To help people from Germany to America understand what we’re about to face, I am publishing translated extracts here.
A week ago, Italy had so few cases of corona that it could give each stricken patient high-quality care.
Today, some hospitals are so overwhelmed that they simply cannot treat every patient. They are starting to do wartime triage.
Here’s the guidance for that.
It's a matter of giving priority to 'the highest hope of life and survival.'"
The extraordinary criteria of admission and discharge are flexible and can be adapted in accordance with the local availability of resources.
These criteria apply to all patients in intensive care, not just those infected with CoVid-19.
"Allocation is a very complex and delicate choice. […]
The foreseeable increase in mortality for clinical conditions not linked to the current epidemic due to the reduction of chirurgical activity and the scarcity of resources needs to be taken into consideration."
"It may become necessary to establish an age limit for access to intensive care.
This is not a value judgments but a way to provide extremely scarce resources to those who have the highest likelihood of survival and could enjoy the largest number of life-years saved."
In case of a total saturation of resources, maintaining the criterion of 'first come, first served' would amount to a decision to exclude late-arriving patients from access to intensive care."
"In addition to age, the presence of comorbidities needs to be carefully evaluated. It is conceivable that what might be a relatively short treatment course in healthier people could be longer and more resource-consuming in the case of older or more fragile patients."
Let me be honest: It’s left me not one bit wiser about what to do in these kinds of dramatic circumstances. So I don’t don’t mean to pass judgment on the contents of this document.
Doctors in America will likely be faced with similarly heartbreaking dilemmas very soon.
But we can avoid that if we:.
* Start engaging in extreme forms of social distancing
* Radically expand ICU capacities
But the moral choices involved in doing what we can today to avert that situation are straightforward.
Cancel everything now.
(Undoubtedly imperfect) translation of it is by me.