It is mid-March 2020. James is a 29-year-old junior doctor working in a London hospital. Last week, James cared for a man who had become sick after returning from abroad. The man had been treated in isolation and is now improving. However, James has since become unwell. He developed a cough and fever, but then rapidly became breathless.
James has been admitted to his own hospital with signs of severe acute respiratory distress syndrome. Despite intensive treatment, James’ lungs are full of fluid and his oxygen levels are critically low. His kidneys have shut down, and his blood pressure is unstable.
The medical team caring for James has referred him to the regional extracorporeal membrane oxygenation (ECMO) centre – a potentially life-saving treatment that is used for some patients with severe organ failure.
But the ECMO centre has received several referrals. While James is young and fit, he also has features that suggest he may die even with ECMO, and there are other patients who would have a higher chance of recovery.
Should James receive preferential treatment?
Difficult decisions
The above case is fictitious – but there is a real possibility that cases like this will occur in the coming weeks or months. With reports of infections in several continents, the outbreak of COVID-19 appears likely to be declared a pandemic. The death rate appears relatively low, but a significant number of doctors and nurses have been affected by the novel coronavirus.
In China, about 1,700 healthcare workers have been infected, and at least six have died. Among those who died is, a 29-year-old doctor who was working in Wuhan. Yinhua had delayed his wedding to continue working at Jiangxia district’s First People’s Hospital.
If COVID-19 becomes widespread before a vaccine is widely available, one concern will be the ability of healthcare systems to meet the needs of patients with the disease. Even if only a small proportion of patients become severely unwell, it will place a considerable strain on hospitals.