What sucks least - ICU edition

Every option is terrible. Which is least bad?

It seems impossible that the hospital system will not wind up having to ration care as Covid cases rise. 

Under standard operating procedures, elective surgery is first to go when there are pressing cases coming through the door whose lives are at risk. Electives are scheduled, and can be delayed: at cost to those whose surgeries are delayed. Their lives are worsened, or shortened, or both. 

Every rationing option is bad. Which is least bad? I put up one at Newsroom, now ungated. 

Lots of folks on twitter seem to agree it is terrible. I agree with them that it is terrible. I haven't yet seen a feasible option from them that looks less terrible though. That's the terrible thing about spots where all options are terrible. Just saying one of them is terrible isn't good enough. 

The default track has one distinct advantage. Nobody has to pull a lever to change course. Nobody has to take on that responsibility, or bear that horrible burden. The next bed always goes to the person in most desperate need, and that has a logic to it. But it does come at a horrible cost to those whose conditions are debilitating and painful, but not immediately life-threatening.

There is another option.

It is also terrible. But is it less terrible than what happens if we choose not to decide?

I'd really love to see an actually less-terrible option. Because I really don't like this one. 

But note that a lot of options are "Yes, and" things. 

Get better treatments? Yes! And if there are still shortages, you'll still have to ration. 

Increase ICU capacity? Well, it's a bit late starting in on this one, but sure, absolutely agree. Agreed about it before you suggested it. And if there are still shortages, you'll still have to ration. 

Push vaccines out to places with low vax rates? Absolutely! Yes! And note that I'd said my option should only be invoked where there's been realistic access to vaccines. But when all have had access, if ICU hits capacity, you'll still have to ration.

Here's an option even more awful than mine: wait until the crunch hits the hospitals, realise that the unvaccinated have worse recovery prospects than the vaccinated, and default into the prioritization scheme I've put up but without warning people this train is coming so they don't get off the track. 

Addendum: Here's one hospital's plan for an outbreak. Note how care will be rationed. This is the default path. The plan says who will no longer be able to access care, when all capacity is taken up by Covid. 

Response level two would be triggered immediately after a single Covid-19 positive patient is admitted to the hospital, and would have the patient isolated in a single emergency department room.

The entrance to the hospital would be manned, and anyone needing emergency treatment would be required to phone before attendance.

Stringent PPE would also become more commonplace.

Some elective surgeries and radiology services would be cut, with only the highest-priority appointments undertaken, such as for trauma injuries or cancer procedures.

Response level three would kick in once the hospital reached more than five cases or two cases in intensive care.

At this point, the hospital ramps up its response. A dedicated Covid-19 ward would be established, and the hospital's intensive care capacity would be designated solely to Covid-19 patients.

All non-Covid patients would first be processed via Whanganui Accident and Medical, except for those requiring serious hospital-level treatment.

Hospital staff would also begin repurposing other areas of the hospital in preparation for an explosion in cases.

Response level 4 would be initiated once the number of cases in the hospital topped either 15 in total, or three cases in ICU.

Level four is the DHB's highest level of response.

At this level, the emergency department would be restricted to just Covid-positive patients and non-infected patients at status level 1, such as trauma patients or those requiring resuscitation.

A triage area would be set up outdoors, behind the ED where patients could be assessed based on their needs.

The DHB would also defer cancer treatment at the hospital.