An old doctor friend tells me the age of 60 was the cut off for admission to ICU in the hard-worked public hospital system when he started his training.
The age limit lifted first to 70 as the odds/demands trade-off and medical technology improved.
It subsequently became somewhat undefined.
Decisions about how much effort, money and resources should go into attempting to prolong life are the daily business of the medical fraternity, whether at a very personal level off to the side of an ICU bed, the triage station during an emergency, or at the macro level of setting health budgets.
You could add such decisions to the aphorism about laws and sausages – they’re easier to respect if you don’t see them being made.
Now, under the COVID-driven glare of public attention, everyone with a keyboard and a platform has jumped into the ethical minefield – “it’s mainly the old and sick who are close to dying anyway …”
Subsequent pile-ons have been spectacular, especially with sillier clickbait efforts or when there’s a suspicion of barrow-pushing in the more cold-blooded economic arguments.
So I’d better stake my claim to an opinion early before I’m accused of being a granny killer by mentioning costs.
I left most of my lymphocytes in the Royal North Shore’s Cancer Centre last year. It will be quite a while before they will need to worry about social distancing. My prognosis is good, but the doc says it would be wise for me not to cop a dose of ’Rona.
Thus I have some “skin in the game” when suggesting cost does come into the necessary decisions about how and when the current lockdown will be eased.
And it’s not just a what’s-best-for-business economic case.
There are present medical costs – other people’s lives – involved in minimising COVID deaths.
Otherwise preventable deaths
We see the horror of medical systems overrun in Italy and New York, count the statistics of high death rates there, get caught up in the local blame games – but we don’t see other costs we’re incurring.
For example, the Queensland government has wound back indigenous antenatal programs. That means some gestational diabetes won’t be picked up – potentially at a dreadful cost.
Breast cancer screening has been paused.
Will that mean a cohort of women will suffer from having their cancer detected late?
And there are worse examples from the safe distance of Britain’s National Health Service via the blog of Scottish doctor and self-proclaimed sceptic Malcolm Kendrick.
“Last week, in intermediate care, we sent two patients into the local hospital who were seriously ill,” Dr Kendrick wrote.
“They were both sent back almost immediately. They both died. Yes, they were ill, and may have died anyway. But I believe they should both have been admitted, and treated, and they could both still be alive. They died because of COVID.
“Ambulance crews are under very heavy pressure not to admit anyone unless absolutely necessary. Some of those, not admitted, will die.
“These people, all these people, are dying ‘because of’ COVID. Because of the fact that almost the entire focus of the NHS is now on COVID – to the virtual exclusion of anything else.
“Our local hospital now has more empty beds than at any time in history. Elective surgery has stopped, to free up resources.
“There is enormous managerial pressure to clear more and more people out of hospital, out of intermediate care beds, back home with little support available. Some of them will die because of this.”
The NHS, as good as it is compared with the American disaster, has its own problems.
The Australian medical system isn’t the NHS, but there are elements here of medicine being put on hold in case COVID-19 takes off.
While the public was hoarding toilet rolls, hospitals have been hoarding beds.
So, carefully, the start of easing the lockdown may be in medicine. Some of the cancelled “elective” surgery involves serious quality-of-life issues for people in pain – facelifts are a minor part.
The price of life
In the way we routinely price life and death, the optics of some deaths mean disproportionate resources are devoted to their avoidance.
I wrote in another place three years ago about the cold reality of the price of life, of how avoiding gruesome death gets more money than it deserves – the money we spend on shark nets when the chance of being killed by a shark is remote.
Now our front of mind has images of intubated COVID-19 sufferers drowning in their own fluids. We are appalled by it and prepared to take drastic action to avoid it, but pneumonia is always going about that job among the old and immuno-challenged.
In a March 29 post subsequently reprinted in Australian Doctor magazine, Dr Kendrick goes through the calculated business of QUALs – Quality Adjusted Life Year.
Again, it’s a British example but applies well enough here – we’re blowing our usual QUALy budget on the Rona.
I suspect that’s understandably driven by the fear of the disease taking control the way it has most obviously in Italy and New York.
As civilised people, we can’t countenance sudden wholesale slaughter, society visibly failing so many people, losing control.
Get it under control though, make it something that becomes part of the background, something out of sight and out of mind, like diabetes in our indigenous communities, and a few folk like me and nursing home residents dropping off the perch won’t attract as much attention or care.
I’d prefer not to, as a young 60-something, but they are the odds pending a vaccine. It is what it is – a tricky balancing act of keeping the rate of infection and number of deaths manageable.
Meanwhile, the debate about the cost of fighting the disease has been further muddied by intergenerational sniping – the charge that the debt burden is the Boomer generation’s last cruel kick at young people, that youth are suffering more from the lockdown.
There’s actually plenty of pain to go around.
Yes, youth unemployment will be higher, but the young will have time to get back into work and build savings while older people losing jobs are less likely to get them again and have little time to repair balance sheets that are supposed to sustain them.
Yes, youths are missing their sport and travel for now, but the old are adjusting to the idea they may never travel again.
Yes, there will be debt to be paid off down the track, but much of that debt will come from measures that provide employment for the young and relatively young.
The unemployment benefits and wage subsidies aren’t flowing to many boomers, let alone the 70-year-olds some hint should be tamely surrendered to the virus.
Australia has intergenerational inequalities that have nothing to do with the coronavirus.
They need to be dealt with – bad policies for the nation are bad policies whatever age someone might be.
There are big policy debates to be had as we get used to living with COVID-19.
It’s already a worry that the Prime Minister’s first instinct seems to be doctrinaire conservative: Trickle-down economics and WorkChoices.
People interested in a better future for the nation will need to focus on achieving the better big picture, not sectional grievances.