Seeking an ethical way to treat our COVID-positive elderly

The catastrophic situation that has arisen in Victoria over the COVID-19 crisis cannot be allowed to continue (“Hospital does not want them”, 13/8).

The Australian reported on Thursday residents in one nursing home who are COVID-positive, but otherwise well, and who wander about and cannot be easily isolated, are being heavily sedated. This is said to be after arrangements had been made to transfer some of these patients to the Royal Melbourne Hospital. The ambulances were then cancelled. The Victorian Department of Health and Human Services is quoted as having said it did not have beds for “those type of patients at this point of time”.

The Royal Melbourne Hospital is attempting to look after these patients in the nursing home with its Residential In-Reach program, but it would be extremely difficult to do this effectively. Coronavirus patients have low plasma oxygen levels that are not clinically obvious. The In-Reach care team would have to include intensive care-trained nurses and, ideally, intensive care medical specialists as well; in addition they would need fingertip oxygen monitors for all the patients, oxygen cylinders and masks, and lots of assistants. If patients infected with Coronavirus also suffer from Alzheimer’s disease they will not co-operate by wearing masks, keeping pulse oximeters on their fingers or accepting oxygen by mask or nasal catheter. This is an acute respiratory disease; sedation to induce compliance is absolutely contra-indicated.

The only way such unco-operative patients could be managed would be if they were sedated, paralysed and ventilated in an intensive care unit. But this is undesirable, unethical and almost certainly unattainable since it would require more intensive care staff and equipment than is available.

A partial solution to this terrible ethical dilemma could be on offer. Australian digestive disease expert Professor Thomas Borody has stated a combination of three commonly used off-the-shelf medicines (Ivermectin, doxycycline and zinc) has been used off-label to treat coronavirus infections in small trials in the US and that the results seem to have been extraordinarily good. These were not the double blind controlled trials used to prove that treatments are safe.

Use of these curative drugs in combination with sedation would be ethical. Relatives and treating doctors would at least feel something was being done to help the patient, a conviction they cannot have at present.

Bruce Jones, surgical and intensive care specialist (retired), Narre Warren East, Vic

It is incomprehensible that Sharri Markson’s article “Hospital does not want them” actually relates to Australia. Having worked in the public and private health care systems, I have never heard of people being denied care on the basis of their age or, in fact, for any reason. Who are these faceless bureaucrats making these decisions? Obviously, Victoria’s Health Minister and Premier have no idea what is going on. It certainly won’t be clinicians making these decisions. It would be different if they were denied care as happened in Italy because there are no beds available. But to tell aged care facilities to put them “on end-of-life care and/or sedation” where there are not sufficient trained staff or facilities to prevent cross-infection beggars belief, especially when a geriatrician has advised the families that beds are available. As far as I am concerned these so-called faceless people need to be called to account. No wonder it has spread through aged care facilities like wildfire.

Glenys Clift, Toowoomba, Qld

In Australia in 2018, approximately 440 people died every day of various causes. Of these about 50 a day died of coronary heart disease, 40 a day from dementia, 20 a day from lung cancer and nearly nine a day from suicide. Up to 20 people a day are dying from Coronavirus, which is a tragedy. But all deaths are a tragedy and we do not print headlines every day because someone dies from a stroke or of Alzheimer’s disease and those deaths are no less significant or cause any less distress for their families.

The obsession with the daily death toll from COVID-19 is unhelpful and just adds to community anxiety, leading to almost a group hysteria about this virus that makes it more difficult to formulate rational policies to balance the risks of the virus against those of economic collapse, which in itself will lead to deaths. This virus is now endemic and we will have to learn to live with it.

Nicholas Ingram, Richmond, Vic