Italy might soon be forced to deny intensive care to coronavirus patients over the age of 80

Italy, with the oldest population in Europe, is leaving no stone unturned in its attempt to stem the rampant spread of the coronavirus. Having seen the most number of COVID-19 deaths—apart from China—the country has been forced to shut down while exhausted doctors and nurses work around the clock to keep the infected alive. However, as the surge of coronavirus patients shows no sign of slowing down, Italy may soon have to make some hard decisions regarding who gets access to intensive care. According to a written proposal by the civil protection department of the Piedmont region (one of those hardest hit by the outbreak), those aged 80 or above may be denied access to intensive care treatments in the event of insufficient spaces.

The document, seen by The Telegraph, reportedly states: "The criteria for access to intensive therapy in cases of emergency must include age of less than 80 or a score on the Charlson comorbidity Index [which indicates how many other medical conditions the patient has] of less than 5." Under the protocol developed by the crisis management unit, the ability of the patient to recover from resuscitation will also be taken into consideration when determining whether they qualify for intensive care. Doctors fear those denied intensive care will effectively be left to die if the situation worsens enough to implement the proposed guidelines.

"[Who lives and who dies] is decided by age and by the [patient's] health conditions. This is how it is in a war," said a concerned doctor. The draft plans for the next phase of the crisis anticipates that the demand for intensive care resources will soon outstrip supply. "The growth of the current epidemic makes it likely that a point of imbalance between the clinical needs of patients with COVID-19 and the effective availability of intensive resources will be reached," the document states.

"Should it become impossible to provide all patients with intensive care services, it will be necessary to apply criteria for access to intensive treatment, which depends on the limited resources available," it adds. "The criteria set out guidelines if the situation becomes of such an exceptional nature as to make the therapeutic choices on the individual case dependent on the availability of resources, forcing [hospitals] to focus on those cases in which the cost/benefit ratio is more favorable for clinical treatment."

The document is currently pending approval from a technical-scientific committee before it is sent to hospitals and government sources revealed that the criteria are expected to apply throughout Italy. Speaking of the proposed guidelines, Luigi Icardi—a councilor for health in Piedmont—said, "I never wanted to see such a moment. It [the document] will be binding and will establish in the event of saturation of the wards a precedence code for access to intensive care, based on certain parameters such as potential survival."

Although Italy has 5,090 intensive care beds, which currently exceeds the number of patients who need them, the country is now working to create new bed capacity in private clinics, nursing homes, and even tents as the number of confirmed cases of COVID-19 continues to rise. While Lombardy remains the most critical region, the situation is equally dire in neighboring Piedmont. Roberto Testi, president of the coronavirus technical-scientific committee for Piedmont, said, "Here in Piedmont we aim to delay as long as possible the use of these criteria. At the moment there are still intensive care places available and we are working to create more."

"We want to arrive as late as possible at the point where we have to decide who lives and who dies. The criteria relate only to access to intensive care - those who do not get access to intensive care will still receive all the treatment possible. In medicine, we sometimes have to make difficult choices but it's important to have a system about how to make them," Testi added.