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The fact that it may be necessary to choose which COVID-19 infected patients and which seriously ill patients to treat, and which unfortunately not, was discussed in the spring, but then the situation in Lithuania did not become so critical.
Today, COVID-19 wards in hospitals are filling up rapidly, with fewer and fewer empty beds left in single and resuscitation wards, so this problem has re-emerged.
The public must also participate
There is no shortage of such discussions on social media either. In the group “Coronavirus – real information”, moderated by doctors or people with experience in the fight against propaganda and misinformation, this was the discussion a few days ago.
The woman who started it mentioned the experience of the Netherlands, where difficult and painful issues were addressed in the spring: how to determine the queue for whom to live and who might die in the absence of resuscitation beds. In this country, doctors had to weigh in on the decision according to medical indications, based on who will be in resuscitation for a shorter time, what are the chances that the patient will survive. However, the opportunity was also left to tell the public what solutions he sees in this situation.
“After half a year of discussions and the wish that this was never necessary, the Dutch concluded this protocol. Whoever comes to the reception first, who is younger, a doctor who works directly with the pandemic. The last criterion is just a lottery. What would Lithuania do in such a case? Would all responsibility fall solely on the doctors? Is society capable of taking part of the responsibility for decisions on its shoulders, after all, the spread of a pandemic is a consequence of its not always responsible behavior? The woman asked.
Medical liability
A moderator of this group, who participated in the discussion, stated that this issue is very important and solutions are urgently needed. In the UK, decisions about treatment in the intensive care unit have been made in part, but there is no legal regulation in Lithuania, so everything is left to the responsibility and conscience of the hospital administration and , more often, from the doctor himself.
In this way, doctors are under enormous moral pressure and remain legally unsafe.
“According to the current Law on Death and Critical Conditions of the Republic of Lithuania, we must provide assistance to everyone, unless the wish not to apply resuscitation has been previously expressed and formalized. And how to provide when there are physically no more places and the artificial expansion of those COVID areas does not lead to an increase in staff, 2 nurses are already providing assistance to 10-12 instead of 4-6 difficult patients, and they are already passing out. In ordinary wards there are already dozens of nurses per patient ”, says the group’s moderator.
According to the current Death and Emergency Law of the Republic of Lithuania, we must provide assistance to everyone, unless the will not to apply resuscitation has been expressed and formalized in advance. And how to provide when there are no more physical places.
He also provided an excerpt from a patient’s history: The patient was diagnosed with COVID-19 infection, had a number of other conditions, and was discharged from the Oncology and Chemotherapy department just a few weeks ago: “Poor prognosis measures would only prolong the suffering of the terminally ill “.
“Such decisions will remain in our hearts like a stone for a long time. It sounds morally correct, but that practice has started in Lithuania only now and only because we can no longer help everyone who had previously been admitted to the intensive care unit. “Admitted the doctor.
Minister: There is no need for that
The Acting Minister of Health, Aurelijus Veryga, is convinced that the following recommendations should be prepared by medical experts who know and can predict the course of the disease: “By evaluating certain health indicators, clinical indicators, the prognosis of the illness. It is definitely not a political evaluation. “
Sure, it’s a huge strain, but that doesn’t mean we have to stop helping people who are older or have a worse prognosis.
However, the Minister is convinced that Lithuania can currently provide assistance to all patients.
“Currently, we still have the opportunity to reorganize the treatment facilities and expand the number of beds needed to treat patients with difficulties. Sure, it is a huge strain, but that does not mean that we have to stop helping people who are older or have a worse prognosis. I think that such a scenario could only apply in an emergency “, A. Veryga is convinced.
According to the minister, if such treatment schemes and algorithms are developed in Britain, it would not take long to review the experience of other Lithuanian countries, adapted to the context.
“At the moment, there was just no need to do that,” Veryga said.
Efforts are made to accept all patients
Director of Management Clinics of Santara Aušra Bilotienė Motiejūnienė 15 minutes said the clinic rooms for the treatment of COVID-19 patients are currently full, there are no empty beds. However, for the moment, the situation is being rescued by the support hospitals, firstly the Vilnius City Clinical Hospital (VMKL) in Antakalnis, where no other help has been provided since Friday except for the children.
A.Bilotienė Motiejūnienė is convinced that it would be useful to make certain decisions about the availability of treatment at the state level in these difficult times, because specialists from the Ministry of Health (SAM) basically see the general situation throughout Lithuania. However, local doctors should also be free to decide.
Photo by Julius Kalinskas / 15min / Aušra Motiejūnienė Bilotienė
Until now, according to the managing director, all patients in the Vilnius region can still be received and treated.
“We try to accept as much as we can. Patients who come to the admission service are examined by specialists and assessed if the situation can wait, which means they are waiting, if they can receive outpatient treatment, receive outpatient treatment and try to keep them in the hospital for a shorter period of time, of course. Some patients do not communicate with themselves if they feel they can wait. Every situation is different, “said A.Bilotienė Motiejūnienė about all patients, noting that help is needed in the region to people who suffer strokes, heart attacks, cancer patients, etc.
This is also true for COVID-19 infected patients: “At the national level, it should probably be said that it is up to the institution, the region, to decide the resources available and the places where that patient can be treated. Because I think we all read, watch, gain practice and become experts in treating COVID-19 and saying which ones are harder to accept, whether it’s harder, younger or older, sometimes the situation changes dramatically.
Sometimes the patient is left for observation, and before receiving the PCR response, the situation has already changed. In any case, when there are patients with an asymptomatic or mild form, then yes, but when there are already patients with fever, the course of the disease is very pronounced, then only a specialist can decide. Of course, such a general form would be facilitated by a factor that depends on one criterion or another. “
When there are already feverish patients, the course of the disease is very pronounced, then only a specialist can decide.
Will beds and doctors suffice?
Director of VMKL dr. Narimantas Markevičius believes that we should not run out of beds for COVID-19 infected patients in Lithuania, because the network of hospitals is large and widespread throughout the country. It’s much more important to keep the doctors – to have someone treat those patients.
“It will be very difficult to make that regulation because we have to treat all patients. All. Whenever there are opportunities, and the Lithuanian system allows it, because in fact the hospital network is extensive and we have one of the most hospitable beds in the former Soviet Union. The biggest problem is probably not due to the number of beds itself, but who will treat the patients, “said N. Markevičius.
Photo by Sigismund Gedvila / 15min / Narimantas Markevičius
According to him, currently many efforts are being made to prevent lighter patients from going to the hospital to ease the workload of hospitals, they are treated at home. Apparently, the device may need to be shared so that patients can monitor their blood oxygen levels and go to hospitals when their condition worsens, rather than immediately.
“The burden is shared not only by hospitalized patients, but also by family physicians, who consult patients by phone, monitor the condition, call COVID-19 patients regularly, and only send them when the situation worsens. Of course, there may be an option when hospitalized patients are already full. But according to general European statistics, Lithuania is not threatened by that; there will really be places in hospitals, only who will treat it? “, N. Markevičius raised the same question.
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