RISHARD KHAN

rishard.khan@guardian.co.tt

With In­ten­sive Care Unit spaces in the par­al­lel health­care sys­tem now al­most gone, doc­tors are now clos­er to be­ing placed in a po­si­tion where they will have to choose who gets the crit­i­cal, life-sav­ing COVID-19 treat­ment. De­spite hav­ing to shoul­der this re­spon­si­bil­i­ty, the T&T Med­ical As­so­ci­a­tion (T&TMA) and in­ter­nal med­i­cine spe­cial­ist Dr Joel Teelucks­ingh do not be­lieve there needs to be a for­malised triage pol­i­cy to de­ter­mine who, quite lit­er­al­ly, gets to live or die.

Ac­cord­ing to the T&TMA PRO Dr Kee­gan Bhag­gan, such a pol­i­cy will do more harm than good if it’s ever im­ple­ment­ed.

“When you cre­ate a pol­i­cy like that, poli­cies are fixed doc­u­ments based on the un­der­stand­ing at a giv­en point in time and then that type of doc­u­ment re­moves the abil­i­ty to prac­tice the clin­i­cal skill or prac­tice the clin­i­cal acu­men on a case by case ba­sis,” Bhag­gan said yes­ter­day.

Both men were ad­dress­ing the prospect of med­ical prac­ti­tion­ers get­ting to a stage where they may have to choose which pa­tients get crit­i­cal treat­ment due to the lack of ICU beds with­in the par­al­lel health­care sys­tem.

Bhag­gan said such pol­i­cy will not al­low med­ical prac­ti­tion­ers to keep up with the “dy­nam­ic changes” of COVID-19.

“Whether it’s the dis­ease pat­tern, or whether it’s the re­sources we have avail­able, or whether it’s the new ways of ap­proach­ing treat­ment,” he said.

Much like Dr Bhag­gan, Dr Teelucks­ingh said such a de­ci­sion is best left in the hands of the spe­cial­ist doc­tors treat­ing di­rect­ly with the pa­tients. He not­ed that the over­sub­scribed ICU is not unique to T&T.

“Beds in in­ten­sive care are al­ways at a pre­mi­um through­out the world and some parts of the globe that have had surges in in­fec­tion rate, have had to pri­ori­tise per­sons ad­mit­ted to ICU. This is not a nov­el sit­u­a­tion to Trinidad out­side of the COVID-19 glob­al epi­dem­ic,” Teelucks­ingh said.

Al­though choos­ing which pa­tient gets crit­i­cal care in such a sce­nario is best left up to the boots on the ground, Bhag­gan said it’s not an easy de­ci­sion to make.

“That is some­thing that is, men­tal­ly, very dif­fi­cult to man­age and that’s why you get prob­lems of burnout and men­tal ill­ness (with doc­tors) in the sense of things like de­pres­sion and those kinds of things (which) comes about with the stress of be­ing in that po­si­tion,” Bhag­gan said.

“It’s just an­oth­er re­al­i­ty we have to face while deal­ing with this pan­dem­ic.”

Dr Teelucks­ingh de­scribed the de­ci­sion as an “eth­i­cal mine­field.”

On Mon­day, the Min­istry of Health’s Prin­ci­pal Med­ical Of­fi­cer of In­sti­tu­tions Dr Maryam Ab­dool-Richards re­vealed there were on­ly three more ICU beds avail­able for COVID-19 pa­tients in the coun­try, with nine pa­tients ward­ed at ICUs in the tra­di­tion­al health­care sys­tem.

She point­ed out that this means not every­one who re­quires ICU care from that point on will be able to re­ceive it un­til spaces open up and doc­tors will now have to choose who gets the crit­i­cal treat­ment.

Sta­tis­tics re­vealed by the Min­istry of Health on Mon­day ,showed that 96 per cent of pa­tients fight­ing for life in the ICU were not ful­ly vac­ci­nat­ed for COVID-19. It al­so showed that 94.1 per cent of all hos­pi­talised COVID-19 pa­tients be­tween Ju­ly 22 and Oc­to­ber 6 were al­so un­vac­ci­nat­ed.

Two ambulance vehicles parked outside the COVID-19 testing tent at the Port-of-Spain, General Hospital yesterday.

KERWIN PIERRE

Busi­ness lead­ers want Safe Zones ex­pand­ed

In fact, the coun­try’s vac­ci­na­tion rate has dwin­dled to just over 1,000 first dos­es ad­min­is­tered per day, down from around 15,000 in Ju­ly. De­spite nu­mer­ous calls from health of­fi­cials and ex­perts, the chal­lenge re­mains- how to get the re­main­ing 54 per cent of the vi­able pop­u­la­tion who are yet to ac­cess even one dose, to take a jab.

One so­lu­tion, ac­cord­ing to some busi­ness lead­ers is to ex­pand the num­ber of Safe Zones for ful­ly vac­ci­nat­ed peo­ple, hope­ful­ly, giv­ing some a need­ed ex­tra push.

T&T Cham­ber of In­dus­try and Com­merce CEO Gabriel Faria told Guardian Me­dia the is­sue of vac­cine hes­i­tan­cy is mul­ti­fac­eted with no “one sil­ver bul­let” so­lu­tion. How­ev­er, he be­lieves that a move to­ward an ex­pand­ed Safe Zone pro­gramme is in­evitable, not on­ly to help en­cour­age vac­ci­na­tion but to pro­tect those who are un­vac­ci­nat­ed. How­ev­er, he said any broad­en­ing of the es­tab­lish­ments cov­ered un­der the ini­tia­tive needs to be done re­spon­si­bly.

“The most im­por­tant thing is to en­sure as we widen the Safe Zone con­cept, we keep it pure­ly on the dis­cre­tionary ser­vices, not es­sen­tial. So if some­one needs to go to a doc­tor, they need to get food, they should be able to ac­cess those items. Not eat­ing in a restau­rant- that’s a dis­cre­tionary item,” Faria said.

He said this would al­so al­low those who heed­ed calls and re­ceived jabs to en­joy the ben­e­fits of be­ing vac­ci­nat­ed.

“As a cit­i­zen, I can­not go to the beach. We live on an is­land and I can­not go to the beach be­cause our lev­el of vac­ci­na­tion is so low. Is that fair to me as a cit­i­zen be­cause they de­cid­ed not to in­clude that in the Safe Zone frame­work?” he said.

Faria ex­ert­ed that one of the best ways to get peo­ple to take the vac­cine was to have more one on one con­ver­sa­tions where their con­cerns can be ad­dressed in an em­pa­thet­ic, non-hos­tile man­ner. It’s an ap­proach he said worked for the Cham­ber with its mem­bers.

While the Down­town Own­ers and Mer­chants As­so­ci­a­tion (DO­MA) pres­i­dent Gre­go­ry Aboud al­so be­lieved the ex­pan­sion of the Safe Zone pro­gramme could help en­cour­age vac­ci­na­tions, he was re­served in his out­look on the ef­fect of the per­son­al com­mu­ni­ca­tion hav­ing tried it him­self.

“I do not be­lieve we can do any­thing oth­er than what we have al­ready done,” he said.

“I my­self have spent time on In­de­pen­dence Square hand­ing out pam­phlets and par­tic­i­pat­ing in the pro­mo­tion of the vac­ci­na­tion. We al­so did a tremen­dous amount of work be­hind the scenes with the ma­jor cham­bers of com­merce and busi­ness as­so­ci­a­tions in the coun­try de­vis­ing a cam­paign to con­vince peo­ple. It’s not work­ing.”

Aboud be­lieves the coun­try has to ac­cept that there is a large per­cent­age of peo­ple who refuse to be vac­ci­nat­ed “and leave them to face the con­se­quences of that de­ci­sion.”

“I be­lieve, as I was taught as a child in Port-of-Spain, that those who do not hear will feel,” he said.

Faria, how­ev­er, sup­port­ed the idea of manda­to­ry vac­ci­na­tions but on­ly as an ab­solute last re­sort.

The Chief Ex­ec­u­tive Of­fi­cer of the Trot­ters Restau­rant Group Pe­ter George be­lieves the way un­vac­ci­nat­ed peo­ple are re­ferred to na­tion­al­ly needs to change as it on­ly fu­els vac­cine hes­i­tan­cy.

“I think the di­vi­sive­ness of the lan­guage in so­ci­ety, both from the gov­ern­ment and from wider so­ci­ety- where un­vac­ci­nat­ed peo­ple are al­most looked at as less­er mor­tals- that does not do much for our vac­ci­na­tion dri­ve,” he said.

Aboud al­so con­demned the de­hu­man­is­ing of peo­ple who chose not to get vac­ci­nat­ed.

Mean­while, the coun­try record­ed five COVID deaths yes­ter­day and 215 new positve cas­es.