Coronavirus Activate code blue for covid-19 cases


The harsh reality of the covid-19 pandemic and the lack of supplies to meet the high demand for medical care led the authorities of Mexico City to create the blue code, which rules out giving priority care to patients who paramedics consider that they have little chance of survival and are not intubated.

The Regulatory Center for Medical Emergencies (CRUM) has classifications to determine the vital signs of patients, since mid-December: white code and blue code.

A person classified with the white code is the one they consider likely to recover; the one that is cataloged with the blue code is the one whose oxygen saturation is less than 45%, has some of the comorbidities that aggravate the condition or are older than 65 years.

For them, the patients with a blue code already in the hospital, in a corridor in the emergency area, only palliative treatments remain.

Among the symptoms that patients with little chance of survival may present are extreme shortness of breath, cough, fever, and headaches, arms and legs.

The palliative care that is given to the patient aims to control pain, clear their secretions and help them breathe better. They also need support when they go to the bathroom to be able to move their oxygen tanks, since most are very heavy devices that they must have at their side at all times or they would be suffocating again.

This blue code was added in the care of patients due to the severity of the pandemic and directing existing resources for recoverable patients ”, commented one of the paramedics interviewed by Excelsior, who requested anonymity to avoid any kind of retaliation.

A few days ago the debate on medical decisions was revived to provide more care to some patients than others, according to the resources that are counted, since the Emergency Medical Services Agency of Los Angeles County, California, ordered the ambulance teams that do not transport patients with little chance of survival to hospitals and that conserve oxygen for those who value that they could overcome the disease and in Mexico City, the Regulatory Center for Medical Emergencies (CRUM), asked paramedics to classify Covid-19 patients as “non-recoverable”, through a “blue code”.

Doctors from the CDMX Secretariat of Health, the military and even the National Institutes of Health had already told me about this system with an area assigned to ‘die with dignity’ since either the oxygen intakes are collapsed or there are no medications to sedate and to relax and intubate patients. On January 6, in just one of these high-specialty hospitals, they told me about 30 deaths, the highest number since the pandemic began, ”explained Xavier Tello, a doctor and health policy analyst.

The growth of infections and the demand for medical attention led the Mexican capital to the dilemma of applying the so-called “war medicine”, destined to attend to those who can live.

José Ángel Córdova Villalobos, the former Secretary of Health at the federal level, who attended the AH1N1 influenza epidemic in 2009, commented to Excelsior during the first wave of infections and deaths in the covid-19 pandemic that “what other countries face (as happened at that time in Italy), where in the absence of respirators or fans they disconnect a person, because they already have more than 80 years, to give it or put it on a patient under 60, is criminal. That is what terrifies me, that we are going to face a situation like this ”, a reality that occurred in Mexico City, nine months after this interview, since only a few will be those who can have the support of a fan team, according to their chances of survival.

Also, since April 30, 2020, the Ministry of Health published the Bioethics Guide for the Allocation of Limited Resources for Critical Medicine in Emergency Situations, which precisely stipulates that health professionals who face covid-19 have priority in the allocation of scarce resources, if required.

A friend told me her personal story from the Central Military Hospital, where her brother is one of the more than 70 patients who, in the emergency room, need to bring their own oxygen and have been sitting near the emergency area for more than 2 or 3 days. Family members must collaborate in everything, since the staff is very scarce and exhausted, ”said Tello.

On Wednesday, January 6, at the Central Military Hospital, its 204 beds were occupied, 86 for intensive care and 118 for covid hospitalization, according to its own screen, which read: “RED Situation”; in addition to the 70 civilian patients who were in the emergency room sitting on chairs.

Almost a year after the covid-19 pandemic began in the country, the medical personnel of the hospitals have not stopped to guarantee care. Photo: Special

Since mid-December, when the code blue was ordered to be applied, infections and deaths related to covid-19 have increased. On the 19th of last month, it was recorded in C5 that there were patients who waited an average of two hours and 35 minutes to receive care from an ambulance, which quadrupled the time it took for assistance to arrive.

Doctors and nurses, inside these hospitals, mentioned to us that the lack of medications is already noticeable, such as dexamethasone, enoxaparin, linezolid, meropenem, azithromycin and even paracetamol; RT / PCR tests are also missing.

Since December 10, Claudia Sheinbaum asked Sedena and Semar (National Defense and Navy) for help to convert military units into covid-19 hospitals in CDMX, because the city’s hospitals were already beginning to be exceeded, ”explained Tello.

And he added that “the problem is that there is a lack of advanced facilities to handle gases under pressure, so oxygen becomes scarce, and the use of fans becomes very complicated.”

In a report, the newspaper The New York Times published on December 21 that federal authorities modified two indicators with which they determine the epidemiological traffic light to avoid turning Mexico City into red from December 4 (maximum alert).

The percentage of occupied ventilator beds was 58% and not 45%, as reported, and the positivity in the tests was 36% and not 25%.

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