“Resources may have to be used first for those with a higher probability of survival and, secondly, who has the most years of life left, and offer the maximum number of benefits to the majority of people.”
The coronavirus outbreak in Italy has killed 827 people, up nearly 200 from a day earlier. Some 12,462 people have been infected, prompting the government to announce a new wave of measures on top of its earlier decision to lock down the whole country until early April.
Under the new rules, all shops, bars and restaurants must close for at least two weeks and only pharmacies, supermarkets and stores selling “essential items” are allowed to open.
“We will only be able to see the effects of this great effort in a couple of weeks,” Prime Minister Giuseppe Conte said.
The outbreak has overwhelmed hospitals in the country’s hard-hit north, where the majority of cases are. Nearly 6000 people are in hospital and a further 1028 in intensive care.
The virus is particularly harmful to elderly people and those with existing medical conditions.
The advice by the Italian College of Anaesthesia, Analgesia, Resuscitation and Intensive Care noted any decision to deny intensive care treatment such as respirators would need to be clearly communicated and documented.
Hospitals regularly make decisions about how to devote resources to patients with limited chance of recovery but a firm age limit on intensive care admission would be new territory and could cause a major backlash.
The advice, issued in an Italian language publication, said failure to implement an age ceiling could prove fatal for healthier and younger people who contract coronavirus in the later stages of the outbreak.
“In a scenario of total saturation of intensive resources, maintaining a criterium of first in, first served would be the same as deciding not to treat successive patients [patients who came late] that would be excluded from intensive care,” it said.
It also warned predictions for the “next few weeks” suggested there would be a major increase in patients with acute respiratory problems, creating an “enormous imbalance between the clinical necessities of the population and the availability of intensive care resources”.
Italy is now the worst-affected country outside China and many infections in other European nations have been linked to travel in Italy.
France has about 2300 cases, Germany 1900, Spain 2300, Netherlands 500 and Britain 460. The number of infections in Demark shot up from 35 to 514 in just two days.
On Wednesday German Chancellor Angela Merkel predicted between 60 per cent and 70 per cent of the population – about 50 million people – could contract COVID-19.
“This is a test for our solidarity, our common sense and care for each other. And I hope we pass the test,” she said, while also ruling out closing borders.
The World Health Organisation decided to call coronavirus a pandemic on Wednesday based on the “alarming levels of spread and severity, and by the alarming levels of inaction”, said director general Tedros Adhanom Ghebreyesus.
He said there were more than 118,000 cases in 114 countries, and 4291 people had died.
The United Kingdom is expected to shortly announce it will abandon its ‘containment’ strategy in favour of a ‘delay’ strategy designed to push the peak of the crisis towards summer when the National Health System can better cope with a deluge of patients.
The pandemic has also reached the British Parliament, where one of Prime Minister Boris Johnson’s cabinet members is in isolation awaiting confirmation of whether they have coronavirus.
UK media is reporting the cabinet minister – who has not yet been named – expects the test results to come back on Thursday.
Nadine Dorries, a junior health minister, has tested positive for COVID-19, as has a member of her staff. Some British politicians want Parliament to be suspended over fears MPs could bring the illness back to their constituents.
Bevan Shields is the Europe correspondent for The Sydney Morning Herald and The Age.