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MILAN. 6,592 infections and 10 deaths yesterday alone. With a ratio of 494.9 cases per 100 thousand inhabitants. Double in Italy and Austria, five times more than in Germany. Switzerland is about to be overwhelmed by the peak of the pandemic and is taking action. The document prepared by the Swiss Academy of Medical Sciences and the Swiss Society for Intensive Medicine has been in force since March 20, although it has not yet been officially adopted. The title is accurate: “Triage of Intensive Care Treatments in Case of Resource Scarcity.” To a question that is asked in all the hospitals in the world, Switzerland puts an answer in pencil on paper: “At level B, unavailability of beds in intensive care, cardiopulmonary resuscitation should not be performed.”
Age limits for care
A Page 5 of the document indicates the types of patients destined not to be hospitalized in intensive care: «Age over 85 years. Age older than 75 years accompanied by at least one of the following criteria: liver cirrhosis, stage III chronic renal failure, NYHA class heart failure greater than 1 and estimated survival less than 24 months. At level A, ICU beds available but resources limited, the criteria for not entering resuscitation are more severe. Among others: “Recurrent cardiac arrest, cancer disease with a life expectancy of less than 12 months, severe dementia, NYHA class IV heart failure, end-stage degenerative disease.”
Like in war
The cure or not will be the prerogative of the doctors. Or rather the number of hospital beds. Until last Monday, the latest data available, in Switzerland there were 22,000 301 beds, of which 6,000 and 353 are still free. With 586 patients hospitalized for Covid-19, of which 97 in intensive care and 29 intubated. But the progression of the virus is rapid. The decisions that Swiss doctors could make shortly are the same ones that Bergamo doctors faced, overwhelmed by the first wave of pandemics, in March. Thirteen of them had written a letter to the New England Journal of Medicine that had gone around the world: “Older patients are not resuscitated and die alone without even the comfort of adequate palliative care.”
In Switzerland, the same problem becomes a medical criterion. With a premise drawn up by the academics and rescuers themselves: “Decisions must be taken in order to limit as much as possible the number of seriously ill and dead.” However, even in the pragmatic Switzerland, things made a lot of impression, admits Franco Denti, president of the Order of Doctors of the Canton of Ticino: “When this directive came out, we got on the chair. Deciding who to resuscitate and who is not heavy, too heavy for any doctor. But this document, which is public, is a guarantee for doctors and patients themselves who may not want to undergo further treatment.
In the press release presenting the protocol, the academics speak of the need to “make rationing decisions.” Military term that refers to war medicine. Inevitable according to the president of the Ticino doctors: “Every decision rests with the ethics committees of the hospitals. I am not aware that it has already happened, but we are very worried.
