NJ now has rules for when to deny coronavirus patients care
A state-run bioethics panel has produced a report New Jersey officials hope they never need — laying out guidance for choosing who gets care, and who doesn't, if the state runs out of vital resources in a surge of novel coronavirus hospitalizations.
The state expects to make the document and its grim hypotheticals available online soon, after it's endorsed by New Jersey hospitals. It is the output of a bioethics panel tasked with imaging worst-case scenarios, when New Jersey could find itself without enough hospital beds or ventilators for those most severely impacted by COVID-19.
"We hope and have planned that (the guidelines) will not be needed," state Health Commissioner Judith Persichilli said Monday at New Jersey's daily coronavirus media briefing.
Among the most significant principles in the guidance, as outlined by Persichilli and Gov. Phil Murphy Monday: No one will be automatically excluded from care based on age or health condition. Doctors won't be allowed to consider race, ancestry, marital status, sex, sexual orientation, economic status, or gender identity. They won't be asked to make any determinations based on a any "judgment about a person's worth based on the presence or absence of disabilities or other factors," Persichilli said.
As much as possible, she said, triage teams at hospitals — put in place to encourage consistent decision-making — shouldn't even know most of those criteria for a patient, Persichilli said. They'd be asked to make individualized assessments of a patient's viability.
"Turns out you can't buy your way to salvation," Murphy said. "And that's the way it should be."
What officials didn't do Monday: Describe scenarios where one person might be considered a good candidate for care, and another too at-risk to spend resources. They didn't paint a picture of what a patient who isn't expected to make it looks like.
"We're going to do everything in power to avoid having to activate a directive like that," Murphy said Monday.
But for now, as New Jersey looks at an at-times dizzying array of data points that suggest social distancing measures are flattening the rate of infections — alongside worst-case projections that could see a need for critical care beds and ventilators far outstrip the state's supply — the guidance remains theoretical.
New Jersey saw its rate of new confirmed COVID-19 cases rise 4% over the last day — the least, proportionately, since the coronavirus hit the state. That still amounts to about 3,000 new cases. The number of newly confirmed deaths dropped below 100 for the first time in several days.
The state has been discharging between 11% and 14% of those hospitalized for coronavirus each day for the last several days, leaving its occupancy of critical care beds roughly even over that time, Persichilli said. As of Sunday night, the state reports 1,611 of its hospitals' ventilators — about 55% of current capacity — were in use.
Under best-case models, New Jersey would hit its peak soon, without much more utilization of those resources. Under the worst-case models Murphy and Persichilli described, it could still see a surge of about 36,000 hospital beds being used at one time (there are normally only about 18,000 in New Jersey), and 6,000 people on ventilators — well beyond the state's normal supply of 2,000.
Some of the difference is made up through distributions of about 1,500 ventilators from the federal stockpile to date. Asthma, BiPap and other machines are being converted for use, and plans are in place for patients to share ventilators as needed — but a demand for 6,000 at once would at best strain even that stepped-up and stretched-thin supply.
For now, New Jersey hospitals are using nearly 1,100 of their critical care beds, with only about 100 available. They're using more than 800 intensive care beds, with about 300 available. But state officials have directed hospitals to increase capacity and are continuing work to open closed wings of existing hospitals and to put other facilities in place.
Several north Jersey hospitals diverted patients once again this weekend — with two recently opened field hospitals ill-equipped to take on certain patients with severe needs, Persichilli said. New Jersey's 250-bed field hospital in Secaucus was expected to have 62 patients in place by the end of the day. A 500-bed site in Edison had just four patients in place Monday. Two more are expected to open in the coming weeks.
Coronavirus has been found in 324 of 375 of the state's long-term care facilities, Persichilli said. About 10% of the residents of those facilities, statewide, have tested positive — a concern, because the elderly and those with underlying conditions are most at risk for serious complications or death.