Sunday, 29 March 2020

Meta Triage

Result of search for “Triage” on Google Trends

That spike in searches for “Triage” was when we learnt that Italy didn’t have enough beds for all the ICU patients and so they had to “triage”. That is, to make choices about who should get a bed and ventilator. Older folks were at the end of the queue.
A few things to say about triage:
I reckon I first learned the word in the sixties, from my nursing mates. They told me: patients come in to emergency wards; they’re handled first-come, first-served. But if there are too many at once -- after an earthquake, say -- you have to triage. They explain: you make judgements about who should be helped first and who should be tended to next. That’s Triage. The most extreme cases get first attention, then the less severely injured, then those who can simply wait.
I’ve heard the word “triage” used elsewhere.
By my sailing mates for example. If we’re offshore and hit by a squall, with multiple damages, the crew boss says: “we’ve gotta triage it, mate”. God bless the English language penchant for verbifying nouns!
Like most folks who know the word, I assumed that “triage” means “divide into three”. (1) most extreme (2) less extreme (3) can wait.
But no. The word comes from the French trier which means “to sort”. Not necessarily into three.
Which beings me to “Meta Triage”.
By this I mean the choices — the sorting — that politicians and governments must do.
Doctors and nurses have to triage patients coming into ICUs. As they’ve had to do in Italy.
The world economy is also in intensive care. Mass shutdowns, mass unemployment, mass shortages, all these are real and happening right now.
We must beware of the fallacy of two choices.
The apparent belief of many that it’s either (a) look after the sick and blow the economy or (b) look after the economy and blow the sick.  Of course it’s not a choice, singular. It’s choices, plural. It’s a matter of choices, of sorting. Of Meta Triage. 
How much can we open up the economy? Where and when? When and where can we let people go back to work? When can we reopen bars and restaurants? When can we fly again? When can sports restart?  What do these choices, this sorting, mean for hospital capacity? How many more deaths will that mean? What can we accept, as a price foe a minimally functioning economy? For medium function? Maximum function?
These are all choices, all about sorting. It’s a Meta Triage.
These are the balances, the choices, the triaging, that governments have to do. It’s what Trump and Johnson and Morrisson have to do. To demean them for that is silly.
One of the critics of my post, a British medical worker said — in caps, and after calling me unfeeling and uncaring — “…ONE DEATH IS TOO MANY. FULL STOP”.
But that is absurd. Virtue signalling to the max. If you really thought that, you’d not let people come to work anytime. Because getting to work involves risk, of a road accident, of death, of a heart attack at ones desk. Someone said, of the “one death is too many” mantra, they’re not serious people. For the stand is simply not tenable.
Meantime, Joe Biden has been getting his dentures in a twist at a CNN virtual Town Hall, over the choices, the sorting, that the Trump administration is making. Althouse sets it out.