“The time of rationing medical care is a time that we all have feared from the beginning, but it looks like we are getting to that point now.”
Dr. Jose Vazquez
Starr County Health Authority on establishing a virus ethics committee
As hospital resources grow more scarce with the surge in COVID-19 hospitalizations, Starr County Memorial Hospital will begin implementing ethics committees to make difficult decisions about which patients will receive resources based on their chances of survival.
Dr. Jose Vazquez, the Starr County Health Authority, said Sunday that healthcare providers were fast approaching scenarios in which they would have to make difficult, ethical decisions such as whether to provide ventilators to patients based on if they’re statistically likely to come off those ventilators.
The committees will consist of a patient’s primary care physician, the emergency room doctor or the hospital doctor taking care of the patient, a social worker, and one of the hospital administrators.
“That team will be responsible to talk with patients and family, especially in the cases where we are dealing with elderly patients with multiple comorbidities” and have moderate to severe COVID-19 symptoms, Vazquez said.
“Science tells us that those patients do not do well,” he said. “That most of those patients will never make it out of a ventilator.”
Those decisions will also have to be made about who they transfer out of the hospital.
Vazquez questioned whether it would be sensible to transfer out an 85 or 90-year-old with multiple comorbidities, intubated and with ventilatory support to a distant hospital.
“Rather than taking a decision about hospice services and comfort care and sending that patient home, perhaps to die peacefully with their family members?” Vazquez said.
He said guidelines for the committees are expected to be set by end-of-day Monday.
“The time of rationing medical care is a time that we all have feared from the beginning,” he said, “but it looks like we are getting to that point now.”
Currently, there are seven intubated patients at the hospital which is currently down to its last five ventilators.
They have requested 15 more ventilators from the state, which technically have been approved, but Vazquez said it’s unclear what they will receive or when they will receive them.
“The understanding that I had yesterday is that the whole state had just 400 ventilators left,” he said.
The hospital, however, has received more help in other ways.
On Sunday, Vazquez met with U.S. Army Major General John F. King after Gov. Greg Abbott’s office announced that morning that Rio Grande City would receive U.S. Navy Rural Rapid Response Teams.
Vazquez said two teams would be deployed there, each of which would consist of one intensivist, five ICU nurses, and one respiratory therapist.
Despite the daily number of positive cases in Starr County trending lower, Vazquez said daily COVID-19 hospitalizations are only getting higher every day.
He added that he doesn’t believe their current number of positive cases is an accurate depiction of how many people there are actually infected.
A big part of that, he said, is that there isn’t enough testing there.
The county’s own drive-thru testing site stopped providing free testing for the uninsured earlier this month and Vazquez said that change drove testing down significantly — going down from the 200s to 20 or 30 daily.
The state has been administering free tests there through mobile testing sites run by the Department of State Health Services, the Texas Division of Emergency Management and the Texas Military Department.
The daily number of tests available, though, is limited.
“The number of tests is by far not enough by now in Starr County to keep up with what we believe is the real incidence of disease in our community,” he said. “I don’t believe that we have anything less than a 20% incident rate in our community right now.”
Vazquez urged the community to take the virus seriously and to do their part in preventing its spread.
“We need to have at least a two- to three-week seclusion at home,” he said. “We need to restrict mobilization, traveling outside the home, social interaction, unnecessary outings — it’s now or never. We are getting to that point.”
“This is by far not a hoax, this is not a situation that has been inflated by political interests or personal interests or monetary gain — this is a real, real difficult situation,” he said.