ICU bed shortage means it’s survival of the fittest
OLD and chronically ill coronavirus sufferers are being turned away from Italian hospitals so younger patients with better survival chances can be assured of a bed.
Overwhelmed medicos have revealed the grim lifeand-death lottery playing out in Italy’s health care system, as the government imposed an unprecedented national lockdown of the population to stop the spread of the disease.
Doctors compared themselves to wartime triage medics deciding who lives, who dies and who gets access to the limited number of intensive care beds.
The Italian society of anaesthesiology and intensive care published 15 ethical recommendations to consider when deciding on ICU admissions during the virus crisis and the ICU shortage. The criteria include the age of the patient and the probability of survival, and not just “first come first served”.
“It’s a reasoning that our colleagues make,” Dr Guido Giustetto, head of the association of doctors in northern Piedmont, said. “It becomes dramatic if, rather than doing it under normal situations, they do it because the beds are so scarce that someone might not have access to medical care.”
The epidemic has exposed the impact of drastic cuts to Italy’s public health system over the past few years, and prompted calls for the government to authorise hiring of thousands of doctors and nurses. In Lombardy, nursing students were allowed to graduate a month early so they could be put to work immediately. Officials have been alarmed by Italy’s high fatality rate: with 463 dead and 9172 infected, Italy’s fatality rate is running at 5 per cent nationwide and 6 per cent in Lombardy, far higher than the 3-4 per cent estimates elsewhere.
Dr Giovanni Rezza, head of infectious disease at the National Institute of Health, attributed the high rate to the fact that Italy has the world’s oldest population after Japan, and the median age of its virus-related dead is 80.
On Monday, the government took drastic measures to restrict Italians’ movements nationwide and prevent social gatherings, realising that limited restrictions weren’t containing the spread. For example, the region surrounding the capital Rome — Lazio — saw its cases jump from 87 to 102 in a day, a sign that the virus was propagating far from the northern concentrations.
The Lombardy government has been scrambling to increase its ICU capacity, converting operating and recovery rooms into isolated wards to treat the 440 critical virus patients currently in need. It has cobbled together 150 more beds in the past two weeks and expects another 150 in the coming week. But it may not be enough. “Unfortunately we’re only at the beginning,” said Dr Massimo Galli, head of infectious disease at Milan’s Sacco hospital.
There was one piece of good news after a 38-year-old man — known as Patient No. 1 — was moved out of intensive care for the first time since he tested positive on February 21 and opened Italy’s health care crisis.
The man, known as Mattia, began breathing on his own and speaking, said Dr Francesco Mojoli.
“Now we hope that the fact that he was young and in good shape will help him get back to his normal life.”