News & Politics

As Coronavirus Spreads, Italian Doctors Face Impossible Choice: Who Lives and Who Dies

Staff sell masks at a Yifeng Pharmacy in Wuhan, Chin, Wednesday, Jan. 22, 2020. Pharmacies in Wuhan are restricting customers to buying one mask at a time amid high demand and worries over an outbreak of a new coronavirus. The number of cases of the new virus has risen over 400 in China and the death toll to 9, Chinese health authorities said Wednesday. (AP Photo/Dake Kang)

In the Italian province of Lombardy, there are 900 beds for intensive care patients with a serious case of the coronavirus. The disease is spreading so fast that medical authorities are now saying the number of coronavirus cases will soon far outnumber beds available.

At that point, doctors will have to start making some tough choices.


With no clear sign of when the epidemic will spike, anesthesiologists and doctors are being called on to make increasingly tough calls on who gets access to beds and respirators when there are not enough to go around.

“It is a fact that we will have to choose [whom to treat] and this choice will be entrusted to individual operators on the ground who may find themselves having ethical problems,” said a doctor working in one of Milan’s largest hospitals.

The bug is particularly lethal in Italy. Nearly 30 percent of the population is over the age of 60. Italy also has an inferior healthcare infrastructure, according to experts. Combine those two factors and you have the situation you now have in Lombardy: too many very sick patients, not enough beds, and doctors being forced to decide who lives and who dies.

For now, the marching orders are: Save scarce resources for those patients who have the greatest chance of survival. That means prioritizing younger, otherwise healthy patients over older patients or those with pre-existing conditions.

“We do not want to discriminate,” said Luigi Riccioni, an anesthesiologist and head of the ethical committee of Siiarti, the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care, who co-authored new guidelines on how to prioritize treatment of coronavirus cases in hospitals. “We are aware that the body of an extremely fragile patient is unable to tolerate certain treatments compared to that of a healthy person.”

Perhaps only in wartime are doctors called on to make such difficult choices.

In an interview that went viral after it was published in the Italian daily Corriere della Sera Monday, Christian Salaroli, an anesthesiologist from a hospital in Bergamo, recounted scenes of wartime triage, where old patients have to be left by the wayside. “The choice is made inside of an emergency room used for mass events, where only COVID-19 patients enter. If a person is between 80 and 95 and has severe respiratory failure, he probably won’t make it.”

If you’re wondering if the situation confronting Italian doctors could happen here, the answer is a qualified yes. It would have to be a pandemic of historic proportions before the U.S. healthcare system was overloaded. This doesn’t preclude the possibility of isolated local crises where some healthcare facilities are overwhelmed. But the chances of the sort of healthcare disaster that Italy is facing occurring in the U.S. are remote.

But what’s happening in Italy is an object lesson in how not to handle an epidemic. Apparently, there is no strong, central authority for healthcare. Regional directors are in charge and they’re not always on the same page. The critical initial response to the disease was haphazard and not coordinated well with Rome. This led to several points of entry for the coronavirus — too many for health authorities to deal with.

Italy has taken the draconian step of quarantining 16 million people in the northern provinces. But news of the quarantine leaked and thousands of people in the north fled to the south to avoid it. That means that southern Italy — which is even less prepared to handle and epidemic — is now in the crosshairs of the disease.

It’s going to get a lot worse before it gets better.