In Italy, triage and lies for virus patients
The fight against death pauses every day at 1 p.m.
At that time, doctors in the intensive care unit phone relatives of the unit’s 25 critically-ill coronavirus patients, all of whom are sedated and have tubes down their throats to breathe, to update the families.
Lunchtime used to be for visiting hours at this Milan hospital. But now, as the country grapples with a coronavirus outbreak that has killed more than 2,000 people, no visitors are allowed in.
Every time a bed comes free, two anesthesiologists consult with a specialist in resuscitation and an internal medicine physician to decide who will occupy it.
Age and pre-existing medical conditions are important factors.
Says Marco Resta, deputy head of Policlinico San Donato’s Intensive Care Unit, "If there is no chance, he says, you have to “look a patient in the face and say, ‘All is well.’ And this lie destroys you.”
Resta says that 50% of those with COVID-19 who are accepted into intensive care units in Italy are dying.
Doctors have warned that northern Italy – where the universal healthcare system is ranked among the world’s most efficient – has crippled the network of hospitals, putting their intensive care units under colossal strain.
Doctors must choose more often, and more quickly, who deserves a greater chance of survival - a triage that is particularly wrenching in a Catholic country that does not allow assisted dying, and where the population is, according to statistics agency Eurostat, the oldest in Europe with nearly one person in four aged 65 or older.
Italian doctors say that so many elderly COVID-19 patients are showing up with breathing problems, they can’t take a chance on those who have a slim hope of recovery.
This triage is happening outside of hospitals, too.
On Friday, the mayor of Fidenza, a city just outside the Lombardy region, shut access to the local hospital for 19 hours. It was overcrowded with COVID-19 patients and hospital staff had worked 21 days without a break. While the closure was aimed at keeping the hospital going, it meant some people “died at home,” said the mayor, Andrea Massari.
Italy’s Association of Anaesthesia, Analgesia, Resuscitation and Intensive Care published new guidelines on March 7. Because it expects a “huge imbalance” between the clinical needs of the population and intensive care resources over the next few weeks, it told those on the front lines: Give priority to those with “greater life expectancy.”
https://www.reuters.com/article/us-health-coronavirus-italy-ethics-speci/all-is-well-in-italy-triage-and-lies-for-virus-patients-idUSKBN2133KG
