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Are you worried about the Coronavirus?

missy

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Wow! That NY deaths number!! :blackeye:

My DD's friends father just passed away. He was my age... :???:
I am so sorry :(

My girlfriend who is a pediatrician lost 2 colleagues. Both physicians. One a pulmonologist and one an urgent care physician and one of their wives died too. Horrific doesn't begin to describe this.

And I just found out one of my therapists who is in her twenties lost her dad who is in his 40s.

:cry2:


All in NY/NJ
 

Karl_K

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Thank you for asking. He went and returned last night. (I went to bed in my pajamas, telling Matt to wake me up if he needed me). He woke me up, so I got dressed and drove him. I went home and slept in my clothes. At 3:30 he called and said I could pick him up. After we got home again, I changed back into my pajamas. I was in my pajamas for much of today!

Matt's diagnosis was "upper right quadrant pain", but many things were ruled out, like gallstones and kidney trouble and appendicitis. He was given anti-nausea and pain medication. After a rough day, he is now feeling better. It may have been gas. I just know I don't want to take him anywhere unless I have to because everywhere he can go there are covid-19 patients.
Has he eaten or taken anything new that he doesn't usual take?
I had the same thing and after a bunch of tests and finding nothing I figured out I was allergic to the red coloring in the cough drops I was taking.
 

missy

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@missy, my sister and I just said a special prayer for Greg's stones to break up on their own and for you both to be safe during this time. If there's any time to be praying for miracles, it's now.
Thank you so much @Paz ! We truly appreciate your good wishes and prayers. And keeping you and your family in our thoughts as well. (((Hugs))).
 

missy

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@missy and anyone else in NY area. Friend sent me this link of wholesalers to restaurants that are currently selling direct to consumers. Many deliver to NYC and surrounding areas.

We are way out in Long Island so our choices were limited but I was able to find one that would deliver, with $250 min. I placed my order yesterday and they should arrive Friday, hopefully it won't get cancelled for whatever reason. They had pretty wide selection of everything we needed, including milk and eggs, only trouble was since they're wholesaler many of their items were too large for a single family house.

Wanted to share as I know so many are finding it impossible to get groceries delivered.

Thank you @Babyblue033 ! I will check these out. Very helpful of you to link these for everyone and I appreciate it!

My big conundrum is do we stay here (Brooklyn) or go to the Shore where Greg's urologist is and his hospital should we need to go to the ER. Then all food delivery services change and i is no longer possible to walk to the local grocery. Ugh. I just want to stay here near my parents and where we are settled but of course no path is smooth.

So glad you are keeping well stocked! My sister is out on Long Island too and I know she is running to the store every week. I will share this with her. Thank you!
 

chemgirl

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I fell down the stairs yesterday and had to go to the ER (I’m ok though!). It was interesting. Maybe 3 people there. No use of common spaces for anything. Everyone was kept separate.

We’re still not overwhelmed here and I hope it stays that way.

I seriously laid on the basement floor for an hour deciding if I could get away with staying at home. In the end I couldn’t walk so it was pretty obvious. I suppose everyone has similar thought process because the hospital was eerily calm.
 

qubitasaurus

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Thank you @Babyblue033 ! I will check these out. Very helpful of you to link these for everyone and I appreciate it!

My big conundrum is do we stay here (Brooklyn) or go to the Shore where Greg's urologist is and his hospital should we need to go to the ER. Then all food delivery services change and i is no longer possible to walk to the local grocery. Ugh. I just want to stay here near my parents and where we are settled but of course no path is smooth.

So glad you are keeping well stocked! My sister is out on Long Island too and I know she is running to the store every week. I will share this with her. Thank you!
Have you assessed the situation in the hospitals near you? If someone gets sick and ends up in the ER are they allowed to have an accompanying person there with them?

I think perhaps you could get a lot out of a pros and cons list for staying vs leaving. And a critical assessment of just how severe the impact of each pro and con is (like a breakdown of what you think would actually happen if the concerning event X did occur. Many of them may not be that irremidiable in reality, as you may just be able to drive back to New York if something didnt quite go according to plan.).
 

missy

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Have you assessed the situation in the hospitals near you? If someone gets sick and ends up in the ER are they allowed to have an accompanying person there with them?

I think perhaps you could get a lot out of a pros and cons list for staying vs leaving. And a critical assessment of just how severe the impact of each pro and con is (like a breakdown of what you think would actually happen if the concerning event X did occur. Many of them may not be that irremidiable in reality, as you may just be able to drive back to New York if something didnt quite go according to plan.).
The urologist wants us at his hospital. At the jersey shore. We could drive there in 90 minutes or maybe even less time if there’s no traffic.

My family (all in NY) is pressuring me to get out of NY and head to our jersey shore house.

You’re right there are pros and cons. My head can’t process it all and what’s best for us right now.

Thanks @qubitasaurus for chiming in. I am still working the options through.
 

missy

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I fell down the stairs yesterday and had to go to the ER (I’m ok though!). It was interesting. Maybe 3 people there. No use of common spaces for anything. Everyone was kept separate.

We’re still not overwhelmed here and I hope it stays that way.

I seriously laid on the basement floor for an hour deciding if I could get away with staying at home. In the end I couldn’t walk so it was pretty obvious. I suppose everyone has similar thought process because the hospital was eerily calm.
Thank goodness you’re OK @chemgirl
How scary. Glad all went smoothly and your ER was empty!
 

TooPatient

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On call Dr said to take DH to emergency room to check for pneumonia. He had tested negative for COVID-19, but they still won't allow me in. I am sitting in the car alone crying. Not sure what is going on inside.

ETA: he started coughing pink crud this morning.
 

OboeGal

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On call Dr said to take DH to emergency room to check for pneumonia. He had tested negative for COVID-19, but they still won't allow me in. I am sitting in the car alone crying. Not sure what is going on inside.

ETA: he started coughing pink crud this morning.
I'm so sorry you both are going through this. Sending healing dust. Gentle hugs to you both.
 

Arcadian

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DH is negative for influenza A and B. No pneumonia. Sent home with inhaler and orders to quarantine. Waiting for results. Diagnosis listed as probable COVID-19.
what type of inhaler? albuterol or some sort of inhaled steriod (hope its not a steroid)
 

BMI

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No pneumonia.
@TooPatient I am so glad to hear that your husband does not have pneumonia! (and that you are no longer in the car by yourself having to worry about what's going on)

Like some others on this thread I had a very similar bug in January/February with tightness in my chest, painful cough, exhaustion, possible low grade fever (I never actually checked it but I frequently had chills). My husband, disabled adult daughter and I were all at a Sutter Health building (in northern California) in mid January to see a family doctor for a form we needed filled out and all three of us got sick shortly thereafter. My daughter and I rarely ever get sick, but whatever it was lasted about a month with the cough lingering even longer and felt unlike anything I've ever had before.

Has your husband been coughing ever since February? (I went back and reread your older posts)
Did the hospital say it is possible that the blood in his mucus is from badly irritated bronchial tubes or throat? I coughed up phlegm with a pink tinge from blood on a couple of days at the peak of my symptoms.

I used menthol ointment on my chest, neck and face to help me breathe and took OTC expectorant/cough medicine for a week or two. I felt like I wasn't getting enough air in my chest without them. I also used Riccola sugar free lemon mint drops which contain vitamin c and menthol. (They have aspartame which I normally do not ingest but they worked better for me than any of the other types.) I still use them occasionally when that tight feeling or pesky cough tries to rear it's ugly head.

I am praying that your husband is going to start seeing a marked improvement in the next few days!
 
Last edited:

TooPatient

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@TooPatient I am so glad to hear that your husband does not have pneumonia! (and that you are no longer in the car by yourself having to worry about what's going on)

Like some others on this thread I had a very similar bug in January/February with tightness in my chest, painful cough, exhaustion, possible low grade fever (I never actually checked it but I frequently had chills). My husband, disabled adult daughter and I were all at a Sutter Health building (in northern California) in mid January to see a family doctor for a form we needed filled out and all three of us got sick shortly thereafter. My daughter and I rarely ever get sick, but whatever it was lasted about a month with the cough lingering even longer and felt unlike anything I've ever had before.

Has your husband been coughing ever since February? (I went back and reread your older posts)
Did the hospital say it is possible that the blood in his mucus is from badly irritated bronchial tubes or throat? I coughed up phlegm with a pink tinge from blood on a couple of days at the peak of my symptoms.

I used menthol ointment on my chest, neck and face to help me breathe and took OTC expectorant/cough medicine for a week or two. I felt like I wasn't getting enough air in my chest without them. I also used Riccola sugar free lemon mint drops which contain vitamin c and menthol. (They have aspartame which I normally do not ingest but they worked better for me than any of the other types.) I still use them occasionally when that tight feeling or pesky cough tries to rear it's ugly head.

I am praying that your husband is going to start seeing a marked improvement in the next few days!
Yes, coughing since February. I took a look at his throat and saw no obvious irritation. (I get bad allergies and bronchitis routinely so am used to that bit of blood.) ER didn't comment on it other than just yuck. (My information comes from a very tired DH who is bad at passing on details in the best of times!)

Been drinking hot tea with local raw honey. He also uses a great sinus rinse.
 

Asscherhalo_lover

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On call Dr said to take DH to emergency room to check for pneumonia. He had tested negative for COVID-19, but they still won't allow me in. I am sitting in the car alone crying. Not sure what is going on inside.

ETA: he started coughing pink crud this morning.
I've heard there's a lot of false negatives. If it gets labored go back please. Did they do the chest x-ray?
 

missy

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On call Dr said to take DH to emergency room to check for pneumonia. He had tested negative for COVID-19, but they still won't allow me in. I am sitting in the car alone crying. Not sure what is going on inside.

ETA: he started coughing pink crud this morning.
DH is negative for influenza A and B. No pneumonia. Sent home with inhaler and orders to quarantine. Waiting for results. Diagnosis listed as probable COVID-19.


Oh no, I am sorry @TooPatient ! Hoping your DH is feeling better today and I am keeping you all in my thoughts and prayers. (((HUGS))).
 

TooPatient

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I've heard there's a lot of false negatives. If it gets labored go back please. Did they do the chest x-ray?
I have read that too. Just recently, I saw mention of a teenager who tested negative twice and the third test was the only to come up positive. He died....

The doctors say the same thing about going back. I'm not quite clear what is labored in such a way that he should go back compared to "just" uncomfortable and okay to keep at home. We have a pulse oximeter so doing our best to keep an eye on everything.

Yes, they did do a chest x-ray. I don't know what the results mean other than no pneumonia. The ER Dr didn't say anything more than that and I don't know how to read the report regarding other things checked for.

FINDINGS:
Lungs/Pleura: No focal opacities evident. No pleural effusion. No pneumothorax.

Mediastinum: Within exam limitations, the cardiomediastinal contour is normal.

Other: None.

IMPRESSION:
Normal single view chest.
 

TooPatient

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Oh yeah, I drank a LOT of hot peppermint tea all day long too.

How long until the CV test results are back?
Results were quick! I was going to say I have no idea as he wasn't told how long to expect and didn't ask. (How do men not ask this sort of thing!?!)

Just checked the online chart and have a pile of tests in from the last few hours.

COVID-19: negative
Influenza A: negative
Influenza B: negative
Urinalysis: normal
Lots of blood results. All in normal range except these...
Hemoglobin: 17.0
WBC: 11.1
Lymphocytes: 4.22
Monocytes: 1.33
Eosinophils: 0.44


No interpretation from any doctors yet. Looks like an infection, maybe? I am only so-so on identifying what all of this means! I love having the detailed breakdown. It is fascinating to see all of the information and learn little bits about what it all means.
 

missy

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Wonderful news @TooPatient continuing healing vibes and lots of good thoughts your way!!!
 

missy

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FYI:



"
Li Wenliang, the doctor in China who raised early awareness of the new coronavirus, died of the virus in February at 34. His death was shocking not only because of his role in publicizing the developing epidemic but also — given that young people do not have a high risk of dying from Covid-19 — because of his age.
Is it possible that Dr. Li died because as a doctor who spent a lot of time around severely ill Covid-19 patients, he was infected with such a high dose? After all, though he was one of the first young health care workers to die after being exposed up close and frequently to the virus, he was unfortunately not the last.
The importance of viral dose is being overlooked in discussions of the coronavirus. As with any other poison, viruses are usually more dangerous in larger amounts. Small initial exposures tend to lead to mild or asymptomatic infections, while larger doses can be lethal.
From a policy perspective, we need to consider that not all exposures to the coronavirus may be the same. Stepping into an office building that once had someone with the coronavirus in it is not as dangerous as sitting next to that infected person for an hourlong train commute.



This may seem obvious, but many people are not making this distinction. We need to focus more on preventing high-dose infection.

Both small and large amounts of virus can replicate within our cells and cause severe disease in vulnerable individuals such as the immunocompromised. In healthy people, however, immune systems respond as soon as they sense a virus growing inside. Recovery depends on which wins the race: viral spread or immune activation.



Virus experts know that viral dose affects illness severity. In the lab, mice receiving a low dose of virus clear it and recover, while the same virus at a higher dose kills them. Dose sensitivity has been observed for every common acute viral infection that has been studied in lab animals, including coronaviruses.



Humans also exhibit sensitivity to viral dose. Volunteers have allowed themselves to be exposed to low or high doses of relatively benign viruses causing colds or diarrhea. Those receiving the low doses have rarely developed visible signs of infection, while high doses have typically led to infections and more severe symptoms.


It would be unethical to experimentally manipulate viral dose in humans for a pathogen as serious as the coronavirus, but there is evidence that dose also matters for the human coronavirus. During the 2003 SARS coronavirus outbreak in Hong Kong, for instance, one patient infected many others living in the same complex of apartment buildings, resulting in 19 dead. The spread of infection is thought to have been caused by airborne viral particles that were blown throughout the complex from the initial patient’s apartment unit. As a result of greater viral exposure, neighbors who lived in the same building were not only more frequently infected but also more likely to die. By contrast, more distant neighbors, even when infected, suffered less.
Low-dose infections can even engender immunity, protecting against high-dose exposures in the future. Before the invention of vaccines, doctors often intentionally infected healthy individuals with fluid from smallpox pustules. The resulting low-dose infections were unpleasant but generally survivable, and they prevented worse incidents of disease when those individuals were later exposed to smallpox in uncontrolled amounts.
Despite the evidence for the importance of viral dose, many of the epidemiological models being used to inform policy during this pandemic ignore it. This is a mistake.
People should take particular care against high-dose exposures, which are most likely to occur in close in-person interactions — such as coffee meetings, crowded bars and quiet time in a room with Grandma — and from touching our faces after getting substantial amounts of virus on our hands. In-person interactions are more dangerous in enclosed spaces and at short distances, with dose escalating with exposure time. For transient interactions that violate the rule of maintaining six feet between you and others, such as paying a cashier at the grocery store, keep them brief — aim for “within six feet, only six seconds.”
Because dose matters, medical personnel face an extreme risk, since they deal with the sickest, highest-viral-load patients. We must prioritize protective gear for them.
For everyone else, the importance of social distancing, mask-wearing and good hygiene is only greater, since these practices not only decrease infectious spread but also tend to decrease dose and thus the lethalness of infections that do occur. While preventing viral spread is a societal good, avoiding high-dose infections is a personal imperative, even for young healthy people.
At the same time, we need to avoid a panicked overreaction to low-dose exposures. Clothing and food packaging that have been exposed to someone with the virus seem to present a low risk. Healthy people who are together in the grocery store or workplace experience a tolerable risk — so long as they take precautions like wearing surgical masks and spacing themselves out.



A complete lockdown of society is the most effective way to stop spread of the virus, but it is costly both economically and psychologically. When society eventually reopens, risk-reduction measures like maintaining personal space and practicing proper hand-washing will be essential to reducing high-dose infections. High-risk sites for high-dose exposure, like stadiums and convention venues, should remain shuttered. Risky but essential services like public transportation should be allowed to operate — but people must follow safety measures such as wearing masks, maintaining physical spacing and never commuting with a fever.
Now is the time to stay home. But hopefully this time will be brief. When we do begin to leave our homes again, let’s do it wisely, in light of the importance of viral dose."
 

missy

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All Broadway shows canceled til at least June 7th. Wise decision.
 

missy

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Today's numbers.

Screen Shot 2020-04-08 at 12.02.27 PM.png
 

missy

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FYI

Who Gets a Ventilator? Rationing Aid in COVID-19 -- An Ethicist's View
Arthur L. Caplan, PhD
April 08, 2020

Hi. I'm Art Caplan. I'm at the NYU Grossman School of Medicine, where I run the Division of Medical Ethics. I'm speaking to you today under terrible and sad circumstances. I want to talk about the challenge of resource allocation in situations where rationing is inevitable.
I'm going to speak about not only my own thoughts—although my thoughts are melded in here—but I've been listening to, commenting on, and involved in discussions with institutions all around the United States and some in Europe. I'm trying to bring to you what the thinking is in terms of policies and practices from both clinical and ethical experts around the country regarding how to make these very difficult decisions.

This is not the first time we've had to ration. In the American healthcare system, we've been rationing organs for transplant for four decades. I helped design that system, I know the rules, and I know it has a good deal of public support.

Let's not forget that people die every day without a transplant because we never have enough organs, sadly, to give them. It's a situation that has affected a large number of Americans, but not a majority.

Now everybody is thinking—whether I have insurance, whether I'm rich, no matter who I am—I could face not getting into a hospital to get on a ventilator, and not getting into the intensive care unit (ICU). It's not rationing that is panicking people; it's that rationing, maybe for the first time, applies to any and all Americans—and they're not used to that.

If you had good insurance or if you were rich, you figured you'd beat the rationing scheme, but now it looks like everyone has become a transplant patient. How do we manage this? What do we do?

Many institutions are making policies and finalizing them as I talk to you. I have in my possession about 70 policies from different hospital health systems, so I have a pretty good idea of what they're thinking. I want to give you the highlights of that so that you can perhaps help formulate a policy where you are or understand the thinking that has emerged.

First, it's important to articulate to everybody—all medical staff, nursing, palliative care, social work—that we're going to give everybody an equal chance. To be fair, everybody has to feel that they have equal opportunity. Whether you're disabled, transgender, rich, uninsured, a prisoner, or even someone who doesn't have papers to be here, we ought to consider everybody as a potential candidate for the required healthcare resources if they get sick. We don't rule out categories of people.

That has to be asserted, because that makes people support rationing rules. If they think they're getting the bum's rush because of who they are—their religion, their race, their gender—then they're not going to support whatever rules we create. It's important to articulate that and make that clear.

Then, what rules should we follow? Well, in transplant and in other situations of rationing that we encounter due to bombings or hurricanes or natural disasters, we try to use the resources we have to save the most lives.

That's what we do in transplant. We know there aren't many livers. We know there aren't many hearts. When trying to advocate among very seriously eligible people who might benefit, you try to make a medical judgment about who's doing best.

I think that's the first rule that we have to go to when allocating beds and personnel and to try to help somebody in allocating ventilators and other forms of respiratory support. If you are an 85-year-old with four underlying diseases who has just had a heart attack 10 minutes before, you're probably not at the same access in a scarce rationing scenario as a very healthy 25-year-old.

Conversely, if you're a very unhealthy 25-year-old with many chronic diseases, multiple injuries, and who also has a viral infection, and you're up against a 60-year-old with nothing else except the viral infection, then the 60-year-old might trump you. It's not a strict age cutoff. It is basically trying to determine who is likely to do best.

I don't think that even if you're 80 you should be ruled out in principle, nor do I think that if you're 10 you should absolutely go first, no matter what. We have to have medical judgment about who's likely to do well.

I know that medical judgment may be based on incomplete information. You're in the ER; you don't have time to order up all the labs you want; and you may have to make a judgment on the history, the physical, and the presentation, and that's how it's going to be.

Next rule. Well, age does come into play, because young people generally do better than old in terms of responding to treatments. I do think that at that point, once you've made a medical judgment, you can use age as a surrogate for who's likely to do best.

What next? Well, one group is healthcare workers, and I think that can be a tiebreaker, because we want the workforce to be there and we want people to come to work. If, other things being equal, you have two medically suitable candidates about the same age, I would give the nod—and this is me speaking personally—to the healthcare worker. I wouldn't use that as my first criterion to screen, but I'd use it as a tiebreaker.

Those are some of the patterns of thinking that I think are involved in justice. Fairness is giving everybody a shot. Justice is sorting out everybody you've got who might need a resource and using principles that make sense to determine who's going to get a scarce resource.

The third area is whether we have people whom we're not going to consider eligible at all. It could be that someone comes in with a very bad cold or bad infection but is permanently vegetative. It's a kind of disability, but I think someone who has no hope of recovering consciousness or has an underlying cancer that we know is going to kill them in a few days or a week isn't going to make it onto scarce resources either. They're just ruled out because their prognosis is so very grim or their quality of life is so extremely, extraordinarily limited.

Let me be clear: That's not the same as being in a wheelchair or having physical limitations. That's saying that in the case of someone who is so impaired that their quality of life is basically nonexistent, I don't think we want to push resources in that direction.

Another tough dilemma: Once you're on life support, once you're getting the ventilator, what happens if people come in who seem to be better in terms of likelihood to succeed? I think we may have situations where we have to take someone off who has been on for 8 or 9 days of ventilator support and isn't responding, and we have someone who comes in who is young and otherwise healthy and looks like they would do better. We have to be prepared to make very tough decisions about ending support when we might not have under normal circumstances.

It's even been suggested that if someone's on a ventilator and has COVID-19, we automatically make them DNR—do not resuscitate. Well, I'm not ready to go there, because I think you have to still look at that case by case.

If someone has a heart attack, they've been in there for a while, and they don't look like they're doing well, the resuscitation team would have to gear up to protect themselves, and there may not be time to do that. In that case, there may be no crash cart call; I'm not going to ask people to come in under those circumstances and sacrifice themselves. That's a very tough call.

Some hospitals may be able to keep their resuscitation team geared up, relatively speaking, ready to go if that happens. That makes it different from place to place. I don't favor an automatic DNR for everybody who's got the virus and is on life support, but it's going to be likely that the ability to resuscitate them, should they have an arrest, is very limited. We have to understand that.

A few other points. If we're going to roll out these policies, whatever principles are being used at your institution, or in your practice, or that you're involved with, you have to be ready to explain them to the staff clearly and make sure they have support. These are emotionally awful decisions. I would have social work, psychiatry, and psychology ready to talk to the staff.

We also need to have people ready to talk to families. If someone is being told that their loved one's going to die, they need to have support for palliative care and for psychological and emotional support.


Does your living will count under these circumstances? Probably not. We're probably going to have to suspend that. Even if you said in a piece of paper that you want everything, and to do everything, I don't think that's going to hold in a pandemic emergency.

Across the board, there are miserable, difficult, tough decisions that we're going to have to face. We should be ready to be transparent about them. We should be ready to make those decisions. We should be ready to support our peers, our colleagues, and those who work with us in the dining halls and in the laundry so they understand what's going on as much as the doctors and the nurses.

Then, we have to be ready to give emotional support to families, who I think are going to need a lot of it when they face rationing for the first time.

I'm Art Caplan at the NYU Grossman School of Medicine. Thank you for watching.

Arthur L. Caplan, PhD, is director of the Division of Medical Ethics at New York University Langone Medical Center and School of Medicine. He is the author or editor of 35 books and 750 peer-reviewed articles as well as a frequent commentator in the media on bioethical issues.

Follow Medscape on Facebook, Twitter, Instagram, and YouTube
Medscape Business of Medicine © 2020 WebMD, LLC
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Arthur L. Caplan. Who Gets a Ventilator? Rationing Aid in COVID-19 -- An Ethicist's View - Medscape - Apr 08, 2020.
 
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