What can Hurricane Katrina's hospital crisis teach us about our COVID-19 response?
Health-care workers in New Orleans were faced with harrowing life-and-death decisions, says Sheri Fink
It's been nearly 15 years since Hurricane Katrina ravaged the American southeast, but New York Times journalist Sheri Fink sees echoes of that disaster in today's COVID-19 outbreak.
Fink won a Pulitzer Prize for her coverage of the harrowing life-and-death decisions doctors at Memorial Medical Center in New Orleans were forced to make during the storm — such as choosing which of their hundreds of patients had to be airlifted to safety first as the building flooded.
A decade later, Fink says doctors and nurses in the U.S. and elsewhere are having similar conversations about how to ration care for COVID-19 patients as medical supplies dwindle.
"These types of dilemmas … are kind of echoed any time that there is a disaster where the needs seem to outstrip the capabilities," she told Day 6 host Brent Bambury.
Here's part of their conversation.
I want to talk about the reporting you did after Hurricane Katrina, 15 years ago. Can you remind us what those doctors were up against?
In this case, the storm hit, [then] the levees failed, which is what allowed the city to fill with water. It's a city below sea level, so it was like a bowl. And this hospital was in one of the lowest parts of the city.
They knew that they could lose power at any time because some of the circuitry for the backup generators was below where the flood level was expected to go.
And so they had to make this choice. They had close to 300 patients. Helicopters could take maybe one or two patients at a time. And who do you choose to evacuate first when you know that you could lose power at any time?
That was the scarce resource, so to speak, in that situation. And then, you know, the creative thinking: How do you find other ways to get people out? How do you find ways to sustain people when you're faced with a situation that really we're not that familiar with — in this country, at least, and also in Canada.
Around the world right now, hospital staff are having very serious conversations about how to decide who gets treatment when there aren't enough supplies. What do you think about the way those conversations are currently unfolding?
We certainly have seen in Italy, for example, [places] where some hospitals were so overwhelmed that doctors described having to choose who got a ventilator, much as the doctors in New Orleans had to choose between patients to rescue.
The other thing that happened in New Orleans — and why this story became such a known story — was that there was a second dilemma that arose. Some of the medical staff were later arrested and accused by the attorney general of Louisiana of second-degree murder — of intentionally hastening the deaths of their patients when they felt that there was no chance they would be rescued.
They always have proclaimed their innocence. I interviewed a couple of doctors who said that, yes, they did this. That is where the legal trouble came: not from making a difficult decision about which patient to prioritize, but actually the intentional hastening of death, which is not currently legal.
And in fact, expert bodies that looked at that case came out and said: "You know, even in a time of disaster, we don't want to cross that line. People can be given comfort."
And so we really need to remember that ... it also takes resources to provide good comfort [and] care if we do run out of things like ventilators [and] potentially lifesaving measures.
I think one of the things that Hurricane Katrina did, and then I would say SARS, was that it raised the awareness that we may end up in situations like this.
So now, started by some work in Toronto and now really spread around the world, [there] have been some efforts to come up with plans ahead of time that would relieve some of that burden of choice is on the frontline providers.
What have health-care workers on the frontline told you about the decisions that they're making right now?
So at least in New York, currently, there hasn't been yet a decision where they've said: "Go ahead and implement the New York ventilator triage guidelines," which New York has had for many years.
So that's a big question: What is the trigger? When do you pull it?
So far, fortunately, the focus has really been on "How do we expand capacity?" Because, of course, you don't want to have to make those tragic choices unless you have no other choice.
So there is just a scramble to obtain ventilators, to be creative, to open up space in hospitals … to be used for expanded intensive care units. And this is the hope — that somehow these measures will prevent those really, really tragic choices from having to be made.
Do you believe that the trigger will need to be pulled on those triage protocols at some point?
I really hope not. I'm seeing such ingenuity and so many efforts to avoid having to do that. The advantage with [those protocols] is that they take some of that moral distress off of the frontline workers who might have to choose between patients.
The other advantage is that they should be transparent. The public would, you know, sort of get a chance to understand how the decisions are being made — not easy if it's your family member who desperately wants that ventilator ... but there is some comfort in that.
The disadvantage is that we really have very little data to suggest that those kinds of protocols lead to a better overall outcome. We hope so, but there's not been a huge amount of research.
And there's some really difficult aspects. A lot of the protocols call for people to be, say, given a ventilator for a certain amount of time, and if they're not improving, to be removed from that ventilator — likely to die — so that the ventilator could be provided to somebody else.
And, you know, when you think about that and the fact that this particular virus can cause an illness that could take two or three weeks, in some cases, for somebody to recover on a ventilator, that's kind of scary to think about people being cycled off of them so quickly.
So hopefully it won't have to come to that. But certainly it is very possible. And that's on a lot of people's minds.
Written and produced by Annie Bender. Q&A edited for length and clarity.
To hear the full interview with Sheri Fink, download our podcast or click Listen above.