LitCovid-sentences  

PMC:7265102 / 1022-12460 JSONTXT 12 Projects

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Id Subject Object Predicate Lexical cue
T11 0-89 Sentence denotes Nearly every country is now affected by the coronavirus disease 2019 (COVID-19) pandemic.
T12 90-208 Sentence denotes The disease is spreading rapidly and is taxing the global healthcare system, particularly intensive care units (ICUs).
T13 209-330 Sentence denotes Physicians are faced with ethical decisions regarding the allocation of these precious resources, especially ventilators.
T14 331-522 Sentence denotes Although only a few of those infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) require admission to intensive care, the burden on healthcare systems is unprecedented.
T15 523-629 Sentence denotes This article focuses on ethical issues in decision-making regarding COVID-19, particularly in the elderly.
T16 630-727 Sentence denotes Madrid has been one of the cities with the higher number of COVID-19 cases and casualties so far.
T17 728-821 Sentence denotes We have suffered from limited resources and lived with these ethical issues on a daily basis.
T18 822-976 Sentence denotes Also, Spain is experiencing population ageing at a rate that is unprecedented in Europe and COVID-19 infection is particularly severe in the elderly.[1,2]
T19 978-992 Sentence denotes Prioritisation
T20 993-1088 Sentence denotes Prioritisation for the allocation of scarce resources is not confined to the COVID-19 outbreak.
T21 1089-1305 Sentence denotes Transplant organs are examples of scarce resources where prioritisation criteria for allocation are common and physicians have to make a case-by-case evaluation in order to establish which patient receives the organ.
T22 1306-1440 Sentence denotes Prioritisation reflects established practices that regulate the distribution of finite resources when demand happens to exceed supply.
T23 1441-1618 Sentence denotes Discrimination based on sex, race or age has no role in prioritisation unless clearly justified, for example sex mismatch might influence the outcome of a heart transplant.[3,4]
T24 1619-1727 Sentence denotes Prioritisation does not mean that one life is more valuable than another, as all lives are equally valuable.
T25 1728-1866 Sentence denotes When resources are insufficient to save all those in need, prioritisation means allocating the available assets in the most effective way.
T26 1867-1965 Sentence denotes This method allows priority treatment of patients more likely to benefit from the scarce resource.
T27 1966-2067 Sentence denotes Prioritisation should be as objective as possible but also flexible to changes in clinical situation.
T28 2068-2274 Sentence denotes Transparent mechanisms to determine which patients will receive a specific resource are desirable and should be explained to patients who finally receive an organ, to those who are denied and to the public.
T29 2276-2282 Sentence denotes Ageism
T30 2283-2386 Sentence denotes Ageism encompasses stereotyping, prejudice and discrimination against people on the basis of their age.
T31 2387-2489 Sentence denotes Ageism is widespread and an insidious practice that has harmful effects on the health of older adults.
T32 2490-3061 Sentence denotes A recent systematic review showed that the significant adverse relationship between ageism and health is even more consistent than the relationships found in systematic reviews of the effects of racism on health.[5] Moreover, European doctors worry about the care they will receive when they are old, with 80% of healthcare professionals anxious about how they would be treated, suggesting they realise that ageism is very common.[6] Paradoxically, increasing numbers of elderly people are remaining healthy and some of them have important international responsibilities.
T33 3062-3149 Sentence denotes For instance, Pope Francis is now 83 years old and Queen Elizabeth II is 94 (Figure 1).
T34 3150-3159 Sentence denotes Figure 1:
T35 3161-3253 Sentence denotes Queen Elizabeth II and Pope Francis Queen Elizabeth II, aged 94, and Pope Frances, aged 83.
T36 3254-3320 Sentence denotes Would they receive optimal management if they had severe COVID-19?
T37 3321-3329 Sentence denotes Sources:
T38 3330-3384 Sentence denotes Cubankite/Shutterstock.com and AM113/Shutterstock.com.
T39 3385-3393 Sentence denotes Table 1:
T40 3395-3483 Sentence denotes Therapeutic Planning Checklist for Elderly Patients Admitted to Hospital due to COVID-19
T41 3485-3509 Sentence denotes COVID-19 and the Elderly
T42 3510-3745 Sentence denotes The risk posed by COVID-19 is higher for elderly people than for younger people.[2] For this reason, medical and political authorities should offer older adults strict preventive measures to minimise the risk of exposure and infection.
T43 3746-3923 Sentence denotes In the event that an effective vaccine for SARS-CoV-2 is developed, priority should be given to vaccination of the elderly, with the aim of maximising the number of lives saved.
T44 3924-4027 Sentence denotes This is also true for other preventive measures, such as possible pre- or post-exposure prophylaxis.[7]
T45 4028-4092 Sentence denotes In the case of people with COVID-19, the situation is different.
T46 4093-4253 Sentence denotes When allocating resources in these scenarios, healthcare professionals might prioritise those most likely to survive over those with remote chances of survival.
T47 4254-4316 Sentence denotes Making a decision based on chronological age is not justified.
T48 4317-4421 Sentence denotes In addition to age, other aspects that determine theoretical life expectancy must be taken into account.
T49 4422-4537 Sentence denotes Biological age and the use of frailty scales and comprehensive geriatric assessment are essential for this purpose.
T50 4538-4913 Sentence denotes The recent statement of the Executive Board of the European Geriatric Medicine Society insists that advanced age alone should not be a criterion for excluding patients from specialised hospital units.[8] If an elderly patient is dismissed from a specialised hospital unit for any reason, access to medical attention, symptomatic treatment and palliative care must be ensured.
T51 4914-5104 Sentence denotes This last point is essential, as palliative care is frequently suboptimal in elderly patients with other conditions, such as heart failure, and this is probably the case in COVID-19.[2,9,10]
T52 5106-5153 Sentence denotes Therapeutic Adaptation after COVID-19 Admission
T53 5154-5342 Sentence denotes In patients with advanced age who are admitted to hospital due to a severe SARS-CoV-2 infection, it is very important to establish a therapeutic adaptation plan from the time of admission.
T54 5343-5605 Sentence denotes This plan should be clearly documented in the clinical history, making it clear whether or not the patient is a candidate for mechanical ventilation and, in case of their condition worsening, when to propose the withdrawal of life-sustaining therapies (Table 1).
T55 5606-5772 Sentence denotes Decisions that maximise survival to hospital discharge, the number of years of life saved and the possibility of living each of the stages of life can be prioritised.
T56 5773-5952 Sentence denotes In this regard, patients with minimal expected benefit should not be admitted to ICU and the admission of patients with a life expectancy <1–2 years should be carefully evaluated.
T57 5953-5990 Sentence denotes This applies to patients of all ages.
T58 5991-6085 Sentence denotes A utilitarian mentality should be applied, which should prevent prejudice against the elderly.
T59 6086-6305 Sentence denotes For example, a frail elderly patient might have a low chance of surviving the prolonged intubation required to recover from COVID-19 pneumonia, but this is also the case for young patients with severe comorbidities.[11]
T60 6307-6328 Sentence denotes The Madrid Experience
T61 6329-6459 Sentence denotes During the peak of the outbreak, more than two-thirds of beds in most hospitals in Madrid were occupied by patients with COVID-19.
T62 6460-6828 Sentence denotes Figure 2 depicts the official numbers of patients admitted to hospital, admitted to ICUs, who died and who recovered in Spain between mid-March and the middle of April.[12] Non-invasive ventilation was attempted frequently, even using improvised alternative strategies like the modified Easybreath diving mask to administer continuous positive airway pressure therapy.
T63 6829-7108 Sentence denotes Invasive ventilation was often necessary and, in spite of tremendous efforts by the hospitals (for example Gregorio Marañón University Hospital opened ICUs in operating rooms and in the library), there were not enough ICU beds for all the critically ill patients who needed them.
T64 7109-7280 Sentence denotes The limited availability of ventilation support was even more problematic due to the prolonged intubation – often more than 3 weeks – that many of these patients required.
T65 7281-7513 Sentence denotes The news that prioritisation criteria were being applied in Spanish hospitals sparked widespread controversy and triggered a debate about the right of every individual, particularly the elderly, to access specialised healthcare.[13]
T66 7515-7541 Sentence denotes Use of Off-label Therapies
T67 7542-7952 Sentence denotes Effective therapies for this novel coronavirus are needed urgently and several clinical trials are now underway.[14] Meanwhile, the use of use of off-label therapies based on in vitro data and early clinical experience with COVID-19 has increased dramatically; examples include remdesivir, lopinavir, ritonavir, interferon, chloroquine, hydroxychloroquine, azithromycin, tocilizumab, steroids and cyclosporine.
T68 7953-8131 Sentence denotes To date, no therapies have been shown to be effective.[15] Moreover, some of these drugs have frequent and potentially life-threatening side-effects, particularly in the elderly.
T69 8132-8214 Sentence denotes Most are known to prolong the QT interval and can have a proarrhythmic effect.[16]
T70 8216-8228 Sentence denotes Confinement:
T71 8229-8242 Sentence denotes Pros and Cons
T72 8243-8426 Sentence denotes Confinement is an effective way to decrease SARS-CoV-2 transmission and is a way to win time until effective therapies are developed and/or an effective and safe vaccine is available.
T73 8427-8519 Sentence denotes However, the stay-at-home policy has negative effects in those with advanced age (Figure 3).
T74 8520-8671 Sentence denotes The psychological risk of confinement is particularly high among vulnerable populations, such as those in a situation of dependence or that live alone.
T75 8672-8757 Sentence denotes The negative consequences are multifaceted, with physical, mental and social aspects.
T76 8758-8890 Sentence denotes Staying at home for long periods of time facilitates sedentary behaviours and might worsen previous frailty or pre-frail conditions.
T77 8891-9008 Sentence denotes At the time of writing this article, our parents/grandparents (aged 82 and 78) have not left their home for 2 months.
T78 9009-9058 Sentence denotes We are certainly concerned about their situation.
T79 9059-9207 Sentence denotes Moreover, confinement is extremely negative for the economy and the elderly might end up suffering the consequences of a severe economic depression.
T80 9208-9274 Sentence denotes Finally, the legal situation varies a lot from country to country.
T81 9275-9387 Sentence denotes New laws have created legal frameworks that frequently restrict or prohibit the movement of people and vehicles.
T82 9388-9472 Sentence denotes Some countries have severe penalties for those who do not comply with the new rules.
T83 9474-9493 Sentence denotes Family and Mourning
T84 9494-9580 Sentence denotes The COVID-19 pandemic has isolated the elderly not only at home but also in hospitals.
T85 9581-9614 Sentence denotes Visits are usually not permitted.
T86 9615-9722 Sentence denotes Several patients of advanced age with severe infection have died alone in the hospital or in nursing homes.
T87 9723-9876 Sentence denotes The suffering of the family does not end there, as containment measures also apply in the context of mourning, which adds trauma to that of death itself.
T88 9877-10003 Sentence denotes Corpses are considered potentially infectious, so are deposited as soon as possible in a body bag that will never be reopened.
T89 10004-10125 Sentence denotes During the peak of the outbreak in Madrid, we had so many deaths that an ice rink had to be used as a provisional morgue.
T90 10126-10215 Sentence denotes It was frequently impossible for families to see their deceased loved ones one last time.
T91 10216-10225 Sentence denotes Figure 2:
T92 10227-10378 Sentence denotes Official Daily Evolution of the Number of Patients Admitted to Hospital, Admitted to Intensive Care Units, who Died and who Recovered in Spain Source:
T93 10379-10407 Sentence denotes Ministerio de Sanidad et al.
T94 10408-10417 Sentence denotes 2020.[12]
T95 10418-10427 Sentence denotes Figure 3:
T96 10429-10631 Sentence denotes Confinement – the Stay-at-home Policy – has Positive and Negative Effects in Individuals of Advanced Age The rules of social distancing put in place by the health authorities applies also at funerals.
T97 10632-10820 Sentence denotes Services must be limited to close family members only (with a maximum of three people), usually with video recording and streaming for those who wish to attend the funeral from a distance.
T98 10821-10886 Sentence denotes Finally, the vast majority of older people in Spain are Catholic.
T99 10887-10988 Sentence denotes The fact that public masses have been cancelled makes the situation even more difficult for families.
T100 10990-11000 Sentence denotes Conclusion
T101 11001-11299 Sentence denotes COVID-19 in elderly patients raises some ethical issues; however, most of these issues are similar to ethical problems in other conditions, such as heart failure.[17–19] The correct prioritisation for the allocation of scarce resources should be based on various factors relating to the individual.
T102 11300-11392 Sentence denotes Chronological age should not be the only factor that influences the decision-making process.
T103 11393-11437 Sentence denotes This is essential to good clinical practice.