UKZN and Oxford University Collaborate on COVID-19 Research
UKZN academic Dr Kantharuben Naidoo of the Department of Family Medicine and Dr Reshania Naidoo of Oxford University in England conducted collaborative research on COVID-19 and the associated ‘ethico-legal deliberations intensivists face on a daily basis’.
The researchers work looked into: ‘Prioritising already-scarce intensive care unit resources in the midst of COVID-19: A call for regional triage committees in South Africa.’
They reported the following: ‘The worsening COVID-19 pandemic in South Africa poses multiple challenges for clinical decision-making in the context of already-scarce ICU resources. Data from national government and the last published national audit of ICU resources indicate gross shortages. While the Critical Care Society of Southern Africa (CCSSA) guidelines provide a comprehensive guideline for triage in the face of overwhelmed ICU resources, such decisions present massive ethical and moral dilemmas for triage teams.
‘It is therefore important for the health system to provide clinicians and critical care facilities with as much support and resources as possible in the face of impending pandemic demand. Following a discussion of the ethical considerations and potential challenges in applying the CCSSA guidelines, the authors propose a framework for regional triage committees adapted to the South African context. Beyond the national CCSSA guidelines, the clinician has many additional ethical and clinical considerations. No single ethical approach to decision-making is sufficient, instead one which considers multiple contextual factors is necessary.
‘Scores such as the Clinical Frailty Score and Sequential Organ Failure Assessment are of limited use in patients with COVID-19. Furthermore, the clinician is fully justified in withdrawing ICU care based on medical futility decisions and to reallocate this resource to a patient with a better prognosis. However, these decisions bear heavy emotional and moral burden compounded by the volume of clinical work and a fear of litigation. We propose the formation of Provincial multi-disciplinary Critical Care Triage Committees to alleviate the emotional, moral and legal burden on individual ICU teams and co-ordinate inter-facility collaboration using an adapted framework. The committee would provide an impartial, broader and ethically-sound viewpoint which has time to consider broader contextual factors such as adjusting rationing criteria according to different levels of pandemic demand and the latest clinical evidence. Their functioning will be strengthened by direct feedback to national level and accountability to a national monitoring committee. The potential applications of these committees are far-reaching and have the potential to enable a more effective COVID-19 health systems response in South Africa.’
The second stage of the researchers’ work involves field-testing the concept of the Critical Care Triage Committees across the country, including public and private hospital domains.
• Dr Kantharuben Naidoo and Dr Reshania Naidoo are also the South African investigators for another Oxford University, Nuffield School of Medicine Research collaborative research project titled: Development and Validation of Medical Internship Experience Scale (MIES) for LMICs. It is a multinational study involving scientists from nine countries working in collaboration with the Nuffield School of Medicine.
Words: Nombuso Dlamini