Switzerland has adopted a protocol on the hospitalization of patients due to the coronavirus, to curb the admission of the elderly to ICUs: “Those with the possibility of recovery will have priority.” In the last 24 hours, Switzerland has registered 6,592 new infections and 10 deaths. The spread of the virus begins to be exponential: 494.9 positives per 100,000 inhabitants, twice as many as in Italy and Austria, and five times as much as in Germany. To deal with the pandemic with a peak that alarms the country, according to “La Stampa”, the Swiss Academy of Medical Sciences and the Swiss Society of Intensive Care Medicine have drawn up a Protocol (in force since March 20, although not yet has been officially put into practice) that specifies which patients should not be admitted to the ICU when the means are saturated: «Age over 85 years. Over 75 years of age 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.
The decision that Swiss doctors could take shortly are the same with which Bergamo doctors confronted in March, the city hardest hit by the virus in Lombardy, with hospitals completely overflowing with coronavirus infections and saturated ICUs. Thirteen doctors from Bergamo, La Stampa recalls, wrote a letter to the New England Journal of Medicine, a news item that went around the world: «Older patients are not cared for in intensive care and die alone, without even being comforted with adequate palliative care ”.
In Switzerland, the same problem becomes a medical criterion. Being cured or not in intensive care will be at the discretion of doctors or the number of ICU positions. “Decisions must be made in order to limit as much as possible the number of seriously ill and dead”, write the members of the Swiss Academy of Medical Sciences and the Swiss Society of Intensive Medicine. In a statement presenting the protocol, the academics speak of the need to “Make rationing decisions”, a military term that refers to war medicine. Inevitable according to Franco Denti, the president of the College of Physicians of Ticino, the southernmost Swiss canton in Switzerland, where Italian is spoken: “All decisions rests with the hospital ethics committees. I am not aware that it has already happened, but we are very worried.
The Turin newspaper highlights that even in the pragmatic Switzerland it has made a lot of impression, according to Franco Denti, president of the canton Ticino doctors: “When this directive came out, we jumped on the chair. Deciding who to revive and who not to resuscitate is hard, very hard 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. So the rules are clear ”.