Israeli doctor in Italy: We no longer help those over 60 | Hacker News Reader

Israeli doctor in Italy: We no longer help those over 60

jpost.com

https://www.snopes.com/fact-check/italy-elderly-coronavirus/

This is from 16 March. The article was published today.

True. I also googled to find corroborating reports but could not, so I remain skeptical of the characterization in the article.

This doesn’t clarify whether the article is correct or not.

Yes, this reek of fake news. If Doctor really had to make the tough choice of who to keep alive, it wouldn’t be just an age cutoff (and definitely not such a young age), but a spectrum of input, including life expectancy and quality of life expectancy for the patient.

There is an official directive to cut off the 80+ year old and people with a certain comorbidity index if... I guess they are unofficially doing it already and the cut-off age is based on realities. There is a thing called triage, doctors and humans practice in tough times.

"The criteria for access to intensive therapy in cases of emergency must include age of less than 80 or a score on the Charlson comorbidity Index [which indicates how many other medical conditions the patient has] of less than 5." https://www.telegraph.co.uk/news/2020/03/14/italians-80-will...

Please note that is the richest area in Italy and hospitals are top notch. Just the volume...

Rating: "mixed", i.e. "true after a fashion", admitting that guidelines allow for that, but ignoring that the real claim is not "Italy officially abandoned the elderly", but "Italy's healthcare effectively doesn't treat them", and the latter is corroborated by at least two interviews with staff on-site that appeared on Twitter and in the news.

Doctors make calls like that all the time. It may not be worth it to expend resources on a patient with low survival likelihood. It may not even be in the patient’s best interest.

Of course! Which makes this Snopes article a piece trying to debunk proper medical practice.

https://www.snopes.com/fact-check/italy-elderly-coronavirus/

> Claim: Italy has stopped treating elderly coronavirus patients due to "socialized medicine."

> Rating: Mixture

> What's true: Italian health care workers who are overwhelmed with COVID-19 cases could be faced with decisions about allocating limited life-saving treatment to those with the most likelihood to live longest upon survival.

> What's false: However, Italy hasn't abandoned elderly patients to die. Instead, Italian health care workers, when faced with more patients than available equipment and capacity to treat them, may possibly be forced to prioritize treatment of those with the highest likelihood of surviving long-term.

The egregious (and slimily political) claim that Snopes needs to refute is that this is due to "socialized medicine." It's not, it's really due to a simple lack of capacity.

"Free market medicine" wouldn't do any better, it'd just prioritize the wealthy instead of the young, leaving the poor to get worse (or no) care and potentially die.

Not sure what point you're trying to make here?

1. As the fact-check you posted says: "Italian health care workers who are overwhelmed with COVID-19 cases could be faced with decisions about allocating limited life-saving treatment to those with the most likelihood to live longest upon survival. "

2. Age is one of the major risk-factors for death from COVID-19. [1]

3. The Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care published guidelines, which read: "Informed by the principle of maximizing benefits for the largest number..." ... "...the allocation criteria need to guarantee that those patients with the highest chance of therapeutic success will retain access to intensive care. ... It may become necessary to establish an age limit for access to intensive care."

Therefore the concept that elderly people might be de-prioritised for life-saving care (such as access to ventilators) in favour of other more likely to survive and/or live longer upon survival, is valid. Whether the exact quote ('we no longer help those >60') is accurate or not (or an accurate but hyperbolic quote from the doctor in question) doesn't detract from the awful situation ongoing in Italian hospitals right now.

[1] https://www.thelancet.com/journals/lancet/article/PIIS0140-6... [2] http://www.siaarti.it/SiteAssets/News/COVID19%20-%20document...

As of today it's mostly a fake news. The question "are people dying for lack of ICUs?" is asked each day by journalists during the update from Head of the Civil Protection and the answer up to today is "still not". North Italy (in particular Lombardia) is approaching the limit of available ICUs every day. New ICUs are activated every day and there are daily transfers of patients under ICU from Lombardia to other regions (that still don't suffer from much traffic). Still we can't exclude to hit such limit in a few days. It's true that once that limit will be hit there are official guidelines in place that say to give ICU to people with better life expectancy.

If you are interested to see how much Lombardia is hit compared to other regions, take a look here http://opendatadpc.maps.arcgis.com/apps/opsdashboard/index.h...

Slightly unrelated... I'm not questioning validity of the claims in the above link.

Politics taints journalism far too much. I've found snopes.com to have the similar set of biases as the left-leaning media like NYT, WP and CNN. I don't think it's reasonable to accept for-profit orgs as arbiters of truth, since they don't have an inherent incentive to be truthful. To say that "you as a for-profit are going to say truth and only truth" is problematic and in itself deceitful. At least NYT and others are not claiming that.

> Peleg said that, from what he sees and hears in the hospital, the instructions are not to offer access to artificial respiratory machines to patients over 60 as such machines are limited in number.

In other words Peleg merely surmises what's going on, and has not received an order directly.

I get that this is a rapidly-evolving situation, but this kind of claim should be corroborated by the reporter.

The article seems to apply to one hospital. Extrapolating that to the entire country seems an exaggeration at best.

Though that being said, it seems that Italy still has a lot of pending cases still (that is, that have not been discharged or ended otherwise).

Would more inter-european coordination and solidarity make a difference here? Some countries are currently much better off than others (infection rate-wise). Are there good reasons for not taking in patients from different countries as long as capacity remains available? Not being able to do anything for (apparently) a large number of patients is a terrible situation.

> Are there good reasons for not taking in patients from different countries as long as capacity remains available?

I don't know about Italy but I do know that german and swiss hospitals are taking in patients from Alsace (the easternmost tip of france) which is currently very hard hit.

Where factually correct, the numbers are... smallish:

"Two hospitals in Basel and one in Jura, in northwestern Switzerland, said they would each take two French patients after the Alsace authorities sent out a distress call for help. The French region has been particularly badly hit following contagion among a large church service last month.

Hospitals in Germany are also providing help along with the Swiss hospitals that say they are providing help in the spirit of solidarity and international cooperation."

Understandably so, since the rush is just hitting Switzerland itself.

We're even preparing for a complete lockdown, I (this weekend) received an official document that allows me to travel between my home address and work.

> We're even preparing for a complete lockdown, I (this weekend) received an official document that allows me to travel between my home address and work.

Interesting, are you in Switzerland? After the press conference on Friday I thought the federal council does not want to go to the direction of complete lockdown because it would not be useful because it would not respected.

> are you in Switzerland

Yes. And as said: this is preparation. When the infection doubling rates do not go down (nicely displayed here: https://interaktiv.tagesanzeiger.ch/2020/covid-19-ausbruch-i...) from about 2.7 to > 3 days, it will come.

I'll believe it when I hear it from an Italian source, in Italian. The information in this article presumably went through a linguistic game of telephone consisting of: Italian --> Hebrew --> English.

How come the industrial capacity of the world is not sufficient to produce enough equipment?

Is it too specialized, too complex to be produced by commonplace manufacturing methods?

Not enough in time, but even if you have 30k ones, you need trained staff. (I guess--not being a doc--a nurse with a few hours of training can do 95% of the job but still.)

It’s about ramping up the production. Given time we can produce ridiculous quantities per day if needed, but it takes time to set it up.

In my software or electronics I've designed, a lot of work has gone into making design temper proof, reverse engineering proof. So it's needlessly complex. Specially where we need to protect IP, for example using client and server side software when all the work can be done on client side because you fear your competitor will steal your secret sauce by reverse engineering your binary. I wonder how many such anti tamper efforts is used in these medical machine.

I don't really understand this question. The industrial capacity of the world is not a single thing. Factories have specific tooling in place to make specific things.

Even assuming the magic ability to re-tool instantly, raw materials occupy time and space and need to get to places.

Even ignoring that, shutting down transport and logistics pipelines due to not wanting many workers to be congregated also slows everything down.

Right now I'd guess the bulk of the world's manufacturing capacity is under quarantine. Can't produce things without workers.

stock management issues, it's more a matter of being caught pants down by a problem growing faster than the machine can accelerate

In Canada the constraint is going to be the number of doctors that we have, not the number of ventilators or the physical space to house patients.

As far as I understand (from random reading on the net) its more or less the same bunch of procedures for most patients. After a day or two everyone in the ICU probably knows what to do.

That's a valid question, why the downvotes ?

There's a marketing theater that says that anything is possible and that high tech is constantly mass produced.

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