Though we’ve been given updated instructions for screening patients for coronavirus - which say that a person need not have a history of recent travel to qualify for testing - the hospital feels mostly like its normal, hectic self, as it did before I left the country. They are “completely living in another world,” Bertolini says, because “unless you are inside this situation, you cannot understand fully.” People are, it seems, woefully bad at grasping how future events will unfold, whether in the city next door tomorrow or across the Atlantic a couple of weeks later.īack in New York, I work a couple of shifts in the E.R. Vergano notes that most of the criticism has come from regions in Italy that have yet to be hit as hard as Lombardy. “From colleagues to journalists to bioethicists - we are in firing lines these days,” Bertolini adds. “You cannot imagine to what extent we have to face harsh criticism,” Vergano says. Swift and fierce denunciation of the group and its recommendations follows the document’s release.
“Soft utilitarian” is how Vergano characterizes the approach. They strongly advise against allocating precious resources, like ventilators and beds, on the traditional basis of first-come, first-served, which would reduce the number of lives a hospital could save. The document’s fundamental thrust, though, is that those with the highest chances of survival - the young and the healthy - get priority. They want doctors to have flexibility but use these principles to guide and justify their decision-making. Soon after, the group decides to delete the specific cutoffs, so that hospitals can adapt their responses to circumstances, which are changing hourly. If you are over 80 or one of your organs isn’t functioning well or your dementia has advanced past a certain point, you are unlikely to get a breathing tube or a spot in the I.C.U. The first version includes strict criteria. That night, he begins drafting a document. He’s working back-to-back shifts in the I.C.U., but he jumps online with the six other members of the task force that Bertolini has set up.
doctor in Turin, in the neighboring province of Piedmont, who is also the chairman of the bioethics group of Italy’s society of intensivists (Siaarti). They include Marco Vergano, a 45-year-old I.C.U. He begins rounding up - virtually, over Skype - a group of bioethicists and I.C.U. He knows doctors are soon going to have to decide who lives and who doesn’t. beds it needs to care for all the critically ill patients infected with Covid-19. Yet the region has only half the number of I.C.U. “Which is dramatic.” Lombardy is one of Italy’s richest areas, where there is “almost no limit in resources,” he explains. “From my position in the crisis unit, I see the whole picture,” he says. When Bertolini opened it, he tells me, he couldn’t believe the numbers. Some of the pleas had an Excel file attached. He had been high up in the Italian Alps through the last day of February, when the distressing messages started to come in from colleagues asking him to join a new Coronavirus Crisis Unit for Lombardy, a region in northern Italy. Through a colleague of his, I reach out to him over WhatsApp, and we begin corresponding. I want to hear about them directly from health care workers in Italy.Ī few days from now, I will come across the name of Guido Bertolini, a clinical epidemiologist who studies intensive care. Could our hospitals also be overtaken that quickly? What would that look like? I need to know what might come, what decisions I might be confronted with. I know the situation with Covid-19 is already dire in different parts of the world, Italy especially. Doctors and nurses are always multitasking at the edge of their limits. can be swamped, with patients doubled up in rooms and too few monitors and beds to go around. Even in the best of circumstances, the E.R. Though I am more than 7,000 miles away - reporting on a different disease outbreak - I am already worried about what I will face when I return home in two days to my job as an emergency-room doctor in the city. I am in Karachi, Pakistan, on March 2, when I read the news: New York City has its first patient hospitalized with the coronavirus.
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