After reading the autobiography of Ted Ngoy titled “The Donut King” I was delighted to see there is now a documentary of the same name and its executive producer was Ridley Scott so there must have been some serious money behind its production.
Ted Ngoy was a Cambodian military officer in a non-combat position that was training troops in Thailand. While the Khmer Rouge were about to capture the Cambodian capital of Phnom Penh as it was collapsing, he managed to grab a flight on a military plane out of the capital to join his family in Thailand. With $3,000 in their pockets they made it to a refugee camp at Camp Pendleton in California along with 50,000 other Cambodians. America under Ford and Carter were much kinder than the United States of today.
Ngor’s sponsor was a pastor at a Lutheran Church where he worked for $500 a week as a custodian until he obtained a job pumping gas. Then one evening he smelt the most fragrant smell wafting over the gas station. It was from a 24-hour donut shop so bingo a light went off in his head that perhaps selling donuts, which reminded him of one of his favourite Cambodian cakes, was his ticket to the American Dream.
So he took a three month training course at Winchell’s donuts a Californian mega donut chain and they were so impressed they gave him his own store to manage. So with gruelling tenacity he built up the donut shop’s book of business and then left to start up his own shop. California was a great beneficiary of the 1955 US Highway Act and the drive-in culture of California launched the donut business to new heights. In California today there is one donut shop per 7,000 people while in the rest of the United Staters it is 1 for every 30,000 people.
Ngoy opened many donut shops using cheap Cambodian labour of other Cambodians wanting to make the American dream. Then he started leasing donut shops sponsoring many Cambodian refugees. His great legacy is that of the 5,000 or so donut shops in California 90% are owned by Cambodians.
By 1985 Ngoy was making over $100,000 a month and had a net worth of close to 25 million. Therefore he earned the name Donut King and lived like a king until that fateful day he visited Las Vegas and was drawn into the life of a high roller loser losing the shirt off his back admittedly cheating the Cambodian Donut crowd shabbily even forging signatures to fuel his gambling addiction. His wife divorced him and believe it or not he resurged into the donut business a second time making and losing yet another fortune a fact the book reveals but the movie does not. I seem to recall from reading his book after being disgraced he returned to liberated Cambodia for some land development deals and did eventually return to the United States where many forgave him harkening back to the fact he gave them a start.
While the book was more focused on Ngoy the documentary pays more attention to the cloistered Cambodian donut community and the choice many of the sons and daughters of successful donut shop owners about working in the family shop or using their higher education in a more prestigious workplace. Many did stay revolutionizing the conservative Cambodian donut clique with new packaging, new donuts, donut festivals and of course the cronut.
This is not only an interesting documentary about the American Dream but a snapshot of American and Cambodian history and what it takes as a small operator to make the American Dream happen. It is also a warning about the dangers of gambling.
“Thus week by week the prisoners of the plague put up what fight they could. Some like Rambert, even contrived to fancy they will still behaving as free men and had the power of choice. But actually, it would have been truer to say that by this time, mid-August, the plague had swallowed up everything, and everyone, No longer were there individual destinies: only a collective destiny, made of plague and the emotions shared by all. Strangest of these emotions was the sense of exile and of deprivation, with all the cross-currents of revolt and fear set up by these.”
Albert Camus (1913-60) first published “The Plague:” in 1947.
A refrigerated truck leaves the Pfizer plant in Puurs, Belgium December 3, 2020.(photo credit: YVES HERMAN/REUTERS)AdvertisementAt least 110,000 doses of the Pfizer coronavirus vaccine candidate are expected to arrive in Israel before the end of the week and the medical staff at Tel Aviv Sourasky Medical Center will likely be the first inoculated.On Tuesday, Sourasky director-general Prof. Ronni Gamzu confirmed for The Jerusalem Post that the hospital could begin vaccination even before the vaccine receives US Food and Drug Administration (FDA) approval. He said he could administer the vaccine early because it had already been approved in Britain.However, Health Ministry director-general Chezy Levy told the Post that beginning vaccination in any place ahead of FDA approval was forbidden. He added that the country had still not finalized the list of who would be prioritized to receive the vaccine first.”We hope that in the coming days, there will be FDA approval,” Levy said.The FDA advisory panel is set to review the Pfizer vaccine on December 10.”The vaccine is safe for every person on an individual level and for us as a company at the national level,” wrote Gamzu on Twitter. “I am proud to receive this treatment first as part of the global technological advancement. I am convinced that leading by personal example will help gain public trust so all citizens take the vaccine for their health.”https://platform.twitter.com/embed/index.html?dnt=false&embedId=twitter-widget-1&frame=false&hideCard=false&hideThread=false&id=1336276338798432259&lang=en&origin=https%3A%2F%2Fwww.jpost.com%2Fbreaking-news%2Ftwo-individuals-die-from-pfizer-vaccine-651488&siteScreenName=Jerusalem_Post&theme=light&widgetsVersion=ed20a2b%3A1601588405575&width=550px Gamzu received sharp criticism from the Israel Medical Association, whose head Zion Hagay said in a statement that the move was “irresponsible” and will have the opposite of its intended effect – that it will “erode public trust.”The exact day that the Pfizer vaccine will land in Israel is still unknown. The Hebrew website Ynet said Tuesday that the first doses could arrive as early as Wednesday. Kan News reported their arrival would be Thursday.The vaccines are supposed to arrive on a special flight via the DHL shipping company and be directly transferred to the Teva SLE Logistic Center, where they will be stored and then distributed throughout the country.Pfizer vaccines are made of messenger RNA (mRNA) and are required to be kept frozen at negative 70 degrees Celsius. Israel has purchased eight million doses of the Pfizer vaccine – enough to vaccinate four million people.Last week, Levy said during a video meeting with the country’s hospital administrators that some four million doses could arrive before the end of the month. But he said then that although they could come even before they are approved by the FDA, no one will be inoculated before approval.Ahead of the Thursday meeting of the FDA on the Pfizer vaccine, the administration announced Tuesday that two trial participants have died after receiving the Pfizer coronavirus vaccine. One of the deceased individuals was immunocompromised.This information was obtained from documents released on Tuesday by the FDA.The documents were released ahead of a meeting on Thursday of outside experts who will debate whether emergency authorization for the vaccine should be granted.The FDA also said on Tuesday that the data they’re presented with is in line with emergency use authorization, raising hopes for Thursday.At the same time, the FDA said that there currently is not enough research to guarantee the vaccine’s safety for immunocompromised groups, pregnant women and children.Israel’s Midaat Association responded to the report on the deaths, explaining that when vaccines are administered to at-risk populations “there may be unfortunate cases. One should not infer from this about the safety of the vaccine but welcome the transparency required from the pharma companies in the drug approval process.”The association noted that in large trials of tens of thousands of people, death can occur without any connection to the trial, but that companies like Pfizer are required to report those deaths.“According to the published data, six of the participants in the experiment died, two of whom received the vaccine and four of the control group,” said Dr. Uri Lerner, the scientific director for Midaat. “After an in-depth examination, no connection was found between the experiment and the cause of death.”Hospitals across the country are preparing to receive the Pfizer vaccine and inoculate their staff. Baruch Padeh, Barzilai, Wolfson and Soroka medical centers all announced that they were ready for the vaccine to arrive. Baruch Padeh held a preparatory meeting Tuesday morning and sent the it’s 1,500 staff members a message, “We are all getting vaccinated.” “We who are at the forefront of the war against coronavirus should be the first to be vaccinated,” said Erez Onn, director-general of Baruch Padeh, “so that we can continue to give professional and dedicated care… We are the ones who should serve as an example to the entire public.”Wolfson’s Dr. Anat Angel said that the vaccination process for its more than 3,000 employees would be documented and carried out “immediately and without any delays.”“Having succeeded well above average in previous years with staff vaccinations against influenza … I am sure, beyond a doubt, we will also lead in vaccinations against the coronavirus,” she said. The hospitals said that they would receive the vaccinations and inoculate staff with their first does right away. There would be a 28 day waiting period before administering the second dose. Getting the vaccines to the hospitals will be handled by the Teva SLE Logistic Center, which the Knesset’s State Audit Committee visited on Tuesday. “The eyes of the entire State of Israel are here,” said committee chairman MK Ofer Shelach during the visit. “This is the most important and extensive national project since the beginning of the coronavirus crisis.”He said that the visit left him feeling that “the company is unusually prepared and professional. I sincerely hope that it will continue like this.”Yossi Ofek, CEO of Teva Israel-SLE, agreed and said, “there is no room for error here. We understand the magnitude of the responsibility.”Prime Minister Benjamin Netanyahu also spoke about the vaccines again on Tuesday, stressing that although the vaccines are almost here and the country is starting to hopefully see the end of the pandemic, “as in war, when we see the end of the war, we must not lose people. People will die and will be stricken with a serious disease for no reason – it is possible to prevent this.”He called on the country to continue social distancing, wearing masks and following the Health Ministry rules even as the first vaccines arrive in Israel. Reuters contributed to this report.
Fatal COVID Vaccination fatalities are on many minds except those that blindly believe a fast tracked FDA or Health Canada approval acts like a magic protective bubble. Yet a December 8th FDA briefing paper for a December 10, 2020 meeting of the Vaccine and related Biological Products Advisory Committee (VRBPAC) on page 41 reveals fatal outcomes of COVID-19 vaccines on page 41 reproduced below. What did the Duty Sargent say in the long deceased “Hill Street Blues”….”Be careful out there”.
Perhaps a fairer point of comparison would be what is the risk of a COVID death if one isn’t vaccinated? And one must of course not use death of COVID-19 control group members but also the 21 adverse affects in the control group reported in the October 22, 2020 VRBAC meeting.
Then as a last point what is the risk to the hospital system of non vaccination.
Of course there is always the civil rights question of mandatory vaccinations and non mandatory vaccinations with social penalties attached to that such as lack of mobility, restricted access to health care and denial of social benefits that in reality may force vaccinations even where governments say the vaccination is not mandatory?
Pfizer-BioNTech COVID-19 Vaccine VRBPAC Briefing Document Serious Adverse Events Deaths A total of six (2 vaccine, 4 placebo) of 43,448 enrolled participants (0.01%) died during the reporting period from April 29, 2020 (first participant, first visit) to November 14, 2020 (cutoff date). Both vaccine recipients were >55 years of age; one experienced a cardiac arrest 62 days after vaccination #2 and died 3 days later, and the other died from arteriosclerosis 3 days after vaccination #1. The placebo recipients died from myocardial infarction (n=1), hemorrhagic stroke (n=1) or unknown causes (n=2); three of the four deaths occurred in the older group (>55 years of age). All deaths represent events that occur in the general population of the age groups where they occurred, at a similar rate.
It all started out not too badly at my first largecorp
My first legal job was in the mid eigthies with an up-and-coming insurance company in downtown Toronto by the name of Canadian Reassurance Assistance Providers Ltd. or as many referred to it simply as CRAP.
CRAP was initially a regional insurance company in Southwestern Ontario but a series of very innovative advertisements touting its easy accessibility seemed to grab the attention of the retail customers it sold insurance to. It was a revolutionary approach in the 1980’s where insurance companies were big, fat, rich, customer unfriendly and arrogant.
CRAP was held by a holding company, Bleedco Ltd., that controlled its various companies like a stack of cards. Bleedco was what one might call (by today’s standards) an unethical company as some investment managers categorize companies to invest in as aside from holding CRAP it owned companies in the armament, tobacco, South African goldmining, coal, Las Vegas casino and alcohol sectors.
I distinctly remember a colleague of mine at CRAP was making small talk in the CRAP Toronto office elevator to a senior management type visitor from Bleedco. The man from Bleedco reeked of alcohol and somehow let it slip, “We are going to clean you up and sell you off.” Prophetic words for a young buck like me! Why he blurted that indiscrete comment still puzzled me but I took it as a valid and potentially dangerous statement.
I worked in the institutional division of CRAP but there was also the retail division that sold insurance to the public. The retail division was pulling in an increasingly burgeoning profit while the institutional division was its poor cousin.
The institutional division had a half dead Montreal office, a thriving Toronto Bay Street office, a once powerful and now notional head office location in Waterloo, a decent Calgary office and a struggling Vancouver office. The retail division was present in every province of Canada and had many bricks and mortar locations.
So here I was at CRAP newly recruited and knowing virtually nothing about our institutional main lines of businesses being that of selling insurance policies of diverse types to mid size businesses and even better to largecorps. We also sold annuity policies and recordkeeping services to employers sponsoring pension funds and other types of employee benefit funds. Most importantly we also provided segregated funds as investment options to defined contribution and defined benefit pension plans. These segregated funds were managed by professional investment managers CRAP retained.
My notional boss was Mr. Thomas Bang who was a lawyer but had made the jump to management as an executive vice president. He loved nothing more than to roam the floor asking where that miserable wretch of the day was. All in good humour that took a bit of time to get used to. He was a quirky but almost a likeable man. Unlike his Senior Management Team (SMT) colleagues, he was not afraid to take the elevator down from the CRAP executive floor and occasionally mingle “with the troops”.
Bang inhabited the executive suites on the top floor of the building. This was the home of SMT for both the retail and institutional divisions of CRAP. A sacred sanctuary with each office having its own bathroom and shower not to mention a splendid high-tech boardroom, well stocked refrigerators and liquor cabinets.
The cadres of the institutional division of CRAP were all in cubicles except for the Assistant Vice President of CRAP’s institutional division Frank Flansky who rarely showed his face as he spent all day crunching numbers cloistered in his office. He was obviously very awkward dealing with people and left that to my real boss Tommy Afar who was chief manager of the CRAP institutional division. Flansky recently arrived from Poland and his English was exceedingly difficult to understand. What he lacked in English and social skills he certainly made up for in mathematical abilities.
My job was to provide solutions on how CRAP institutional could do its business in accordance with the law. Afar was initially very frustrated with me as I simply gave options without making recommendations which was the preferred solution. He had a valid point! It was time for me to move from theory to reality.
I was a new legal resource to the business unit for the institutional division. Although I was called “Legal Counsel” I was working with and as part of the business unit. The business unit had vehemently complained of the arrogance of CRAP’s Legal Department and its incapacity to provide coherent and timely legal advice to the point that the SMT caved in and brought me into the business unit.
Apparently, John Beluga, CRAP’s General Counsel, was furious about having someone with the title of “Legal Counsel” operating outside his Legal Department however I had the impression those in the executive suites took him as a bit of a buffoon and used him to get approval to do business in a questionable fashion. He started his day in the gym and popped in the office at 10. a.m. went for long lunches and left promptly at 5. He struck me as, intellectually weak, easily manipulated and totally out of his league.
On important legal matters I was to deal with Sally Self in the Legal Department. With the backing of the SMT and according to Beluga’s demands there was no power struggle I had to fight. I lost right off the bat. Sally Self was my informal superior on all legal matters deemed significant by Self. This was rather hurtful to me as I had more than five year’s experience than the newly minted Self. In retrospect I should have walked out the door.
Working in the business unit, I gained valuable experience about how to get the job done within acceptable legal parameters. I was the go-to guy. Approachable, friendly and useful so unlike the service they were previously obtaining from the Legal Department. In the right circumstances with the right people CRAP life was not bad. I worked hard and enjoyed myself for close to a decade.
But after a few years I began to see what CRAP enjoyed doing to its employees For example there were the countless non-monetary incentive programs invented by CRAP’s Human Resources Department.
I recall one of them was the Service Award Games where gold, silver and bronze medals were handed out based on set criteria and medals were hung on the necks of the winning team. Another one was the weekly Client Delight Letter ceremony where we all gathered to hear a letter written by a client praising some aspect of our service. Of course, no monetary awards just subtle pressure to show how wonderful you were. What were those clowns in the Human Resources Department thinking of?
Although these campaigns were initially comical to the novice, they became annoying then obviously oppressive particularly with one campaign where employees were required to wear Mickey Mouse ears. Whatever for I am not quite sure. Being a lawyer, I was fortunate enough to be on the edge of most of this palaver and largely unaffected by it. Morale boosting it was thought to be but morally degrading was more like it.
After 5 years as Legal Counsel I received a promotion to Manager of Compliance for the institutional division. However, in addition to this new onerous position I continued to provide legal services to the business unit. Another largecorp lesson which is to load up as many responsibilities on an employee as possible at minimal cost. I had no one to delegate to and all this new responsibility for an extra $2,000 a year.
Speaking of money, a competitor offered me a position for $10,000 more than I was currently earning. I had the job offer and just had to sign the offer but upon reading the offer there was a probationary period. This for someone with close to 7 years of experience! I wanted this clause removed in their offer but their wonderful Human Resources Department insisted upon keeping the probationary clause in so we parted our ways.
CRAP’s Human Resources Department was also whittling down a once generous stock purchase plan where initially there were matching contributions by CRAP to those made by employees. Year after year CRAP’s contribution requirements dwindled and then a vesting period was imposed to get your hands on the shares whereas previously once the shares were awarded to you they were yours. Eventually they terminated the plan without raising salaries. Perhaps that inebriated Bleedco guy on the elevator had more truth than the vodka fumes would otherwise suggest. When you sell a company you cut costs down to the bone so your profit looks bigger than ever. A stock purchase plan with generous matching contributions by CRAP made CRAP a more expensive acquisition target…less of a bargain you might say.
CRAP’s institutional division was really doing well running from fourth position to a dead heat with the competition for first place all done in just short of a decade. Profits had quadrupled in 10 years. To be part of the team that accomplished this was rewarding to many employees despite no true financial rewards being extended to CRAP employees contributing to this remarkable growth.
All in all, I had an enjoyable time working in the business unit aside from the service campaigns and the poor compensation.
Then three things happened that caused me concern.
The first was that a new Vice President, Myra Pigall, was appointed for our division. She had no experience in the industry as she had been an accountant in her previous positions and spent all her time behind closed doors. She started interviewing employees asking them what they did. Suddenly there were a rash of terminations. Once again cost cutting and cleaning up. As a target for purchase a business unit making a billion dollars in profit with a low expense ratio is more attractive for a purchaser than one with a higher expense ratio. It soon became obvious Pigall’s snout was rooting out expenses to be trimmed like a pig hunting for truffles.
The second event was the termination of Beluga as CRAP’s General Counsel and his replacement being Felicity Poker. Poker was a hot shot corporate lawyer with a law firm that was Bleedco’s major external law firm in Calgary, Ooze & Ooze. I was commandeered into her Legal Department and no longer reported into the business unit.
The third was dealing with a major client of CRAP that wanted a refund of expenses it had paid us as a recordkeeper for its pension fund. Ooze & Ooze was CRAP’s legal counsel for this matter. The lawyer from Ooze & Ooze, Brian Cochon, had stated to me, “You repay that money or we will have you terminated.” I assumed “you” meant CRAP. As Cochon was once a partner with Poker at Ooze & Ooze my assumption should have immediately be seen as incorrect.
A very, very dark place’: Hospitals brace for crisis-care mode with too many patients, not enough staff
Ken AlltuckerUSA TODAY0:190:49https://imasdk.googleapis.com/js/core/bridge3.427.1_en.html#goog_1634236857
COVID-19 deaths and hospitalizations are at record levels, and the rising case toll from Americans’ holiday travel has created an unprecedented surge with no relief in sight.
The problem is especially ominous in the nation’s intensive care units – specialized units crowded with a record number of critically ill Americans as the nation struggles through the most dangerous phase of the pandemic.
On Thursday, California announced stay-at-home orders for regions where intensive care units are nearly full. A growing chorus of medical experts say hospitals and states must prepare to shift to crisis-care mode, a designation with standards for hospitals to navigate life-and-death decisions when they become overwhelmed.
Crisis standards mean hospitals with too many patients and not enough staff likely will need to triage patients, prioritizing care to those mostly likely to benefit when demand outstrips resources.
New York hospitals struggled to adapt to staff and equipment shortages during the deadly spring months. And although hospitals now have more drugs, equipment and expertise, strained medical staffs could limit the number of Americans who get timely care.
“What we see now is just the beginning of the post-Thanksgiving peak,” said Eric Toner, senior scholar with the Johns Hopkins Center for Health Security. “It’s going to be huge, and it’s going to be awful.”
Of the 100,667 hospitalized with COVID-19 as of Thursday, 19,442 were in ICUs – the largest number of critically ill patients since the pandemic began, according to COVID Tracking Project figures. More than 267,000 Americans have died, including 2,879 on Thursday – a new daily record.
U.S. Centers for Disease Control and Prevention Director Robert Redfield said this week that deaths could reach 450,000 by February.On Friday, the agency released a summary of public health recommendations to reduce spread of the coronavirus, such as masking and avoiding nonessential indoor places. Get the Coronavirus Watch newsletter in your inbox.
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Hospitals already are employing strategies to stretch resources. Utah hospitals have canceled surgeries and shifted staff to makeshift ICU units to care for the growing number of COVID-19 patients. North Dakota’s rural hospitals, short on available beds and expertise, in recent weeks transferred patients to surrounding states. And in Colorado, Gov. Jared Polis signed an executive order authorizing the state health department to order at-capacity hospitals to halt admissions and transfer patients.
In the spring, when New York City became the epicenter of the coronavirus pandemic, health care professionals flocked to the Big Apple to help besieged hospitals. But with a limited pool of nurses, doctors and respiratory therapists available for temporary gigs, experts say it’s unlikely hospitals will get meaningful relief from out-of-state practitioners.
Toner said the nation’s stretched health care workforce is “our most critical scarce resource.”
“We have ventilators. We’re doing better with PPE and supplies,” he said. “But we have no way to significantly expand our staffing.”
That is what worries public health officials. The next three months will be “the most difficult time in the public health history of our nation,” Redfield said.
Last week, Johns Hopkins published an extensive study of New York City’s hospitals during the pandemic. The study, led by Toner with input from 15 ICU directors, described gut-wrenching choices, such as when to extend or end life-sustaining care for patients.
The Association of American Medical Colleges this week urged medical schools, hospitals and states to plan or implement crisis standards to battle the latest surge – expected to be the most widespread and deadly of the pandemic.
New Mexico’s ICU beds were at 103% capacity as of Thursday, the highest rate in the nation, according to U.S. Department of Health and Human Services figures.
Hospitals used extra space in emergency departments and operating rooms not licensed for bedsto accommodate patients, but Clark said the major bottleneck is finding enough doctors, nurses and respiratory therapists to care for them.
COVID-19’s effect on health care workers is far greater now than during the spring or summer. Hospital workers can be infected at home or in their communities. Even if they are not sick, workers exposed to the virus often wait up to four days for test results, Clark said.
“That’s where we’re stressed across the state of New Mexico right now,” he said. “While there may be physical beds, there is not a nurse, a nurse tech or respiratory therapist to care for those patients.”
In North Dakota, Gov. Doug Burgum issued an order last month allowing staff who test positive for the virus but show no symptoms to keep caring for COVID-19 patients.
Other states are trying to fill shortages with contract employees who travel out of state for temporary jobs.
Competition is so fierce Clark estimates 70% of contract workers who commit start jobs at their preferred hospitals. With staffing agencies commanding salaries up to three times normal for these positions, there might be multiple lucrative offers for gig employees to choose.
When cases surged in June and July, travel nurses and other temporary workers with Banner Health, Arizona’s largest health provider, filled shifts. With cases again on the rise, the Phoenix-based health system hired 1,500 and is seeking another 900 contract workers, but Chief Clinical Officer Marjorie Bessel acknowledged it’s difficult.
Rhode Island opened two temporary field hospitals with a capacity of almost 1,000 beds to alleviate crowded conditions. Lifespan’s Rhode Island Hospital, which operates a 600-bed field hospital in Providence, hired temporary nurses, nursing assistants respiratory therapists and pharmacy technicians. The state’s hospitals are the fullest in the nation, with 88% occupancy, according to HHS.
“Our staffing issues are significant,” said Cathy Duquette, a Lifespan executive.
Hospitals coast to coast are facing similar staffing challenges, experts say.
“In the past, you could anticipate the cavalry coming,” AAMC’s Orlowski said.
Unlike past crisis situations when health care workers traveled to New Orleans after Hurricane Katrina or to New York this spring, doctors and nurses are needed close to home.
“Reinforcements from other parts of the country aren’t going to be possible now,” Toner said. “For the most part, hospitals will have to deal with the staffing they have.”
Hospitals increasingly must stretch staffing to meet the realities of the surge.
In California, several hospitals have applied to loosen the state’s mandatory nurse-to-patient staffing ratios because of COVID-19-related patient increases and staffing shortages. Last week, Antelope Valley Hospital in Lancaster gained state approval to relax staffing ratios, drawing criticism from a nurses’ union that said the move put patients at risk.
But hospitals will continue to seek ways to stretch resources under crisis-care scenarios, experts say.
Nursing home residents who need to be hospitalized might find such stays are shortened, Orlowski said.
And when things get really tight, hospitals need to choose who gets life-sustaining therapies. A person with minor ailments might get treatment while a person with several preexisting conditions and low oxygen might not.
If doctors determine a person’s chances of death are significantly high, “they may say, you know what, we are going to use our resources not to do this miraculous save, but we’re going to concentrate our resources on people we know who will be improved by our care,” Orlowski said.
New York hospitals struggled with similar decisions when allocating ventilators and kidney dialysis for lifesaving care during the worst days this spring.
According to the Johns Hopkins report, some hospitals did not have clear written guidelines on ventilators when “capacity became limited.” Doctors had to decide whether to intubate, or insert breathing tubes into people, and which type of ventilator to use. In some cases, hospitals had the equipment but not enough staff.
The same was true for COVID-19 patients suffering kidney failure. Therapy was in short supply for these patients, so doctors had to triage, or choose whether kidney failure patients would get two or three days of dialysis, according to the Johns Hopkins report.
During the summer surge, Banner Health in Arizona faced a shortage of ECMO machines. Extracorporeal membrane oxygenation machines are a last-ditch therapy for those whose lungs are damaged and they can no longer effectively breathe with a ventilator. The machine pumps blood to an artificial lung, adds oxygen and returns the blood to the patient.
ECMO machines are limited sodoctors across several hospitals work together to try to maximize use of the therapy. But based on the trajectory of the surge in cases, Bessel said it’s “very likely” some won’t get access.
When the crisis worsens and if hospital must triage limited services, “it’s a very, very dark place to be for health care systems, for patients, for families,” Bessel said. “That’s why mitigation and other tactics right now are so important to try and flatten the curve to reduce the likelihood that we get to a point where we need to operate in such a fashion.”
Dr. Amesh Adalja, a senior scholar at Johns Hopkins Center for Health Security, said hospital administrators face tough choices.
“You have to think about capacity on a day by day basis, because we don’t see this surge ebbing any time soon.”
Ken Alltucker is on Twitter as @kalltucker or can be emailed at alltuck@usatoday.com
” Fledging moralists in those days were going about our town proclaiming there was nothing to be done about it and we should bow down to the inevitable. And Tarrou, Rieux and their friends might give one answer or another, but its conclusion was always the same, their certitude that a fight must be put up, in this way or that, and there must be no bowing down. The essential thing was to save as many people as possible from dying and being doomed to unending separation. And to do this there was only one resource: to fight the plague. There was nothing admirable about this attitude: it was merely logical.”
Albert Camus (1913-60) first published “The Plague in 1947.
“In the early days, when they thought that this epidemic was much like the other epidemics, religion held its ground, But, once these people realized their instant peril, they gave their thoughts to pleasure. And all the hideous fears which stamp their faces in the daytime are transformed in the fiery, dusty nightfall into a sort of heroic exaltation, an unkempt freedom fevering their blood.”
Albert Camus (1913-60) first published “The Plague” (la Peste) in 1947.
“Everybody knows that pestilences have a way of recurring in the world: yet somehow we find it hard to believe in the ones that crash down on our heads from a blue sky. There have been as many plagues as wars in history. Yet always plagues and wars take people equally by surprise.”
Albert Camus (1913-60) published “The Plague in 1947.
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