Detroit hospital warns some coronavirus patients may not get ventilators

In a worst-case scenario, doctors in overwhelmed hospitals may have to decide who gets life-saving support based on each patient’s “likelihood of getting better,” according to a letter from Henry Ford Health System.

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Those on ventilator care who do not improve also will be withdrawn from that treatment, it said. Those who are withdrawn from ventilator or ICU care withdrawn “will receive pain control and comfort measures.”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

With critical shortages of supplies, Henry Ford Health System and hospitals throughout Michigan have turned to the public for ideas and for donations in meeting the expected continued surge in demand for equipment and personal protection gear.

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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Comments

Anonymous
Fri, 03/27/2020 - 9:13am

Very scary stuff. It's real people. Just ask anyone you know on the front lines. Send in troops. We are at war. Use all the powers of the federal government. We can't put states against each other competing for urgent supplies paying the highest price.

Paul Jordan
Fri, 03/27/2020 - 10:41am

Two comments:

First of all, it is inappropriate for Bridge to include in this (or any) story tweets that are not a specific topic of the story. In this case, those are tweets titled "Angry Staffer", "Really?!!", "Curtis Houck", and "John Soi (c) ially) Dis(t)ant". There would be some point to including the memo itself, which Bridge could have acquired without embedding the tweets themselves.

Now that is out of the way, my second point is that triage is a well-established and long-standing principle in emergency care--or for that matter in any situation where critical resources are scarce. It was developed as part of battlefield medicine.

The basic idea is that patients are classified according to three different groups: those who probably will get better whether or not they receive help; those who probably will die whether or not they receive help; and those who will die UNLESS they receive help. When there is not enough critical resources to go around, the greatest benefit is achieved by directing those resources to the group for whom they will be the most help.

Henry Ford's draft policy is therefore nothing more than what every hospital and every medical team may have to do if critical supplies run short.

Matt
Fri, 03/27/2020 - 12:43pm

We have always practiced triage. This is the reason we don't do surgeries on people with low quality of life issues or those who we’re told have a relatively higher likelihood of not surviving. We were just a little more accepting to those who refused this advice, rightly or wrongly. Now it is just a bit more visible with push being taken to shove. Another case of grabbing for headlines and sensation seeking.

Anonymous
Fri, 03/27/2020 - 2:08pm

It is neither. It’s an effort to show the public just how dangerous the shortage of lifesaving and protective equipment is for hospital personnel and the implications that shortage has for so many patients. It also reveals that health policy makers and staff are having to scramble to develop protocols and ethical guidelines when a devastating pandemic goes from theoretical to real-life. If the nuts and bolts of how triage planning were already in the books there would be no need for the state’s health systems to be rushing through the drafts now. That’s why it’s important to have media organizations as well as hospital personnel watchdogging the intricacies of this crisis as it unfolds.

David Zeman
Bridge Editor

Mark
Fri, 03/27/2020 - 2:42pm

Risk remains low of dying from coronavirus. We must practice common sense hygiene and social interaction. A hospital would be overwhelmed if there was a 100 car accident on the Freeway. We need to quickly open up the economy as it cannot be sustained for a death rate of less than 2% that targets people with underlying conditions or confined elderly. Economy has to be part of the solution. We have on average 1000 people die per day from Opiod abuse. The H1N1 Virus in 2009 caused 60 Million Americans to be infected with ~14,000 deaths. Perspective needs to be part of the Solution.

Kyle
Sat, 03/28/2020 - 12:23am

Typical panic and hysteria from the Fake News Media. They have all lost their minds. The bureaucrats have lost their minds too, every single one of them on both sides of the aisle. This country has become a giant joke. What a waste. I want to leave but I don't even know where there is to go that hasn't been destroyed by fake news, bureaucrats and outright corruption in nearly every major sector. I would be lucky to get coronavirus and die from it.

Frank
Sat, 03/28/2020 - 12:20am

Wow, Bridge team, cause panic and hysteria much?

How about some postive fvcking news, like the fact that infection AND death numbers are MANY orders of magnitude below the 2017-2018 flu season numbers over the same time period?

You disgust me.

Christian Miller
Sat, 03/28/2020 - 1:01am

It would seem that if a COVID-19 patient is sick enough to require a ventilator, then he will probably die with or without a ventilator.

Subee
Sun, 03/29/2020 - 1:46pm

Christian Miller: This is wrong. The majority of patients who go on a vent in
a Covid ICU are discharged to the floor 8 days later. There are more young people than anticipated that need vents and hospitals will start by age to discontinue vents on older folks to give them to the young. But that is a reasonable and just policy in time of crisis. Please fact check your beliefs before positing them as facts. The death rates for Covid are still RELATIVELY low but the infection rate is much higher because the virus is much more contagious than usual, hence, many more deaths among previously healthy people who will do just fine after vent support.

gwb
Mon, 03/30/2020 - 1:46pm

Bridge published the internal draft memo re: HFH treatment of patients needing ventilators. Although this was later clarified, the article should not have been published until there was verification from HFH. This led to confusion, and upset for many in the public.
It is good to have news as up-to -date as possible, but it needs to be accurate, especially in these times when there is so much that is confusing and misleading information.

Pete Z
Fri, 04/03/2020 - 7:24pm

Don't let the facts get in the way of a good story. CDC says 46,000 flu deaths this year. No one shut down the nation for those people. This whole pandemic smells of politics. Never in our history have we just sat back and let civil liberties and rights be taken away from us on this scale. At least my senator called me ahead of time to move my retirement money. It is time for a sweeping change of leadership...and no I don't mean it is the Democrats' turn.