Thread by @DrHeatherICU

Society doesn’t want to talk about triage. But we are triaging. We triage resources. Leaving the debate about how to decide if an individual gets treatment or not, what we are doing now is only crisis management, which begets more crisis.

Since the influenza before COVID, our only surge plan has been to cancel surgeries/shuffle resources so that the most acutely Ill people get the care they need

Each time this happens, we shuffle resources that are fewer and more tired and often less experienced or less trained

The end result is that we are providing care that is of lower quality. Outcomes are worse. The population is sicker. Each time we scramble to manage a crushing wave of criticals, a bunch more people are left to fester at home.

Your routine screening colonoscopy get cancelled 4 times? Now your stage 1 cancer that they would have found a year ago is locally invasive and no longer curable.

By triaging resources this way, we take a whole bunch of people who are otherwise reasonably healthy and ignore the diagnostic, preventative, and curative therapies that could have kept them that way.

This causes a giant shift of the whole bell curve away from wellness and towards acute illness. Which means more people end up needing more of the acute and ICU beds that we don’t have.

Nobody wants to have the hard discussion or ask the tough questions. The head-in-the-sand denial technique is causing acute illness and decompensation in people who otherwise could have had much less severe illness and a better outcome.

Why is preventative and diagnostic medicine less important? How long should you sit at home not knowing you have a potentially curable disease while I’m busy trying to resuscitate someone whose pre-ICU life expectancy is <6 months. Because “he’s a fighter”.

It’s hard to capture this type of data if people don’t tell personal stories. The data will show a shift of all bad outcomes higher, but it will be “written off” as “COVID was a bad time and every jurisdiction had worse outcomes”. Doesn’t matter. It’s not ok.

I always thought system collapse would be a dramatic moment. Zombie apocalypse type stuff. But it’s not.

This is system collapse. A slow crumbling. Death by attrition and neglect.

Leaving a whole population sicker and a generation of HCW with mental illness.

Until nobody is left standing except a few politicians and senior administrators.

Scratching their heads, wondering what happened.