新型コロナ、米で病院ベッド不足の可能性　患者選別への懸念高まる

【ワシントンＡＦＰ＝時事】新型コロナウイルスの感染拡大により、米国の病院でベッドや人工呼吸器、マスクなどが不足する可能性が出ており、患者を選別して治療を行う必要性が今後出てくるのではないかと医師らは危惧している。（写真は資料写真）
　ハーバード公衆衛生大学院の外科医で助教授のトーマス・ツァイ氏は、パニック買いやトイレットペーパー不足による不安が広がっていることを指摘し、「病院から防護服や人工呼吸器がなくなり、同じようなパニックが生じたらと想像してほしい。自分が心に描いているイメージはそれだ」と懸念を示した。
　米国内ではこれまでに新型コロナウイルスの感染者４２００人、死者７３人が確認されているが、感染者数・死者数ともにピークから程遠いことは明白だ。
　しかし経済協力開発機構によると、世界の経済をリードする米国の病院ベッド数はわずか１００万床で、これは人口１０００人に対し２．８床の割合にすぎない。この割合は感染流行によって深刻な影響を受けている韓国（１２．３床）、中国（４．３床）、イタリア（３．２床）に比べ、はるかに少ない。
　また米国病院協会によると、集中治療室（ＩＣＵ）のベッド数は１０万床に満たず、すでにほとんどが空いていないという。
　米保健省は、感染者のおよそ５％に病院での集中治療が必要になるとして、ＩＣＵのベッド数は感染状況が穏やかな場合で少なくとも２０万床、深刻な場合であれば最大２９０万床が必要になると推測している。
　また重症患者は人工呼吸器を必要とする場合が多いが、米国の病院には１６万台ほどしかなく、こちらも全く足りていない。
　米メディアの報道によると、ドナルド・トランプ大統領は１６日、新型コロナウイルス対策をめぐって州知事らに対し、連邦政府を頼らず、各自で医療機器を買いそろえるよう要請した。
　このような状況から、医療従事者の中には今後恐ろしい決断を下さざるを得なくなると不安になっている人たちもいる。
　ジョンズ・ホプキンス大学のバーマン生命倫理学研究所で副所長を務めるナンシー・カス氏は、医療従事者がベッドや人工呼吸器を割り振る決断に迫られた場合、「モラルストレス」に陥る危険があると指摘。医師らを一人でそのような恐ろしい選択に直面させないよう、事前にガイドラインを作成するよう当局に呼び掛けている。
　また、軍の活用を検討している人もいる。アンドルー・クオモ・ニューヨーク州知事はトランプ氏に宛てた公開書簡で、「素早く対処しなければ、すぐにでも医療システムが崩壊するのは確実だ」と指摘。
　さらに「われわれが期待していることは、陸軍工兵隊を活用して軍事基地や大学の寮といった既存の施設を改装し、一時的な医療センターとして機能させることだ。そうすれば今ある病院のベッドを重症患者に割り当てることができる」と主張している。【翻訳編集ＡＦＰＢＢＮｅｗｓ】
〔ＡＦＰ＝時事〕（2020/03/18-12:37）

Beds, ventilators and masks soon could all be in short supply in US hospitals rocked by the novel coronavirus, with doctors worrying they may have to start choosing which patients to treat.
You have seen empty shelves in grocery stores, and the stress created by the lack of toilet paper, said Thomas Tsai, a surgeon and assistant professor at Harvard's School of Public Health.
Imagine that same panic if hospitals became empty of protecting gears for physicians, and ventilators. That's the mental image I think about if the crisis deepens, the hospital doctor told AFP.
A lot depends on what will happen in the next few days, in the next few weeks.
There are 4,200 confirmed cases of COVID-19, the official name for the virus, in the United States, and 73 deaths, numbers which no doubt are far from their peak.
But the leading global economic power has only one million hospital beds, which works out to 2.8 beds per 1,000 inhabitants -- far less than other countries that have been severely affected by the pandemic (12.3 beds in South Korea, 4.3 in China, 3.2 in Italy), according to numbers from the OECD.
As for intensive care unit (ICU) beds, there are fewer than 100,000 beds, the vast majority of which are already occupied, according to the American Hospital Association (AHA).
The Health Department estimated that the US would need at least 200,000 ICU beds for a moderate crisis and up to 2.9 million for an acute one, since about five percent of COVID-19 patients require intensive care hospitalization.
- 'Nightmare' -
Intensive patients also often require ventilators to help them breath, but the US has only 160,000 such machines, another vastly insufficient number.
According to US media reports, President Donald Trump on Monday urged state governors to buy their own medical equipment to fight the coronavirus, instead of counting on the federal government.
Under these conditions, some medical professionals are afraid they will soon have to make chilling decisions.
In an essay titled The nightmare of rationing healthcare, published in The Washington Post, doctor Thomas Kirsch recalls waking up with a start, 10 years after a mission in Haiti where he had to decide which patients to give priority treatment.
Health professionals will be under moral stress if it falls on their personal shoulder to allocate beds or ventilators, said Nancy Kass, the deputy director of the Johns Hopkins Berman Institute of Bioethics. She called on authorities to implement guidelines in advance so as not to leave doctors alone in the face of such harrowing choices.
- The army -
We still have an opportunity to prevent the worst-case scenario, said Tsai.
If we are serious about social distancing, we have an opportunity to flatten the curve, the oncology surgeon said, referring to the isolation measures taken over the past week.
To free up resources, hospitals are seeking to minimize patient visits with remote diagnoses, but above all to postpone any non-urgent medical interventions.
I have spent the morning calling upon my patients letting them know, if their operation could wait a couple of months, let's postpone, said Tsai, for whom these efforts could result in a 25 percent increase in bed capacity.
Others are considering employing the army. Without immediate action, the imminent failure of hospital systems is all but certain, said New York governor Andrew Cuomo on Sunday in an open letter to Trump.
Our best hope is to utilize the Army Corps of Engineers to leverage its expertise, equipment and people power to retrofit and equip existing facilities -- like military bases or college dormitories -- to serve as temporary medical centers. Then we can designate existing hospital beds for the acutely ill, Cuomo urged.
In the same vein, Joe Biden, the frontrunner to become the Democratic presidential nominee, called on soldiers to build field hospitals.
Trump has yet to respond.
Meanwhile, multiple hospitals in states ranging from California, to Florida, to North Carolina, have begun setting up tents outside their entrances to conduct initial screenings before patients enter the building.