Austin physicians today face the real possibility of triage—deciding who receives care based on need or likely benefit—as the COVID pandemic threatens to overrun hospitals and spill into the convention center.
"Once our hospitals are overwhelmed, the best possible care can no longer be provided to each patient," Travis County Medical Society President Dr. John Abikhaled said in a video release this week. "Terrible decisions will have to be made about who receives care, and who does not."
COVID-19 Urgent Message for our Communityyoutu.be
Hospitals have triage policies in place, but the hope is they won't have to use them, Texas Medical Association President Dr. Diana Fite told Austonia.
"We are not at that point yet with COVID-19," she said.
But Austin officials worry that it may be close. Austin-Travis County Interim Health Authority Dr. Mark Escott recently tweeted, "Please help avoid the need for other doctors and I having to make a choice on who gets life saving care ... We are 2-3 weeks away from those kinds of decisions."
In the aftermath of the 2009 H1N1 pandemic, the National Academy of Medicine was tasked with developing guidelines for pandemic ethics. Each state then developed its own recommendations for how to allocate vaccines, supplies, ventilators and other resources.
These recommendations, along with guidance from industry associations, helped hospitals develop their own pandemic protocols, Dr. Fite said.
Dr. Diana Fite, Texas Medical Association president and Houston ER physician
Hospital ethics typically revolve around end-of-life decisions—when to stop treatment for a patient who is no longer benefiting from it. But in the case of a pandemic, the focus is on the scarcity of resources—how to choose which patients get treated when demand outpaces supply.
"Public health ethics do differ from, sort of, everyday clinical ethics because there's an idea that we're trying to save the great number of people from a disease," said Dr. Devan Stahl, an assistant professor of religion at Baylor University, where she teaches bioethics and medical humanities.
Dr. Devan Stahl, assistant professor of religion at Baylor University
The best pandemic ethics policies have a few hallmarks, Dr. Stahl said:
- Triage decisions should be made by an independent team, rather than the treating physician.
- They should focus on the patient's likelihood of surviving the hospital stay rather than quality-of-life judgments, which are more subjective.
- And they should avoid deprioritizing care for entire groups—such as patients over a certain age, as happened in Italy, or for patients with disabilities, who are protected under federal civil rights law.
"Those kinds of policies, I think, are blatantly discriminatory," Dr. Stahl said.
The case for transparency
Hospitals are often reluctant to share their ethics policies with the public—for fear of backlash or misinterpretation.
Austonia reached out to the three major hospital systems—Ascension Seton, Baylor Scott & White Health and St. David's HealthCare—to learn more about their policies, but none were made available.
However, BSW provided a statement explaining that patients are informed, upon admission, of their right to access information about the hospital's ethics policies.
So far, the hospital system has "not seen a major change in the number or types of issues coming to our clinical ethics committees as a result of the pandemic," the statement says.
Dr. Stahl said that even though hospitals tend to guard the details of their policies around allocation of care, she favors transparency. "Unlike other hospital policies, this is a public health concern," she said.
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Last year, we examined how Austin has an unlikely lookalike in Boise, Idaho, a fast-growing metro that, like Austin, has earned both praise and ire as thousands flock to the city.
But while Boise and its suburb, Nampa, were named the two best-run cities in America by WalletHub, Austin ranked 85th—below fellow hubs Phoenix and Miami and six fellow Texas cities.
The study, which measures 150 US cities across 38 metrics, compared each metro's quality of city services to its city budget per capita. While Boise ranked third in both categories, Austin's 12th-best quality of services was offset by a city budget that ranked 112th per resident.
Here's a look at how the Sun Belt's former pride and joy fell so far below its tinier "twin":
Booming economies—both cities
Both Boise and Austin ranked in the top 5 for their economies, with Austin taking the cake.
Bolstered by a mass pandemic migration and tech influx, both metros are caught "mid-metamorphosis" as they quickly transform into major cities. While Austin suburbs Georgetown and Leander both saw the fastest growth of any metros from July 2020-2021 with double-digit growth, three Boise suburbs—Meridian (5.2%), Caldwell (5.2%) and Nampa (5.0%) rounded out the top 10.
Tech giants like Tesla and Oracle, alongside other developments in tech and business, helped Austin produce one of the fastest-growing economies in 2021. And with employers like Albertson's, Hewlett-Packard and Micron Technology, Boise's unemployment rate sat at 2.4% in April—well below the national average of 3.6%.
City budget, safety—Boise
Austin's city budget for 2022 was around $1.2 billion. (Hensel Phelps)
Boise's City Hall offers 42% of its budget to general funds. (Boise City Council/Facebook)
With a $661.8 million budget and a projected population of just over 235,000, Boise has the third-best city budget per capita.
As the city experiences rapid change, city leaders said their budget priority was community-oriented, including "housing, transportation, environment, and more," and that 42% of the budget went to general funds.
And while Austin had a $4.5 billion budget this year, the city had to stretch that among its nearly 1 million residents. 1.2 billion—or 26%—of the budget was placed in general allocation, with two-thirds of that slotted toward public safety.
Austin remains one of Texas' safest cities, according to Police Chief Joseph Chacon, but pales in comparison to Boise. While Austin ranked 71st in safety, Boise clocked in at eighth. Boise's crime rate per 1,000 citizens was 35.5 in 2020, a 2.4% decrease from the year prior, while Austin's was 40.98 in the same time period.
Austin has become known as a "brain drain" in part thanks to the University of Texas. (University of Texas at Austin/Facebook)
Boise's biggest university is Boise State University. (Boise State University/Facebook)
Aside from its top economy ranking, Austin also shone in its high school graduation rate, which clocked in at 1st in the US. Known as a "brain drain" city, Austin's college-town status and wealth of job opportunities have created one of the most educated populations in the U.S.
Three of the top 25 public high schools in Texas are located in Austin, and the city's education system ranked 16th. And while four of the top 10 high schools in Idaho are located in Boise, the city's overall education earned just 41st place.
Both cities are known as fitness and health havens thanks to robust outdoor amenities and health-conscious residents. But Austin still edged out its Idahoan lookalike, ranking 7th overall to Boise's 10th.
Affordability and infrastructure issues—both cities
Housing has become a scarce commodity in Austin.
Both Boise and Austin are experiencing affordability issues thanks to an overpriced housing market. (Boise New Construction/Facebook)
Still, the effects of high-speed growth have done some major damage to both formerly sleepy cities.
Both cities pose higher than average incomes relative to their state. But thanks to a rapidly diminishing number of available homes for both new and old residents, both Boise and Austin ranked as the top two most overvalued housing markets in the country, according to a Florida Atlantic study.
With more and more residents priced out of homeownership and burdened with a higher cost of living, both Boise and Austin ranked below the top 30 in the financial stability index.
Both cities have seen even more development in neighboring suburbs—like Boise's Nampa, which was named the US's best-run city for the sixth year in a row—while its inner-city infrastructure often struggles to keep up with the times. While Boise's infrastructure and pollution ranked 32nd overall (Nampa ranked 77th), Austin's car-centric infrastructure ranked 45th.
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