A medic checks the temperature of a tourist as part of precautionary screening in the wake of the coronavirus outbreak, at a hotel in Bikaner Thursday
File image of a medic checking the temperature of a tourist as part of precautionary screening in the wake of the coronavirus outbreak | Representational image | PTI
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New Delhi: With an exponential rise in the number of coronavirus cases in Italy, the country has released a set of guidelines — similar to war-time triage — that doctors are following to deal with the emergency. 

Triage is a process of prioritising treatment.

A substantial number of the patients diagnosed with coronavirus require ventilatory support due to complications that lead to pneumonia.

However, due to limited number of such facilities, doctors have now been recommended to put an age limit on a patient’s access to intensive care.

As a result, doctors are now making the difficult moral choice of prioritising those patients who are more likely to survive.

In less than two weeks, the number of cases in Italy shot up from a few hundred to over 10,000. 

The country is the worst hit by the pandemic after China — with over 10,500 active cases and more than 820 deaths.

Globally, over 4,300 people have died so far and more than 1,20,000 have been infected.


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The guidelines

The Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care has published a set of guidelines last week to tackle the situation under the present circumstances.

“It is not a question of making merely valuable choices, but of reserving resources that could be very scarce to those who have the greatest chance of survival first, and secondly to those who can have more years of life saved, with a view to maximising the benefits for the most number of people,” the document read.

This means that older patients, who are likely to take longer to recover and would gain a relatively shorter period of lifetime through intensive care, would not be prioritised.

The document also warned that in the current scenario, there would also be an increase in the number of deaths among patients who are admitted in hospitals for reasons other than the coronavirus infections “due to the reduction of surgical and outpatient elective activity and the scarcity of intensive resources”.

“Allocation is a complex and very delicate choice, also due to the fact that an excessive increase in intensive beds would not guarantee adequate care for individual patients and would divert resources, attention and energy from the remaining patients admitted to Intensive Care,” the document stated.

The guidelines recommended that the list of patients who are considered to be “deserving of intensive care” should be prepared in advance.

The document further stated that these guidelines will also apply to patients who require intensive care for reasons other than the coronavirus.

‘Protocol should be carefully thought through’

With the coronavirus outbreak now declared a pandemic, other countries such as India may also need to consider preparing for triage.

While India has relatively less number of cases as of now, the country has very few specialists to deal with an outbreak and needs to be prepared to handle such a crisis.  

In a blog published in the journal BMJ, medical professionals argued that countries urgently need to address the question of how access to intensive care will be determined when sufficient resources to treat everyone is not available.

But it also added: “While triage may be an effective way to increase population survival, this is not guaranteed and any protocol should be carefully thought through.”


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