Agonizing decisions being made in Spain’s virus hot spots
ZARZA DE TAJO, SPAIN » Raquel Fernández watched as cemetery workers lowered her grandmother’s casket into the grave and placed it on top of the coffin of her grandfather, buried just three days earlier.
Eusebio Fernández and Rosalía Mascaraque, both 86, are two of Spain’s more than 10,000 fatalities from the coronavirus pandemic.
Like thousands of other elderly victims in Spain, their deaths this week illustrate one of the darkest realities of the crisis: Doctors at overburdened hospitals in need of more resources are having to make increasingly tough decisions on who gets the best care, and age appears to matter more than ever.
“Due to a lack of resources in this country, they won’t put an 86-year- old person on an assisted breathing machine. It’s simply that cruel,” said Fernández, a nurse. “My grandparents fought all their lives to be happy and build their strength so they could grow old with dignity, so of course this moment is very painful, and it is difficult for us to cope with.”
Her grandparents fell ill with a fever and cough. After staying home for several days as health authorities recommended, their son rushed them to a hospital in Torrejón, east of Madrid, on March 25.
Two days later, Eusebio died of respiratory failure after testing positive for coronavirus. Rosalía died 48 hours later but her test was inconclusive. Neither was put in an intensive care unit or on a ventilator, Fernández said.
She said her grandmother had a heart condition, but that she believed her grandfather was in excellent health and should have been given more of a fighting chance.
“I understand that between someone who is 30 or 40 years old and my grandfather, they will not choose my grandfather, but if this had happened in another moment, in a health care system that claims to be among the best in the world, this would not have happened,” she said.
The coronavirus causes mild or moderate symptoms for most people, but for some, especially older adults and people with existing health problems, it can cause more severe illness or death.
Spain has recorded 110,238 infections, placing it just behind Italy’s 115,242 cases, which is the most in Europe. The Spanish government said Thursday the country had over 6,000 patients in intensive care.
Agonizing life and death decisions are being made in Madrid and northeast Catalonia, the main hot spots for the outbreak.
Spain’s Health Minister Salvador Illa said care is being given “based on each patient’s case profile, not their age.”
But two weeks ago, workers in Madrid’s hardest hit hospitals told The Associated Press that patients over 80 were not given priority for ICU beds because of their lower chance of survival.
On Wednesday, guidelines of Catalonia’s medical emergency response service distributed to hospitals and seen by the AP recommended that virus patients over 80 not be intubated. The document said staff should “offer resources to those patients who can most benefit from them as far as years of life to be saved (and) avoid hospitalizations of people with scarce chances of survival.”
Dr. Xavier Jiménez Fàbregas, medical director of Catalonia’s medical emergency system that distributed the guidelines, told AP that age is just one of many factors. He said the guidelines were accepted ethical practices being applied to this crisis, “given the elevated number of patients with respiratory failure.”
The Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care issued 15 ethical recommendations in deciding ICU admissions if beds were in short supply. They called for wartime, triage-type decisions to benefit those with a better hope of survival, not on a first- come, firstserved basis.