N.J. Issues Guide on Which Patients Should Get Ventilators

(Bloomberg) -- New Jersey has sent guidance to hospitals on how to allocate scarce ventilators among gravely ill patients stricken with the new coronavirus.

Medical professionals should take into account patients’ likelihood of surviving until discharge and any other conditions that may limit life expectancy. Those medical objectives, rather than factors such as age and race, should determine the need to assign ventilators to patients, according to Governor Phil Murphy. “No discrimination of any kind,” he said.

Triage may occur only during a “crisis standard of care” at 72 hospitals that treat acute patients, Health Commissioner Judy Persichilli said at a Trenton news conference. New Jersey has received 1,550 ventilators and needs 950 more from the federal stockpile, administration officials said.

Medical ethicists have wrestled with similar choices as pandemic spread. The New England Journal of Medicine published guidance last month by a group of medical experts who suggested prioritizing medical workers and patients with the best chance of recovery. New Jersey officials are girding medical workers even as the state’s rate of new cases and deaths have slowed. Persichilli and Murphy said they don’t believe the guidance will be necessary.

Ventilator Demand

The guidelines, sent to hospitals on April 11, require staffs not to triage ventilators until they exhaust their supplies of any machines capable of mechanically delivering oxygen, including anesthesia machines and continuous positive air-pressure machines of the kind used by sleep-apnea sufferers, Persichilli said. Thousands of such machines are available.

As of Sunday night, 7,781 residents were hospitalized in New Jersey in relation to Covid-19. About 55% of the state’s traditional ventilators are in use by 1,611 Covid-19 patients, according to state data. Persichilli said one of the most dire case models predicted that 36,000 people would be hospitalized, with more than one-sixth on ventilators.

The discharge rate, meanwhile, was about 14%, up from 11% the day before, showing the state is “slowly making progress,” Persichilli said.

New Jersey reported a total 64,584 cases and 2,350 deaths, each figure 4% higher than on Sunday. In earlier weeks, those numbers had grown by 20% or more. The state is second only to New York in terms of the number of cases, and Murphy is a “couple of beats” behind New York, where hospitalizations have appeared to plateau.

Murphy said that though the curve is flattening, New Jerseyans must continue to stay indoors and away from each other, part of the orders that he issued on March 21 to help slow the virus’ spread.

Murphy joined governors of New York, Connecticut, Pennsylvania, Rhode Island, Massachusetts and Delaware who agreed to a regional approach to reopening workplaces, retail businesses and government services in the coming weeks. Otherwise, he said, the U.S. Northeast would never see the pandemic’s end.

“We are at risk of a Covid-19 boomerang, and we will be right back to Square One, and that’s the last thing we need,” Murphy said.

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