"Doctors have reckoned with the need to allocate resources in the face of overwhelming demand long before coronavirus."

"[Lydia Dugdale, professor of medicine and director of the center for clinical medical ethics at Columbia University] points out that the New York department of health’s ventilator allocation guidelines, published in November 2015 to address the issue amid a flu epidemic, states that first-come first-serve, lottery, physician clinical judgment, and prioritizing certain patients such as health care workers were explored but found to be either too subjective or failed to save the most lives. Age was rejected as a criterion as it discriminates against the elderly, and there are plenty of cases in which an older person has better odds of survival than someone younger. So the decision was to 'utilize clinical factors only to evaluate a patient’s likelihood of survival and to determine the patient’s access to ventilator therapy.' In tie-breaking circumstances, though, they did approve treating children 17 and younger over an adult where both have an equal odds of surviving.... 'I would say that leaving some to die without treatment is NOT ethical, but it may be necessary as there are no good options,' David Chan, philosophy professor at the University of Alabama at Birmingham, writes. 'Saying that it is ethical ignores the tragic element, and it is better that physicians feel bad about making the best of a bad situation rather than being convinced that they have done the right thing.'"

From "Ethicists agree on who gets treated first when hospitals are overwhelmed by coronavirus" by Olivia Goldhill (Quartz).

Do you think it's right to take age into account only to benefit the super-young — those under 18? Would you choose between a 20 year old and a 70 year old solely on the basis of who is more likely to survive? I suspect the age factor is bundled into the assessment of who's more likely to survive, which would simply hide the disapproved-of discrimination against the elderly. By contrast:

Italy has prioritized treatment for those with “the best chance of success” but adds as a second criterion those “who have more potential years of life.”

Another thing I wonder about is the issue of surviving without the ventilator. What if, for example, X has an 80% chance of surviving without a ventilator and a 90% chance of surviving with it and Y has a 10% chance of surviving without a ventilator and a 60% chance of surviving with it? Does X, the more vigorous person, get the task of struggling to survive without the ventilator? And do you take into account how long a person will need the ventilator? Maybe you could save 2 of my Xs in the time it would take Y to get well or perish.

"My wife got [a print of a boy on a horse asking, 'What is the bravest thing you’ve ever said?' to which the horse replies, 'Help'] for my birthday, and of all the things that we have..."

"... it’s the thing that I cherish quite a bit. It’s the only thing I pass when I leave my bedroom every day when I’m home. And it’s a reminder that strength is not necessarily being physically strong, but it’s asking for help, to be vulnerable, to be the person that I’m not supposed to be, right? And that’s not necessarily a bad thing."

Item #2 on a list of 10 "essential" things in "David Chang Loves Beethoven’s Ninth (but Won’t Finish ‘Infinite Jest’)/The chef, author and television personality, whose second season of 'Ugly Delicious' just arrived on Netflix, also puts a baby monitor, the Bhagavad Gita and 'Gattaca' on his list of essentials" (NYT).

I've been thinking, in this time of forced seclusion, about what it means to help. You can't be helping in person — unless you have a special medical or other relevant in-person service to provide. And most of us can help by just withdrawing and staying out of (literal) touch in the way that might, in normal times, seem churlish or cold. But beyond the negative help of not becoming part of the problem — not spreading the disease or becoming a consumer of medical resources — you can help. You can help by preserving and sharing whatever good thoughts you have that will make it easier for other people to accept and even to prosper within their seclusion.

I'm trying to do that, and I'm also going to push back when I see people who are not helping. I'm not shunning negativity altogether, but I'm trying to use a light touch. You can assume that when I say something like "Is Fox News helping?" (in the comments thread to yesterday's post about Trish Regan), I mean serious criticism of them for stirring up ridiculous unhelpful resistance to the needed social distancing. Ousting Trish Regan for her really stupid, flat-footed nonsense is the least they could do, and I suspect they only did it because it wasn't helpful to them. But I'd say the only reason Regan could be as stupid as she was is that it wasn't that far out of line with the general environment at Fox.

And that's not to say that the other cable news networks are helping. They seem to be trying to keep hating Trump, using any material he gives them, and every day, there's always something. I want them to make common cause with him and help. It's more important than their ratings and it's more important than who wins the next election. It's time to help.

But back to David Chang and the horse that bravely said "Help." Chang likes the idea of strength in terms of vulnerability — of seeing yourself as the one who needs help. I'm pondering how that balances with what I've been thinking about help: We need to be thinking how can I help. It's not inconsistent. Wondering how you can help is different from going about intending to help. What makes you think you're a fountain of help? Your "help" may have negative value. Seeing yourself as the one who needs help is better than imagining yourself as a giver of help when you are not helping.

First, help yourself. That's the #1 form that your helping can take. Next, quit "helping" with help that is not helpful! Use your time of forced seclusion to contemplate what it means to help others. Do you need some help with that?

"For months, as part of a research project into the flu, [Dr. Helen Y. Chu] and a team of researchers had been collecting nasal swabs from residents experiencing symptoms throughout the Puget Sound region."

"To repurpose the tests for monitoring the coronavirus, they would need the support of state and federal officials. But nearly everywhere Dr. Chu turned, officials repeatedly rejected the idea, interviews and emails show, even as weeks crawled by and outbreaks emerged in countries outside of China, where the infection began. By Feb. 25, Dr. Chu and her colleagues could not bear to wait any longer. They began performing coronavirus tests, without government approval. What came back confirmed their worst fear. They quickly had a positive test from a local teenager with no recent travel history. The coronavirus had already established itself on American soil without anybody realizing it. 'It must have been here this entire time,' Dr. Chu recalled thinking with dread. 'It’s just everywhere already.'... Federal and state officials said the flu study could not be repurposed because it did not have explicit permission from research subjects; the labs were also not certified for clinical work. While acknowledging the ethical questions, Dr. Chu and others argued there should be more flexibility in an emergency during which so many lives could be lost. On Monday night, state regulators told them to stop testing altogether...."

From "'It’s Just Everywhere Already': How Delays in Testing Set Back the U.S. Coronavirus Response/A series of missed chances by the federal government to ensure more widespread testing came during the early days of the outbreak, when containment would have been easier" (NYT).

Coronavirus makes medical ethics look like red tape.

I found that article as I was looking for something about the true number of coronavirus cases in the U.S. I see that, right now, there have been 1,039 cases confirmed in the United States, but, as the linked article makes clear, the testing for the virus has been quite limited.