Official admits tough life or death decisions might have to be made

The Bahamas is close to reaching the point where healthcare workers might have to decide who lives and who dies due to the strain placed on the system by the COVID-19 pandemic, according to Dr. Nikkiah Forbes, director of the National HIV/AIDS and Infectious Disease Programme.

“At this time, I haven’t seen a patient die because we haven’t been able to support them and pick someone else who has had to live,” said Forbes during a Ministry of Health press conference on Friday.

“But I will tell you the reality of the situation is, if we continue beyond capacity, those difficult decisions may have to be made.”

On Thursday, former Minister of Health Dr. Duane Sands said healthcare workers are already making such choices.

Forbes noted that The Bahamas is in “a surge” and that the healthcare system is being “pushed beyond capacity as it relates to the ability to manage patients presenting with COVID-19”. 

“It’s a real challenge,” she said.

“As you heard in the (health) minister’s address, there are currently more patients than the capacity of Princess Margaret Hospital (PMH). There [are] 73 patients, but the bed capacity is, in fact, only 70. The absolute reality of the situation is when healthcare systems are beyond capacity, we won’t be able to care for the number of patients that are presenting.

“Now, I will give you my experience offering care within one of these facilities that has been challenging. On at least one of the nights I was on call, we did have a patient present to the emergency room and we did not have the suitable room to manage that patient.

“What we had to do was shift patients around, more stable patients, so that we can offer that patient the kind of oxygen and respiratory support that patient needed.

“I can’t speak for the other facilities, but I can tell you that the reality of the situation, when facilities are beyond capacity is that you could be in a situation where you could not manage the patient and you might not be able to care for a patient that needs respiratory support.”

Forbes said healthcare workers were forced to open wards in order to provide COVID care.

“I will give you an example of what another doctor abroad said, ‘Every time a ward that was for non-COVID care is swapped into a ward for COVID care, you lose the ability to provide care for other persons presenting with other problems…,’ “ she said.

Medical Chief of Staff Dr. Caroline Burnett-Garraway noted that the management of COVID patients is “much the same as any patient” who presents to PMH.

“In the Accident and Emergency Department, we do a triage of all patients that present and we categorize from one to five depending on severity,” she said.

“It’s determined by vital signs and the condition that they’re presenting with, so they’re presenting complaint. All patients are triaged and sent to the necessary area for management if it’s the resuscitation room or they’re actually triaged away to a clinic because it’s not an emergency situation.”

Burnett-Garraway said healthcare workers have been having “challenges” due to the unavailability of beds. 

She said they’ve been “basically shuffling patients between beds”.

“We have been doing our best in managing that way,” Burnett-Garraway said.

Minister of Health Renward Wells said The Bahamas has a bed capacity of 147.

He said 110 of those beds were occupied.

Mary Walker, who serves on the Ministry of Health’s executive operations committee for COVID-19, said The Bahamas has sufficient ventilators for COVID and non-COVID patients despite diminishing bed capacity.

“At this time, we have not exceeded the capacity of ventilators to those of the demand for ventilators,” she said.

“Likewise in Grand Bahama, there is also the facility for persons who require ventilation. At this point in time, if I’m remembering the data correctly, we have approximately 65 to 66 ventilators in country at our disposal, and we have not put all of those in use given the fact that we are taking care of other persons who require ventilatory support other than COVID patients.” 

Chief Medical Officer Dr. Pearl McMillan noted that the Doctors Hospital Health System is also included in the capacity to provide care for moderate to severe COVID patients.

She said this includes ventilatory support.

“However, I believe it’s becoming very clear, as we would’ve said early and we have continued to say as the cases increase, our hospital capacity will be stretched,” McMillan said.

“Our capacity to provide care for other conditions and to also provide care for COVID-19 patients will become stretched…we are stretched to provide the care, but we are continuing to provide care to individuals as they present with various health conditions.”

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