Should vaccinated people have triage priority in Swiss hospitals?
As intensive care units in many Swiss hospitals are filled to capacity, some health professionals and politicians say vaccinated patients should be prioritised over the unvaccinated ones. Could this controversial measure be introduced?
With the number of coronavirus infections soaring in Switzerland, intensive care beds are becoming scarce across the country and triage of patients may be just around the corner.
This is why a number of health experts and politicians say it is justifiable to favour vaccinated people when it comes to allocating patients in ICUs.
“Triage guidelines need to be changed, as the majority of patients currently admitted to intensive care are unvaccinated”, said infectious disease specialist Andreas Widmer.
"It should not be tolerated that unvaccinated patients steal the place of vaccinated people in intensive care, thus reducing their chances of survival".
On the political front, many elected officials agree with this view.
"It is not acceptable that surgeries for vaccinated patients are postponed because unvaccinated people who get Covid are occupying intensive care beds", said Ruth Humbel, president of the National Council's Social Security and Public Health Commission.
She suggested that the unvaccinated carry advance directives stating they would forgo intensive care treatment in the event of a severe coronavirus infection.
"It is clear that unvaccinated people should not have priority over other urgent cases", according to MP Philippe Nantermod.
Another MP, Verena Herzog, also pointed out that "we cannot accept that vaccinated people, who have assumed their responsibility towards society, die due to hospitalisation of unvaccinated people."
Could such a drastic measure could be implemented in Switzerland legally?
There is nothing in Swiss law that specifically addresses the issue of triage priorities. The only criterion is that, as everyone pays for the compulsory health insurance, nobody can be denied medical treatment.
Even those who don’t pay their premiums or are in arrears are entitled to emergency care.
The cantons are responsible for ensuring that their residents have access to the healthcare services on their territories.
The Federal Office of Public Health (FOPH), which sets rules relating to health insurance coverage, told The Local two organisations are responsible for establishing triage guidelines: the Swiss Academy of Medical Sciences (SAMS) and The Swiss Society of Intensive Care Medicine (ASSM).
The two organisations have jointly created the emergency protocol for triage of patients in intensive care units in cases when hospital overload can’t be resolved by other measures, such as postponing operations or transferring patients to other medical facilities; the final decision on who to prioritise, however, rests with the hospital and its intensive care unit.
Both SAMS and ASSM say that triage system should be based on equity — that is, resources must be made available without discrimination of any kind, in order to avoid any arbitrary decisions.
The rules clearly state that “vaccination status must be ruled out as a triage criterion”.
“Immunisation status is not a triage criterion. In Switzerland, all patients should be treated the same, regardless of their opinion and actions. The same goes for smokers. They will also not be at a disadvantage during triage, although they willfully consume harmful products.”
READ MORE: Do you need a Covid certificate to go to hospital in Switzerland?
What other triage criteria have been established?
“The guidelines provide assistance to ICUs, so that any triage decision can be made according to the same criteria across Switzerland,” said Franziska Egli, communications officer at the ASSM.
“The objective is to save as many lives as possible, but the short-term prognosis is the deciding factor for the decisions”, she added.
This means that patients whose prognosis for recovery or improvement is favourable with intensive care therapy, but unfavourable without this treatment, have top priority.
“The most important criterion for physicians is the prognosis for short-term survival. This means that the people treated are those most likely to survive. If several patients have a good chance, the second criterion taken into account is the investment of medical resources. Someone who, like so many Covid patients, spends a month in intensive care, has poorer chances than someone who only needs shorter treatment”.
Age in itself is not a factor, but it is indirectly taken into account in the context of the ‘short-term prognosis’ criterion, since the elderly often suffer from pre-existing chronic conditions, defined as two or more diseases.
Official directives list illnesses that are deemed to be incompatible with hospitalisation if there is shortage of beds. They include advanced cirrhosis, cancer with a limited life expectancy, and severe heart or neurological problems.
What if ICUs are saturated to the point of having to turn away patients?
Even then, “we are strongly opposed to taking a patient's immunisation status into account as a triage criterion”, Sibylle Ackermann, head of ASSM’s ethics department told Switzerland's Watson news site.
Only medical criteria should be taken into account when it comes to making a selection among patients, she added.
Michele Genoni, cardiac surgeon and president of the umbrella organisation of Swiss surgeons, agrees: “For me, it is obvious that vaccination status should never become a criterion in the allocation of intensive care beds”, he said.
"Even with severe triage, the person with the highest chance of survival should always be favoured, whether it is an unvaccinated Covid patient or an accident victim”.
READ MORE: ‘No more ICU beds’ in Zurich as Switzerland hits all-time Covid case record
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With the number of coronavirus infections soaring in Switzerland, intensive care beds are becoming scarce across the country and triage of patients may be just around the corner.
This is why a number of health experts and politicians say it is justifiable to favour vaccinated people when it comes to allocating patients in ICUs.
“Triage guidelines need to be changed, as the majority of patients currently admitted to intensive care are unvaccinated”, said infectious disease specialist Andreas Widmer.
"It should not be tolerated that unvaccinated patients steal the place of vaccinated people in intensive care, thus reducing their chances of survival".
On the political front, many elected officials agree with this view.
"It is not acceptable that surgeries for vaccinated patients are postponed because unvaccinated people who get Covid are occupying intensive care beds", said Ruth Humbel, president of the National Council's Social Security and Public Health Commission.
She suggested that the unvaccinated carry advance directives stating they would forgo intensive care treatment in the event of a severe coronavirus infection.
"It is clear that unvaccinated people should not have priority over other urgent cases", according to MP Philippe Nantermod.
Another MP, Verena Herzog, also pointed out that "we cannot accept that vaccinated people, who have assumed their responsibility towards society, die due to hospitalisation of unvaccinated people."
Could such a drastic measure could be implemented in Switzerland legally?
There is nothing in Swiss law that specifically addresses the issue of triage priorities. The only criterion is that, as everyone pays for the compulsory health insurance, nobody can be denied medical treatment.
Even those who don’t pay their premiums or are in arrears are entitled to emergency care.
The cantons are responsible for ensuring that their residents have access to the healthcare services on their territories.
The Federal Office of Public Health (FOPH), which sets rules relating to health insurance coverage, told The Local two organisations are responsible for establishing triage guidelines: the Swiss Academy of Medical Sciences (SAMS) and The Swiss Society of Intensive Care Medicine (ASSM).
The two organisations have jointly created the emergency protocol for triage of patients in intensive care units in cases when hospital overload can’t be resolved by other measures, such as postponing operations or transferring patients to other medical facilities; the final decision on who to prioritise, however, rests with the hospital and its intensive care unit.
Both SAMS and ASSM say that triage system should be based on equity — that is, resources must be made available without discrimination of any kind, in order to avoid any arbitrary decisions.
The rules clearly state that “vaccination status must be ruled out as a triage criterion”.
“Immunisation status is not a triage criterion. In Switzerland, all patients should be treated the same, regardless of their opinion and actions. The same goes for smokers. They will also not be at a disadvantage during triage, although they willfully consume harmful products.”
READ MORE: Do you need a Covid certificate to go to hospital in Switzerland?
What other triage criteria have been established?
“The guidelines provide assistance to ICUs, so that any triage decision can be made according to the same criteria across Switzerland,” said Franziska Egli, communications officer at the ASSM.
“The objective is to save as many lives as possible, but the short-term prognosis is the deciding factor for the decisions”, she added.
This means that patients whose prognosis for recovery or improvement is favourable with intensive care therapy, but unfavourable without this treatment, have top priority.
“The most important criterion for physicians is the prognosis for short-term survival. This means that the people treated are those most likely to survive. If several patients have a good chance, the second criterion taken into account is the investment of medical resources. Someone who, like so many Covid patients, spends a month in intensive care, has poorer chances than someone who only needs shorter treatment”.
Age in itself is not a factor, but it is indirectly taken into account in the context of the ‘short-term prognosis’ criterion, since the elderly often suffer from pre-existing chronic conditions, defined as two or more diseases.
Official directives list illnesses that are deemed to be incompatible with hospitalisation if there is shortage of beds. They include advanced cirrhosis, cancer with a limited life expectancy, and severe heart or neurological problems.
What if ICUs are saturated to the point of having to turn away patients?
Even then, “we are strongly opposed to taking a patient's immunisation status into account as a triage criterion”, Sibylle Ackermann, head of ASSM’s ethics department told Switzerland's Watson news site.
Only medical criteria should be taken into account when it comes to making a selection among patients, she added.
Michele Genoni, cardiac surgeon and president of the umbrella organisation of Swiss surgeons, agrees: “For me, it is obvious that vaccination status should never become a criterion in the allocation of intensive care beds”, he said.
"Even with severe triage, the person with the highest chance of survival should always be favoured, whether it is an unvaccinated Covid patient or an accident victim”.
READ MORE: ‘No more ICU beds’ in Zurich as Switzerland hits all-time Covid case record
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