Coronavirus Italy: Intensive care units told not to treat elderly

Italy has said all shops except pharmacies and food outlets will be closed in response to the country’s coronavirus outbreak as the death toll from the disease in the country jumped sharply in the last 24 hours.

A top Italian doctor said intensive care wards should place an age limit on beds as a way of prioritising medical resources amid the deepening crisis.

Rather than admit patients on a ‘first come first served’ basis, hospitals should swap to ‘catastrophe medicine’ guidelines – typically used in war zones and during natural disasters – where those with the greatest chance of survival are given priority.

The guidelines should apply to all patients needing intensive care treatment and not just those suffering from coronavrius, according to guidance published this week by the Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SAARI).

If a limit on beds is implemented it could mean elderly patients with no signs of coronavirus being turfed off ICU wards to make space for younger patients who have longer left to live. 

It comes as total confirmed infections in Europe rose to 22,485 with 940 deaths, according to a new tally which is compiled from official sources. 

In Italy, the number has risen to 12,462 cases with 827 fatalities. More European countries are reporting their first deaths of people with the new contagion. 

A coronavirus emergency checkpoint and triage point at Civile Hospital in Brescia, Italy

A coronavirus emergency checkpoint and triage point at Civile Hospital in Brescia, Italy

A coronavirus emergency checkpoint and triage point at Civile Hospital in Brescia, Italy

Rome's Deputy Maria Teresa Baldini wears a protective mask and gloves inside parliament as she helps deal with the fallout from coronavirus

Rome's Deputy Maria Teresa Baldini wears a protective mask and gloves inside parliament as she helps deal with the fallout from coronavirus

Rome’s Deputy Maria Teresa Baldini wears a protective mask and gloves inside parliament as she helps deal with the fallout from coronavirus

Markers on the floor indicating the safety distance between people at a market stall as part of control measures against the spread of the coronavirus in Trento today

Markers on the floor indicating the safety distance between people at a market stall as part of control measures against the spread of the coronavirus in Trento today

Markers on the floor indicating the safety distance between people at a market stall as part of control measures against the spread of the coronavirus in Trento today 

People wearing sanitary masks as they queue outside a supermarket in Casalpusterlengo, in northern Italy

People wearing sanitary masks as they queue outside a supermarket in Casalpusterlengo, in northern Italy

People wearing sanitary masks as they queue outside a supermarket in Casalpusterlengo, in northern Italy

The death in Sweden of an elderly woman who had been in intensive care represented the first virus-related death for the whole Nordic-Baltic region.

Ireland, Belgium, Bulgaria and Albania reported their first virus-related deaths earlier on Wednesday. 

In Italy a rise in cases of 31 per cent was reported today by the Civil Protection Agency, the largest increase in absolute numbers since the contagion came to light on February 21.

  • World Health Organisation officially declared virus crisis a pandemic as European cases climbed over 22,000
  • WHO said today it was ‘deeply concerned by the alarming levels of spread and severity’ of the coronavirus
  • Director-General Dr Tedros Adhanom blasted governments for ignoring repeated WHO pleas to take urgent and aggressive action since the spread outside China rose 13-fold in the space of a fortnight
  • At least 112,000 patients infected worldwide and 4,000 have died since the outbreak began last December
  • Since it began in China, Europe is now centre of the outbreak, with growing outbreaks in Italy, Spain, France, Germany and the UK where the eighth death was recorded today 

The total number of cases in Italy, the European country hardest hit by the virus, rose to 12,462 from a previous 10,149, an increase of 22.8 per cent. 

However, the agency said some 600 new cases were confirmed on Tuesday but only reported on Wednesday.

The head of the agency said that, of those originally infected, 1,045 had fully recovered compared to 1,004 the day before. Some 1,028 people were in intensive care against a previous 877.

Italy announced 200 deaths from coronavirus on Tuesday in the largest daily rise yet, as infections spiked to more than 12,000. 

Medics have warned that the UK and US are approximately two weeks away from facing the same scenario.

Coronavirus has swept through Europe after a major outbreak in Italy, and is now one of the worst-affected regions outside of China

Intensive care wards should stop treating older patients and those with multiple conditions and instead focus on those who have longer to live and better chances of survival if beds run out due to coronavirus, Italian doctors have said (pictured, an ICU ward in Cremona)

Intensive care wards should stop treating older patients and those with multiple conditions and instead focus on those who have longer to live and better chances of survival if beds run out due to coronavirus, Italian doctors have said (pictured, an ICU ward in Cremona)

Intensive care wards should stop treating older patients and those with multiple conditions and instead focus on those who have longer to live and better chances of survival if beds run out due to coronavirus, Italian doctors have said (pictured, an ICU ward in Cremona)

The entirety of Italy has since been placed on lockdown, with medics in badly-hit regions saying they are struggling to cope with a huge spike in patients. 

In a booklet on coronavirus published on Friday, SAARI lays out its recommendations for a worst-case scenario.

While all efforts should be taken to ensure everyone gets care, doctors say it is likely that multiple hospital will be stretched beyond their limits ‘in the next few weeks’.

Around 10 per cent of coronavirus cases in Italy have so far developed serious complications, they note, requiring extensive treatment with ventilators which are in short supply. 

In the event that they run out, SAARI says: ‘It may be necessary to place an age limit on admission to intensive care. 

‘This is not a value judgment 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.’

Doctors should also take into account how many other conditions patients are suffering from when deciding whether or not they deserve access to intensive care, medics say, and not simply base their judgement on age.

Hospitals may need to stop admitting people on a 'first come, first served basis', medics say, and instead treat those with the best chance of survival (pictured, an emergency war in Brescia, Italy)

Hospitals may need to stop admitting people on a 'first come, first served basis', medics say, and instead treat those with the best chance of survival (pictured, an emergency war in Brescia, Italy)

Hospitals may need to stop admitting people on a ‘first come, first served basis’, medics say, and instead treat those with the best chance of survival (pictured, an emergency war in Brescia, Italy)

The guidelines should apply to all patients and not just those suffering from coronavirus, medics said (pictured, paramedics in an emergency medical tent in Cremona)

The guidelines should apply to all patients and not just those suffering from coronavirus, medics said (pictured, paramedics in an emergency medical tent in Cremona)

The guidelines should apply to all patients and not just those suffering from coronavirus, medics said (pictured, paramedics in an emergency medical tent in Cremona)

Residents wearing a protective mask wait to do their shopping outside a supermarket in Codogno, southeast of Milan

Residents wearing a protective mask wait to do their shopping outside a supermarket in Codogno, southeast of Milan

Residents wearing a protective mask wait to do their shopping outside a supermarket in Codogno, southeast of Milan

They warn that this will lead to an increase in deaths from people who are not suffering directly from the virus, but who can no longer be treated. 

The guidelines have not yet been adopted, but provide a blueprint of what Italy could do should the situation spiral out of control further. 

On Tuesday, the World Health Organization officially declared coronavirus a pandemic after the number of patients struck down by the killer infection across the world surpassed 112,000 and the death toll neared 4,500.

The boss of the UN agency said it was ‘deeply concerned by the alarming levels of spread and severity’, with outbreaks continuing to spiral out of control.

Dr Tedros Adhanom also warned inaction by governments across the planet has fuelled the crisis, adding: ‘We have called every day for countries to take urgent and aggressive action.’

In a desperate call to action to contain the escalating crisis, he said: ‘We’re in this together, to do the right things with calm and protect the citizens of the world. It’s doable.’

A pandemic is defined as the uncontrolled worldwide spread of a new disease – the last crisis to be given the official label was the 2009 swine flu outbreak, which killed hundreds of thousands of people.

Residents walk across a deserted street in Codogno, southeast of Milan, after the whole of Italy was placed on lockdown to stop the spread of coronavirus

Residents walk across a deserted street in Codogno, southeast of Milan, after the whole of Italy was placed on lockdown to stop the spread of coronavirus

Residents walk across a deserted street in Codogno, southeast of Milan, after the whole of Italy was placed on lockdown to stop the spread of coronavirus

Venice's Grand Canal is almost deserted after holidaymakers were told to leave Italy immediately and travel between cities banned

Venice's Grand Canal is almost deserted after holidaymakers were told to leave Italy immediately and travel between cities banned

Venice’s Grand Canal is almost deserted after holidaymakers were told to leave Italy immediately and travel between cities banned

More than 112,000 people globally have now been infected with the coronavirus, which can cause pneumonia and shut down crucial internal organs. The crisis in China, where the outbreak began, has slowed dramatically.

Europe is now the centre of the crisis, with the number of cases soaring every day in Italy – where all 60million residents have been affected by an unprecedented lockdown. Outbreaks are also growing in Spain, France, Germany and the UK.

Britons have been told to leave Italy and go home as the country shuts down everything in a drastic bid to stop a coronavirus outbreak.

The nation is grappling with the worst epidemic in the world outside China and more than 10,000 people have now caught the infection there. 631 have died.

The UK Foreign Office today urged British people to fly home while they still can as the Italian government urges tourists to leave and airlines are cancelling flights.

In a statement officials said: ‘The Italian authorities have advised against travel for tourism purposes throughout Italy, and that tourists already on holiday in Italy should end their travel, unless it is necessary, to return to the place where they live.’

Plane tickets out of Italy are quickly becoming hot property after British Airways, Easyjet, Jet2 and WizzAir cancelled all of their routes between Italy and the UK.

A worker pushing a cart at the hospital in Codogno, southeast of Milan, today a day after Italy imposed unprecedented national restrictions on its 60 million people

A worker pushing a cart at the hospital in Codogno, southeast of Milan, today a day after Italy imposed unprecedented national restrictions on its 60 million people

A worker pushing a cart at the hospital in Codogno, southeast of Milan, today a day after Italy imposed unprecedented national restrictions on its 60 million people

Ryanair is flying normally until Saturday, when it will stop for almost a month, and Easyjet said it would operate ‘rescue flights’ in the coming days.

One couple from Hertfordshire spent £600 in their desperate bid to get out of the country, driving through the night from Milan to Turin to ensure a seat to London.

Others who have returned in the last 24 hours said the situation was nowhere near this bad when they left and many now face two weeks in isolation at home in case they’ve caught the coronavirus.

A statement from the Foreign Office today said: ‘British nationals remain able to depart Italy without restriction.

‘Airports remain open throughout Italy. However, the Italian authorities have advised against travel for tourism purposes throughout Italy, and that tourists already on holiday in Italy should end their travel, unless it is necessary, to return to the place where they live.

‘Airline schedules are subject to change and some flights are being cancelled.

‘We therefore advise all remaining British tourists in Italy to contact their airline operators to arrange return to the UK as soon as possible.’

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