Con covid y sin covid: La vulnerabilidad humana / With or without covid: a tale on human vulnerability

La crisis del COVID-19 deja una enseñanza en forma de reminiscencia. No aprendemos de ella nada nuevo, pero nos recuerda algo que supimos y olvidamos. Nos muestra con nueva luz nuestra vulnerabilidad, la imposibilidad de protegernos perfectamente mediante la predicción y el control. Las ciencias no predicen con certeza y las tecnologías no alcanzan a tenerlo todo bajo control, aunque las primeras y las segundas tengan otras muchas y beneméritas funciones. Las ideologías, no ven el futuro, por más que simulen hacerlo. Y, sin embargo, no carecemos que guía fiable para decidir nuestras acciones. Esta orientación hay que buscarla en el ser, no en el porvenir. Es la fidelidad a nuestra común naturaleza humana la que ha de aconsejarnos, es la realización plena de nuestro ser personal, de nuestra peculiar vocación la que nos guía. Y el medio para la autorrealización consiste en el desarrollo de un carácter virtuoso. El mismo carácter que ha mitigado los estragos de la pandemia, pues en cierto grado estaba ya presente en muchos de nuestros conciudadanos, el mismo que hubiera paliado aun más el sufrimiento de haber estado disponible en más personas y en mayor grado

The crisis of COVID-19 leaves us a teaching in the form of reminiscence. We do not learn anything new from it, but it reminds us of something we knew and forgot. It shows us in a new light our vulnerability, the impossibility of protecting ourselves perfectly through prediction and control. The sciences do not predict with certainty and the technologies do not manage to have everything under control, although the former and the latter have many other and worthwhile functions. Ideologies do not see the future, no matter how much they pretend to do so. However, we are not without reliable guidance in deciding our actions. This orientation must be sought in being, not in the future. It is fidelity to our common human nature that must advise us. It is the full realization of our personal being, of our peculiar vocation, that guides us. So, the means for self-realization consists in the development of a virtuous character. The same character that has mitigated the ravages of the pandemic, given that, to some degree, it was already present in many of our fellow citizens. The same that would have alleviated the suffering even more if it had been available in more people and to a greater degree

Una respuesta ética en la atención a residencias de ancianos en la pandemia Covid-19 / An ethical response in the care of nursing homes in the covid-19 pandemic

La llegada de la pandemia COVID-19 puso en evidencia el riesgo de una posible falta de atención de los ancianos de las residencias de mayores. Aportamos la experiencia de un equipo multidisciplinar con profesionales voluntarios de diferentes especialidades que realizó una labor de apoyo a los profesionales sanitarios de las residencias. Este equipo se implementó desde las gerencias de atención primaria y de atención especializada. La sistemática de trabajo se inspiraba en el de hospitalización a domicilio e incluía la atención directa de los pacientes más complejos y el asesoramiento en las medidas de prevención, aislamiento e higiene dentro de la residencia. De este modo fue posible que los ancianos de las residencias con sospecha o diagnóstico de COVID-19 recibieran una atención adecuada por parte de un equipo interdisciplinar, que se descargara parte de la presión de los profesionales de las residencias y que los familiares percibieran que no existía abandono terapéutico. El compromiso desde diversos niveles asistenciales en una labor coordinada ha conseguido evitar que una población vulnerable pudiera quedar desatendido durante la pandemia

With the arrival of the COVID-19 pandemic, the risk of a possible lack of care for the elderly in nursing homes became evident. We summarize the experience of a multidisciplinary team with volunteer professionals from different specialties who carried out support for healthcare professionals in nursing homes. This team was implemented from both Primary and Specialty Care managements. Its work paradigm was proposed by our home hospitalization team, which included direct care of the most complex patients and general counselling on isolation, hygiene and preventive measures within the nursing homes. Thanks to this support, the elderly population placed there, with suspected or diagnosed COVID-19, received adequate care from an interdisciplinary team, which led part of the pressure to be released from their professional workers, and many family members were aware that there was no neglect of the elderly. Commitment from various levels of care in a coordinated effort has prevented a vulnerable population from being left unattended during the pandemic

Reflexiones éticas en torno a las medidas tomadas en las residencias durante la pandemia / Ethical reflections on the measures taken in nursing homes during pandemic

La pandemia por Covid-19 ha afectado especialmente a los mayores que viven en residencias desde su aparición. Para frenar sus efectos devastadores las autoridades sanitarias pusieron en marcha numerosos protocolos y medidas que han podido vulnerar la debida ética asistencial. El asilamiento social de los ancianos de las residencias, el confinamiento en las habitaciones, el cribado en la derivación de los pacientes mayores a los hospitales, y a las unidades de cuidados intensivos han hecho tanto daño como beneficio. En el presente trabajo se plantean diversas líneas reflexivas en torno a la eticidad de cada una de las medidas adoptadas. También acerca del papel de los comités de ética en la vigilancia y supervisión de todos los procesos asistenciales en las residencias

The Covid-19 pandemic has particularly affected older people living in nursing homes since its onset. To curb its devastating effects, the health authorities have put in place numerous protocols and measures that have been able to violate the proper ethics of care. The social isolation of the elderly from the nursing homes, the confinement in the rooms, the screening in the referral of the elderly patients to the hospitals, and to intensives cares units have done both harm and benefit. In the present work, several reflexive lines are proposed around the ethicity of each of the measures adopted. Also about the role of ethics commit-tees in the monitoring and supervision of all care processes in residences

Valoración del documento: "Recomendaciones generales relacionadas con las decisiones éticas difíciles y la adecuación de la intensidad asistencial/ingreso en las Unidades de Cuidados Intensivos en situaciones excepcionales de crisis" por parte del Consejo Asesor Regional de Ética Asistencial –Dr. D. Juan Gómez Rubí– (carea) / Evaluation of the document: "General recommendations related to difficult ethical decisions and the adequacy of the health care/admission in the Intensive Care Units in exceptional crisis situations" by the Regional Advisory Council of Health Care Ethics. –D. Juan Gómez Rubí- (carea)

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Algunas cuestiones éticas tras la pandemia por Covid-19 y sobre la situación que suscita la presencia de esta enfermedad en nuestra sociedad / Some ethical questions after the Covid-19 pandemic and about the situation that raises the presence of this disease in our society

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Unesco sobre el Covid-19: directrices éticas para una respuesta global / Unesco on covid-19: ethical guidelines for a global response

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Triage of Scarce Critical Care Resources in COVID-19 An Implementation Guide for Regional Allocation: An Expert Panel Report of the Task Force for Mass Critical Care and the American College of Chest Physicians.

Public health emergencies have the potential to place enormous strain on health systems. The current pandemic of the novel 2019 coronavirus disease has required hospitals in numerous countries to expand their surge capacity to meet the needs of patients with critical illness. When even surge capacity is exceeded, however, principles of critical care triage may be needed as a means to allocate scarce resources, such as mechanical ventilators or key medications. The goal of a triage system is to direct limited resources towards patients most likely to benefit from them. Implementing a triage system requires careful coordination between clinicians, health systems, local and regional governments, and the public, with a goal of transparency to maintain trust. We discuss the principles of tertiary triage and methods for implementing such a system, emphasizing that these systems should serve only as a last resort. Even under triage, we must uphold our obligation to care for all patients as best possible under difficult circumstances.

Disaster Preparedness in Neonatal Intensive Care Units.

Disasters disproportionally affect vulnerable, technology-dependent people, including preterm and critically ill newborn infants. It is important for health care providers to be aware of and prepared for the potential consequences of disasters for the NICU. Neonatal intensive care personnel can provide specialized expertise for their hospital, community, and regional emergency preparedness plans and can help develop institutional surge capacity for mass critical care, including equipment, medications, personnel, and facility resources.

When the bells toll: engaging healthcare providers in catastrophic disaster response planning.

Catastrophic disaster planning and response have been impeded by the inability to better coordinate the many components of the emergency response system. Healthcare providers in particular have remained on the periphery of such planning because of a variety of real or perceived barriers. Although hospitals and healthcare systems have worked successfully to develop surge capacity and capability, less successful have been the attempts to inculcate such planning in the private practice medical community. Implementation of a systems approach to catastrophic disaster planning that incorporates healthcare provider participation and engagement as one of the first steps toward such efforts will be of significant importance in ensuring that a comprehensive and successful emergency response will ensue.