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More than 6,500 infections and 10 deaths on Friday alone, with a report of 494.9 cases per 100,000 inhabitants. Twice the size of Italy and Austria, five times the size of Germany. Switzerland is about to be overwhelmed by the pandemic and is beginning to take 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 lack of resources.” To the question posed in all hospitals in the world, Switzerland answers in black and white: “At level B, in case of unavailability of beds for intensive care, cardiopulmonary resuscitation should not be performed.”
On page 5 of the document, the types of patients destined not to be admitted to the intensive care unit are indicated: “Age over 85 years. Age over 75 years accompanied by at least one of the following criteria: liver cirrhosis , chronic kidney failure “in stage III, NYHA class 1 heart failure is greater and survival is estimated to be less than 24 months.” At level A, beds available for intensive care but limited resources, the criteria for not being admitted to resuscitation are more serious. Among others: “Recurrent cardiac arrest, oncological disease with life expectancy of less than 12 months, severe dementia, class IV / NYHA heart failure, end-stage degenerative disease.”
Whether they will be treated or not will be the decision of the doctors or rather according to the number of hospital beds. Last Monday, according to the latest available data, there were 22,301 beds in Switzerland, of which 6,353 were still free. With 586 patients hospitalized for COVID-19, of which 97 in Intensive Care and 29 intubated. But the evolution of the virus is fast. The decisions Swiss doctors could make soon are the same ones that Bergamo doctors faced in March, overwhelmed by the first wave of the pandemic. Thirteen of them sent a letter to the New England Journal of Medicine, which went around the world: “Older patients do not resuscitate and die alone without the comfort of adequate palliative care.”
In Switzerland, the same problem becomes a medical criterion. With a premise written even by academics and resuscitation physicians: “Decisions must be made to limit as much as possible the number of seriously ill patients and deaths.” Yet even in pragmatic Switzerland, this was astonishing, admits Franco Denti, president of the Canton of Ticino Order of Physicians: “When this directive appeared, I jumped out of my chair. Deciding who to resuscitate and who is not difficult.” The document, which is public, is a guarantee for the doctors and the patients themselves, who do not want to undergo additional treatment “.
In the press release, the academics speak of the need to “make rationalization decisions.” A military term reminiscent of war medicine. It is inevitable, according to the president of the doctors in Ticino: “Every decision depends on the ethics committees of the hospitals. I have no information that it has already happened, but we are very concerned.”
