Uncertainty About Legal, Institutional Support for Transparent Triage Protocols Led to Covert Triage During COVID-19

Background: Officially, triage of ICU resources was not required in Germany during the COVID-19 pandemic. However, national triage guidelines were created. The experience of intensivists is less well known. Objective: To determine how intensivists in Germany responded to resource constraints during the COVID-19 pandemic. Design: Qualitative methods study. Participants: 14 senior intensivists who worked in ICU during the pandemic and were involved in triage preparations. Methods: Semi-structured interviews were conducted, audio recorded and transcribed. Three of the authors analyzed the results. Results: Mean age of participants was 48 years. In addition to being senior physicians, 3 participants were department heads. The authors identified 2 types of covert triage described by the participants. Type 1 was informal crisis standards of care. The authors use the following statement as an example of type 1 covert triage: “Doing an ICU trial…we were much, much more cautious& more...