October 27, 2020

COVID-19 MITIGATION: Dilemma in Emergency Epidemic Resuscitation (DEER)

Prof. Dr. Halimu Shauri. Image: (Courtesy)

Episode 36

By PROF. DR. HALIMU SHAURI

(Dean; School of Humanities and Social Sciences; Pwani University)
Our series of COVID-19 mitigation articles directs us today to focus on a difficult decision making process, that of handling an emergency.
Where an emergency is serious, unexpected and often dangerous, the situation requires immediate action. However, not all emergencies are emergencies! I see you wondering. In this, I mean some emergencies are more emergencies than others i.e. some emergencies can graduate into disasters or epidemics.
A disaster is a sudden accident or a natural catastrophe that causes great damage or loss of life requiring external assistance.
This means an emergency of the proportion that requires help from outside the country to intervene is no longer an emergency but a disaster.
Thus, in our framing, COVID-19 epidemic is higher than an emergency. Why? You may ask! Because an epidemic is a widespread occurrence of an infectious disease, in a community, at a particular time that requires assistance beyond a geographical space from where it occurs.
Thus, our question today is whether there is an emergency in an emergency or whether there is a disaster in a disaster or epidemic?
In handling emergencies, can there be another emergency because of the response? Or in handling disasters, are their possibilities of a disaster in a disaster or epidemic in an epidemic!
This is to mean if you intervene in an emergency or disaster or epidemic can there be chances of generating another emergency or disaster?
Some may say yes and others no, generating a hot debate.
However, this concern to shade some insights on this topic has been brought up by a colleague and a friend, name withheld for ethical reasons:

________
Hello comrades, in a scenario where your patient is in need of resuscitation in the isolation ward how do we go about it? 
The colleague raised his concern further by saying “in different forums people have dodged this question… who can shade some light?”
I would want to start by congratulating this colleague for appreciating how difficult this question is and for seeking opinions across professions.
It’s obvious that appropriate responses will come based on professional appropriateness and pragmatics.
What medics may answer is not what business and social scientists will answer because their emergency-in-emergency scenarios are different.
I am a layman when it comes to medicine and medical emergencies in emergency situation but would want to look at it from a medical sociology perspective, a social science sister to medical practice.

Relationship between Sociology and medical sociology. Image: (Courtesy)

In sociology and for context purposes medical sociology, a pandemic is more than an emergency or is a disaster.
In this context COVID-19 pandemic is a disaster, a medical disaster though the country did not declare it so for they used pandemic and war instead, in reference to the virus. Accordingly, in our field a response to an emergency should not generate a further emergency.
This places us to the thinking that there should not be an emergency in an emergency response.
Now if we don’t consider an emergency in an emergency, we expect logically no emergency in disasters and epidemic response. Why? Because disasters or epidemics are even more than emergencies in their destructive potential.
From basics, therefore, emergency procedures or responses are philosophically designed to save a life or lives.
The difficult question in this scenario is what then would be the use of saving a life to lose another life or more lives?
I acknowledge the existence of diverse professions which may have different perspectives or explanations on the same, which automatically generate to what I call a Dilemma in Epidemic Emergency Resuscitation (DEER) in the question by the colleague. There are those who would emphasize the positives of emergency Resuscitation and those who are thinking negatively about the procedure.
Finally, in situations of dilemma it becomes difficult to have a common and acceptable decision for all.

COVID-19 pandemic, a global threat. Image: (Courtesy)

Where interventions generate debate and hence dilemma, decision making is left to the frontline professionals and experts.
However, such decision must be to the best interest of the parties involved. Above all, such decisions must safeguard professional ethics and human rights principles and practices in the field. That would be my take.


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