The old adage “the darkest hour is just before the dawn” dates to 1650 and generally is attributed to English theologian/historian Thomas Fuller.
While it isn’t technically correct – it’s actually darkest closer to midnight – it’s often true in the course of human events that things often get worse before they get better. That’s true even when we have every reason to believe they will get better.
And right now, as we deal with a crushing COVID-19 pandemic, we should be focusing on trying to control just how dark it will get while also looking forward to better days.
Case in point: acting Department of Health Secretary Billy Jimenez’s emergency order recognizing the need for crisis care standards for rationing medical care in New Mexico, while at the same time providers should begin administering a vaccine for COVID-19 here this month.
Drastic and frightening as it was, the crisis standard of care order was the right move as COVID-19 cases and deaths have hit record levels and hospitals are strained to capacity or beyond. Even though cases have dipped slightly in the past week, they are still running far ahead of levels seen in the spring. We are not far off 2,000 deaths, and the number of hospitalized COVID patients is hovering around 1,000.
“Presbyterian continues to exhaust every possible avenue … to care for as many patients as possible during the pandemic,” said Dr. Jason Mitchell, chief medical officer of the state’s largest health care provider network. “This is an incredibly concerning time for our entire community, and especially for our clinicians and staff. We will care for our patients as safely and effectively as possible.”
But there is a limit. New Mexico’s doctors, nurses and hospitals can only provide care for so many sick people – and heart attacks, strokes and burst appendixes don’t take time off because of COVID – before tough decisions have to be made.
Under the emergency order, providers are bracing for the dark possibility of rationing by setting up triage boards and scoring tools to determine which patients get priority if the demand for ventilators or some other medical treatment exceeds supply. The criteria is tied to a patient’s chance of survival, not age, occupation, gender or ability to pay.
Dr. Denise Gonzales, medical director at Presbyterian, says the tool will be “as free from bias as it possibly can be.” But the results may not give that appearance since COVID-19 deaths have been much higher among the elderly and Native Americans – raising the question of whether the fact those groups at far higher risk to begin with will fare worse when plugged into the assessment tool.
But there is still a chance we can avoid having this measure of last resort become a reality.
Gov. Michelle Lujan Grisham’s office said health officials are expecting to get an initial batch of more than 17,000 doses of the Pfizer vaccine this month that would be targeted at front-line health care workers statewide in accordance with a state vaccine distribution plan. Federal regulators were expected to green-light the Pfizer vaccine this weekend, and others should soon follow. State lawmakers have approved $10 million for vaccine distribution and other pandemic-related expenses.
So yes, it would appear the dawn is coming. The vaccine is what Dr. David Scrase, the governor’s top adviser on the pandemic, describes as the “end game.” But it will take time to roll it out, and it will require two doses a couple weeks apart to provide the necessary level of immunity. And some people will refuse to get it. Best guess is it will be late spring or early summer before it takes hold in the population.
Meanwhile, we can avoid or at least lighten Fuller’s “darkest hour” by avoiding gatherings, limiting travel and group activities, wearing masks and social distancing. It’s not that hard. If you don’t want to do it to protect yourself, do it to protect others.
The risk is all too real. Federal data released last week on the percentage of beds occupied by COVID patients in hospitals, including both general and intensive care admissions, show five New Mexico counties rank close to the top: McKinley ranks 21st, Sandoval 34th, Cibola 58th, Rio Arriba 103rd and San Juan 108th. Infections and deaths are once again soaring on the Navajo Nation. Bernalillo County had 560 new positive tests Friday, bringing its total cases to 33,137 and deaths to 412.
“Our hospitals are full,” said Dr. Vesta Sandoval, chief Medical Officer for Lovelace Health System in Albuquerque. “We do not want to have to take this last step. We do not want to ration care.”
That would be the darkest hour. And it is within our power to keep it from happening.
This editorial first appeared in the Albuquerque Journal. It was written by members of the editorial board and is unsigned as it represents the opinion of the newspaper rather than the writers.