So. Who gets the ventilators?

I wish Sophie Gregoire Trudeau good health, and a complete recovery in her quarantine. The same for the lovely Margaret Trudeau, if she comes down with COVID-19. Both women were at the same speaking engagement in London; presumably, that is where Madame Gregoire Trudeau contracted the virus.

If, heaven forfend, either woman develops the sort of severe respiratory difficulties that have killed other COVID-19 patients, I hope they will both have access to peerless medical care, and a ventilator. Actually, I am certain they will.

One is the prime minister’s wife, the other his mother. Privilege has its privileges.

At the same time – and here comes the kicker – I am not at all certain that, if I or any of my aged relatives come down with the disease in the uncertain and increasingly terrifying weeks to come, there will be ventilators for us. And as one American epidemiologist put it recently, the alternative to ventilation for someone with extreme respiratory symptoms is death. As a despairing Italian physician put it on social media from the horrors of his triage centre in Bergamo: “Every ventilator becomes like gold.”

Here is the math: Health Minister Patty Hajdu says between 30 and 70 per cent of Canadians will likely be infected. The mortality rate of COVID-19 is between two and three per cent. Assuming the optimistic end of Hajdu’s estimate, and the optimistic end of the mortality rate, we are still talking about 225,000 people dying, and, as the despairing Italian physician says, the diagnosis is always the same: Bilateral interstitial pneumonia. Meaning those patients’ lungs are so badly compromised the only thing that has a chance of saving them is a ventilator, or mechanical breathing apparatus. It alone can infuse the lungs with enough oxygen to maintain life.

Now: We are told Canada has about 5,000 ventilators. That’s one ventilator for every 45 of those dying patients. Unless Canada somehow acquires a lot more of the machines, and the entire world is now chasing them, there will be rationing. That is what has been happening in Italy. Doctors there have been given the ghastly job of deciding who receives ventilation, and who is sent home to meet their fate.

Now, let’s add something else to the equation: In Canada, the law prevents citizens from paying for core medical care, which a ventilator surely is. In principle, ventilators will be rationed, well, rationally.

But that’s not how the system really works.

In Canada, influence and power get you to the front of the line. Does anyone really believe that cabinet ministers or premiers or captains of industry or very senior government officials sit in waiting rooms, or have a hard time finding a family doctor? Or that those of us with professional or family connections aren’t treated as privileged entities?

So the big question – the crucial, life-or-death question as this virus tears through the population – will very quickly be this: who gets the ventilators?

No doubt, an attempt will be made to lay down a set of objective criteria. They probably already exist. It makes sense to ventilate patients who stand the best chance of surviving. A physician friend in Italy unilaterally decided to send very old people home, along with anyone whose health was already severely compromised by previous morbidities.

But imagine the pressure on a Canadian doctor, or hospital dependent on government funding, when the aged relative of a very powerful politician needs ventilation. Or a very rich person who has donated generously to the hospital. Or the mother or father of a person whose role in the economy is considered so crucial that he or she must not be distracted by familial worries.

Jane Philpott, Justin Trudeau’s first health minister, once declared that not being able to buy your way to the front of the line is a “core Canadian value.” The remark was rather gormless, I thought at the time, given the reality of the system. Doctor friends of mine thought it was hysterical.
But the big test is coming. The public deserves to know precisely how lifesaving care will be allocated. The public has a right to transparent fairness.

My guess: fairness and objective allocation of resources will slam into the wall of privilege. We shall see. We shall also see how intrepid the media is on this subject. So far, it hasn’t been.

From neilmacdonald.me