There is now grave concern regarding the Italian national health system’s capacity to effectively respond to the needs of patients who are infected and require intensive care for the severe acute respiratory syndrome coronavirus 2 SARS-CoV-2 pneumonia. The percentage of patients in intensive care reported daily in Italy between March 1 and March 11, 2020, has consistently been between 9% and 11% of patients who are actively infected.
An aggressive approach needs to be taken with patients who are critically ill with SARS-CoV-2, often including ventilatory support. The system’s capacity to respond to changing circumstances has been under enormous pressure, at least in the Lombardy region, where two clusters have already emerged since Feb 21. We predict that if the exponential trend continues for the next few days, more than 2500 hospital beds for patients in intensive care units will be needed in only 1 week to treat ARDS caused by SARS-CoV-2-pneumonia in Italy. In the meantime, the government is preparing to pass legislation that will enable the health service to hire 20 000 more doctors and nurses and to provide 5000 more ventilators to Italian hospitals. These measures are a step in the right direction, but our model tells us that they need to be implemented urgently, in a matter of days. Otherwise, a substantial number of unnecessary deaths will become inevitable.
Intensive care specialists are already considering denying life-saving care to the sickest and giving priority to those patients most likely to survive when deciding who to provide ventilation to. This attitude has already been criticised by the current President of the Italian Comitato di Bioetica who, in a recent declaration to lay press stated that the Constitution recognises the right of every individual to receive all necessary health care. They might not recognise that the reality is that intensive care wards are overflowing with patients and that COVID-19 is not a benign disease.
COVID-19 and Italy: what next? The Lancet. Published March 13, 2020
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