Why doctors in Italy are letting some coronavirus patients die to save others

In an analysis published in The Lancet, two Italian researchers have predicted a doomsday scenario for Italy if coronavirus infections continue at current rate.

Medical team at work in the Embassy at Rome, collecting samples of Indian nationals for testing COVID-19 | PTI

New Delhi: Two Italian researchers have painted a bleak outlook for the European country, which finds itself at the centre of the coronavirus pandemic with over 1,400 deaths, if infections continue at the current rate for another week.

Over 21,000 people have been diagnosed with coronavirus in Italy, with the epicentre of the pandemic shifting from point-of-origin China to Europe.

In a piece published in the medical journal The Lancet Friday, titled “COVID -19 and Italy: What Next?”, the researchers predicted a rise of 9,000 patients by Sunday if the trend wasn’t arrested.

“If the increase in the number of infected patients follows this trend for the next week, there will be more than 30,000 patients infected by March 15,” the researchers said.

They also noted that Italy might need as many as 4,000 new ICUs by mid-April to tackle new infections, pointing out that 9 per cent to 11 per cent of patients in Italy had required ICU admissions daily between 1 March and 11 March.

According to the analysis, Italy currently has close to 5,200 ICUs.

The analysis, written by professors Andrea Remuzzi and Giuseppe Remuzzi, suggested that the trend of infections in Italy was similar to that reported for the initial phase of the infection in the city of Wuhan, China, where coronavirus originated.

In the worst-hit Lombardy region, despite extraordinary efforts to restrict the movement of people, the country is dealing with “an even greater fear — that the “number of patients who report to the emergency room will become much greater than the system can cope with”, the study noted.

 

Who to save and who not to

Italy has witnessed the second-highest number of coronavirus deaths and infections after China. The country has imposed strict social-distancing measures to restrict the infection amid the mounting toll, but a shortage of medical supplies and hospital beds in Italy is already reportedly forcing doctors to choose which coronavirus patients to save.

The ones with better odds of survival, for example, the young, are being treated while those with a dull chance are reportedly being denied life-saving care.

The two Italian researchers noted the trend too, pointing out that “this attitude has already been criticised by the current President of the Italian Comitato di Bioetica (Italian Bioethics Committee) who, in a recent declaration… stated that the Constitution recognises the right of every individual to receive all necessary healthcare”.

In the same breath, they also noted that such critics may not “recognise that the reality is that intensive care wards are overflowing with patients and that COVID-19 is not a benign disease”.

“Our doctors and nurses are modern heroes in an unexpected war against a difficult enemy. In the near future, they will have no choice. They will have to follow the same rules that healthcare workers are left with in conflict and disaster zones,” they added.

According to the researchers, healthcare professionals who form the frontline of the struggle against this pandemic haven’t been unaffected either — around 20 per cent are believed to have contacted the infection, with some even dying.

The researchers said that the number of newly infected patients in Italy could start to decrease within 3-4 days, departing from the exponential trend, “if the Italian outbreak follows a similar trend as in Hubei province (where Wuhan is located), China”.

However, they added that “this cannot currently be predicted because of differences between social distancing measures and the capacity to quickly build dedicated facilities in China”.

 

How can Italy check the outbreak? 

The objective of the analysis is to help political leaders and health authorities allocate enough resources, including personnel, beds, and intensive care facilities, to manage the situation in the next few days and weeks.

“Our analysis tends to suggest that measures to reduce transmission should certainly be implemented, as our government did on March 9, by inhibiting people’s movement and social activities, unless strictly required,” the researchers said.

Rather than revising the Schengen visa-free zone, they added, the most effective way to contain this viral outbreak in European countries is “probably to avoid close contact at the individual level and social meetings in each country”.

They noted that the government was preparing to “pass legislation that will enable the health service to hire 20,000 more doctors and nurses and to provide 5,000 more ventilators to Italian hospitals”, but call for urgency. “These measures are a step in the right direction, but our model tells us that they need to be implemented urgently, in a matter of days. Otherwise, a substantial number of unnecessary deaths will become inevitable.”