“We have to move away from this paradigm of even thinking about caseloads day over day,” Gupta said. “Because it’s overwhelming. It’s psychologically depressing, it’s discouraging.”

The doctor said he believes that private sector pressure might help force people to get vaccinated, but if more people do not lift up their sleeves, it is time to assess whether those people should be shuffled to the back of the line at struggling hospitals.

“This is where it’s controversial, but we need to talk about this, the bioethics of it broadly because this is not the last respiratory pandemic we’re going to face,” Gupta said. “What do we do with somebody who is unvaccinated who is taking advanced ICU therapies from somebody who is vaccinated in the hospital? How do we rank order that priority? We do it for organs, kidneys, livers, lungs. We say, ‘Did you smoke, did you drink recently?’ If you did, you’re lower on the list, even if you need it. We need to start thinking of that model.”