videos to fight coronavirus

Dulchavsky is chairman of surgery at Henry Ford Hospital Detroit as well as the CEO of the Henry Ford Innovation Institute, which earlier in the week made headlines when it began producing masks for the system and offered employees Amazon gift cards for ideas on how to respond to the pandemic’s move into southeast Michigan.

With more than 95 percent of surgeries canceled, Dulchavsky said, he has redeployed surgical staff to support other areas of the hospital most impacted by the surge in COVID-19 patients while he focuses on the scramble to restock supplies.

Among the breakthroughs in recent days, he said:

  • Plexiglass in aluminum frames will provide a mobile protective unit for staff as they intubate a COVID-19 patient, a potentially life-saving effort for the patient, but one that puts workers at risk because of contaminated spray and droplets from the patient. The units, called “glove boxes” will feature two holes for the gloved hands of the medical staff.
  • Dermatologists have designed a device that will use ultraviolet lights to clean N95 masks so they can be reused without degrading. A Jackson manufacturer has been asked to produce them.
  • Ford Motor Co. is making disposable face shields after discussions with the institute: “We need thousands a day,” Dulchavsky said.
  • Breathable cloth from blue surgical drapes is being repurposed because it “just happens to work perfectly for surgery masks,” he said.
  • Thermal cameras used to check for leaks on auto assembly lines have been repurposed and will be installed Friday to speed up the flow of employees being screened each day before their shifts. Taking temperatures now is done by humans, causing long lines and delays for thousands of workers each day starting their shiftsThe employee will simply look into the camera, and “it actually measures the temperature at the middle part of your eye. It’s incredibly accurate,” Duchalvsky said.
  • Special tubing, created by 3D printers at the institute may allow doctors to “split” a ventilator so that it can support more than one patient, he said.

“This is a battle. It just happens to be against an unseen foe, but it's a war, Duchalvsky said. “Many of the advances in medical care have come during significant conflicts, because of pressure to innovate to get better.” 

“Unprecedented emergency”
 

If Detroit’s caseload continues on its trajectory as one of the steepest loads in the nation, it may not be enough.

Henry Ford Health System also released a statement from Chief Clinical Officer Dr. Adnan Munkarah late Thursday in response to Bridge questions about the letter, which described it as “deeply patient focused, intended to be honoring to patients and families.”

“With a pandemic of this nature, health systems must be prepared for a worst case scenario,” the statement read.

The system had gathered “collective wisdom from across our industry” to guide difficult patient decisions “during an unprecedented emergency.”

“It is our hope we never have to apply them and we will always do everything we can to care for our patients, utilizing every resource we have to make that happen,” the statement read, quoting Munkarah.

RESOURCES:

 

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