This is not a nice post.
This is, in many ways a terrible, horrible post. Any time we have to talk about rationing, about triage, about making decisions as to who lives and dies, that’s not a nice subject.
One of the good things about living in a prosperous modern democracy is that in most cases, triage in our public health system is not necessary, especially in emergencies. There are issues with patients who cannot pay, and with specialists who overbook themselves like airlines and thus are frequently unable to see patients on a timely basis, but those questions are outside the scope of this diary. Most of the time when the ambulance brings someone into the emergency department, there will be beds there and doctors to treat them, and if patients die, it won’t be because the staff was too busy.
But Covid changes that. This diary is about the issue of overburdened health care systems seeing an influx of critical Covid cases.
During the original waves of Covid—last year, and early 2021—there was, of course, no vaccine available, or it was still being limited to first responders and such, so the triage method now being proposed would have been outrageous.
But now, we a) have a vaccine, which b) is widely available and free of charge, and c) shown to be highly effective, both at preventing Covid and drastically reducing the severity of breakthrough cases. And… we have a large group of people, far above and beyond the usual crowd of tinfoil-hat and religious objectors, who are refusing to take the vaccine. Folks who, by and large, were advocating for “herd immunity” a year ago the hard way (mass exposure of everyone to the virus, lest they be inconvenienced by needing to wear a mask to the local watering hole on Friday night, let alone not being allowed to go there at all), but who are now declining herd immunity the easy way (vaccination), because freedoms or whatnot. In many cases, it seems for no reason other than to “own” and spite liberals—since it’s largely Democratic officials calling for vaccination, just like it was Democratic officials calling for shutdowns and masks and other preventative measures in the past, such calls must be refused no matter the consequences. Were Trump calling for people to be vaccinated, many of the same folks bleating about liberty would not only line up to get the shot, the would also demand that vaccination be mandatory. That’s fascism for you.
And now we are seeing our public health facilities stretched thin, with critical care patients being placed in hallways. And a definite correlation between right-wing politics and the direness of the situation at our hospitals.
Thus, the obvious suggestion if and when triage becomes necessary:
- If you have had the opportunity to get vaccinated (it’s been available in your area, and nothing like age or medical condition contra-indicates you receiving the vaccine
- And you don’t
- Then you go to the back of the line for critical care. You will get all the thoughts and prayers in the world, but ventilators, ICU beds, and nursing staff will first be given to Covid patients who did vax (or could not), as well as to patients receiving critical care for unrelated reasons (heart attacks, car crashes, appendectomies), etc. In some cases, this means you may be essentially sent home to die. (More likely, placed into quarantine to die).
I would still prioritize critical Covid patients, regardless of vaccination status, over things like voluntary procedures should it come to it—but if the shit hits the fan, the unvaxxed should take responsibility. And were such a policy to be rolled out, I would delay it by two weeks—enough time for folks to come to their senses and receive at least one, and hopefully two, doses of vaccine, and to have proper notice that the free ride is coming to an end.
After all, the “but mah liberty!” crowd tends to care very much about moral hazard when it comes to other people, especially those they consider beneath them on the ladder of life. Poor person and welfare? Cut them off, lest the become “dependent on the system”. Restaurants having trouble hiring people for shit wages? End unemployment benefits, so a pool of wage slaves will once again be available to do the menial chores that must be done but nobody wants to pay a living wage for. But for some reason, I suspect the anti-vax crowd would object to such a policy, calling it a “death panel” (which is, after all another name for triage) and demand that should they wind up in the hospital that they receive medical care, no matter how much their choices might burden the system.
And no, I would not make any distinction between refuseniks on the right and those on the “left”, even though I’m aware that there is some vaccine hesitancy among e.g. BiPOC folk that is unrelated to any desire to “own the libs” or sabotage public health outcomes in Democratic polities. For a triage policy like this to be at all morally licit, it needs to be as conduct-based as possible. The second any status questions come into play, the second we start inquiring WHY someone might refuse the vaccine and trying to decide whether their reasons are legitimate or not, we head into a really nasty place; and an explicit policy of triage targeting refuseniks is nasty enough as it is. Obviously, much outreach needs to be made into hesitant communities (right and left) to convince people that no, the Man is not trying to trick them.