COME TO YOUR SENSES, LISTEN
MAKING THAT DREADED JUDGMENT CALL
WE are now number one in the world in the number of infections per one million people – a seven day average of 304 cases per million population per day. According to the Ministry of Health (MOH), there has been a notable increase in positive patients with severe disease, as well as an increase in deaths.
The MOH epidemic outlook is that the steady increase in average daily case numbers in combination with other indicators suggest higher daily number of cases, hospitalisations, and deaths in coming weeks, particularly in the Central and Western divisions.
At the time of writing this, there have been 21 deaths because of COVID-19 in Fiji. And another nine COVID-19 positive patients have died from pre-existing non-COVID-19 relating illnesses that they have been receiving treatment for at the CWM hospital
At 8am Wednesday, June 30, we have 3503 active cases in isolation and according to our health people, 80 per cent of whom are mild and do not have any ill effects at all. They are generally known to be asymptomatic.
The severe cases make up 15 per cent and based on the experience in India and other countries, these are the people who need oxygen. A few have died in Fiji, at home, and these could be the severe cases where oxygen could not be administered.
And then there are the critical cases making up 5 per cent. These are on the edge of death and need to be put on the ventilators so the machines support them. We have had deaths in this category in Fiji.
If we go by what our health people are telling us, those categorised as severe and critical, or 20 per cent of the active cases, would need hospitalisation, and that was about 700 people as at that point.
We have yet to see that in Fiji, but the possibilities of that number translating to hospitalisation is very real. And it is generally known that our health system will be overwhelmed and cannot cope.
In his press statement on Wednesday, June 30, Dr. Fong alluded to this. He said, now that the terms of this outbreak have changed, so must our tactics. Our highest priority is to provide life-saving care to those Fijians who are most at risk of becoming severely sick, requiring hospitalisation and dying.
It is a scenario we do not want to contemplate. We have seen images on TV and social media of sick people in other countries lying untreated in hospital corridors; unthinkable, but if we continue to see the spread in infections, it will come to that.
As it is, the burden on our health people is huge today and will become worse. But a phenomenon that is most frightening, which we all want to avoid, is to put our doctors in a position that forces them to make the dreaded “judgment call”.
As the number of sick people become too many and there are not enough beds or equipment to treat them, the doctors will have to make the decision on who to treat and who not to treat. Essentially, the doctor decides on who lives and who dies.
It has happened in other countries with COVID-19 and we thought it would not happen in Fiji, but now we know it is imminent here.
Doctors make judgment calls every day in the course of their work. These are occasions when there are no firm rules or principles to help them make decisions, they simply rely on their own judgment and instinct to make a judgment call. And we trust them when they do that.
But it is different when it comes to COVID-19 as it relates to certain death for someone denied treatment.
In India, where the doctors, health workers and system were overwhelmed, we saw a young doctor in his twenties, deciding who to be admitted and a chance to live, and who to turn away, to certain death.
How did we get here?
Clearly, the Government dropped the ball. Government became complacent and driven by its “we know best” attitude, effectively allowed this deadly Delta variant into our country and to run rampant.
When others, such as the Opposition parties made suggestions and offered help; government scoffed, too proud and too set in its ways to listen to any one.
Early in the piece, the Opposition had made suggestions that islands in Fiji known to have been used for isolation in the past be prepared for COVID-19 cases.
The Opposition wanted the virus to be kept away from areas of critical mass, as Australia is now doing by placing quarantine facilities in the outback.
This suggestion by the Opposition was met with derision from the Minister of Health and his colleagues in government.
To regain normalcy, what is believed is that vaccination is the way as countries such as Israel had shown us. It was assumed that the general populace would be lining up to take the jab, to be free from the restrictions to our lives and free from the fear brought by COVID-19.
But, no, the resistance to vaccination is quite stiff with many hesitant to take the jab.
We now see the Prime Minister calling on the churches and the chiefs to help.
These are the very same people he had been known to treat with disdain; yet were always there and willing to be part of the fight against the virus.
Communications were botched from the beginning with too many people talking resulting in mixed messaging.
People did not understand and the issues too complicated, which a properly designed awareness program could have rectified.
We are in a cliff hanging crisis, day by day now is a matter of life or death for Fijians – the Government cannot afford not to listen. It needs to listen to even those who disagree with Fiji First.
It is now critical to mobilise all the health people, in anticipation of the build-up to the severe and critical cases. It cannot rely only on those on government payroll.
The needs are greater as our health workers are exhausted and their ranks depleted as some have left for better opportunities elsewhere, many to the smaller island nations in our region.
That would be a conversation for another day as to how our people find better employment conditions in countries whose economy are much smaller than ours.
For now and back to our preparations; all clinical people should focus primarily on providing secondary care in the hospitals.
Too many of them are out in the communities as part of the COVID-19 task force. They should return to the hospitals.
Temporary hospitals should now be set up and properly equipped to cater to COVID-19 patients, freeing up the hospitals for non COVID-19 cases.
This has worked in other countries and we should do likewise in Fiji.
We dread the prospect of watching helplessly as our people perish through COVID-19 and for our doctors to make the type of judgment call that can only mean two things, life for one and death for the other.
Government should come to their senses and listen and prepare now to avoid that dreadful scenario.
As it is, the burden on our health people is huge today and will become worse. But a phenomenon that is most frightening, which we all want to avoid, is to put our doctors in a position that forces them to make the dreaded ‘judgment call’ – Viliame Gavoka –