So, what’s new?

The Italian health ministry has been criticised after a draft of the country’s new pandemic plan revealed medics would be permitted to choose which patients receive life-saving care.

This is the first time Italy has updated its pandemic plan since 2006. The absence of an adequate plan is thought to have contributed to Italy’s coronavirus death toll of more than 79,000.

The draft copy of the pandemic plan for 2021-23, seen by the Guardian, stipulates that while health workers are obliged to provide the best and most appropriate care to patients, there are circumstances that may make it necessary to prioritise who to try to save.

Everything is always rationed. Those £30,000 per year QUALYs for example.

All that changes is how you ration, not whether. We do, after all, live in a resource constrained universe.

18 thoughts on “So, what’s new?”

  1. So Much For Subtlety

    What’s the Italian for triage? How could anyone think it otherwise?

    But look at what they are contrasting:

    while health workers are obliged to provide the best and most appropriate care to patients, there are circumstances that may make it necessary to prioritise who to try to save.

    So the choice is between choosing not to save someone or giving everyone the best and most appropriate care? Sometimes the best and most appropriate care would be none at all. So what is the change? The doctors are being allowed to kill the old – even if they have the resources to save them?

    This does not exactly sound like rationing.

  2. SMFS – we seem to be reading this differently. “there are circumstances that may make it necessary to prioritise who to try to save” – this seems pretty realistic, especially in a pandemic. If you have 3 people dying & only time to save 2 you have to make a choice.
    A while back I participated in a local emergency training regimen & when we heard that under certain circumstances the Police would prevent people from getting to the local hospital everyone was shocked. Then we were asked, well, if we allow people to overrun the hospital and nobody gets help, is that better? Oh, we said.

  3. Yeah but the real scandal is- even if you set up your own little fund for you and your family, in the paranoid belief the state couldn’t possibly give as much shit about you as you do yourself. They’ll forbid the private service providers from honouring their contract.

  4. “Everything is always rationed.” Not in America, no siree. Because of American exceptionalism.

    Hell, they have such a supply of demented old geezers that they’ve made one President.

  5. @Esteban: “everyone was shocked. ” Without seeking to be rude, wasn’t that rather childish of everyone? How can someone reach adult life without understanding that argument?

  6. Dearieme, to judge by my local Facebook group, most of the population would be horrified at the very idea of restricting access

  7. to judge by my local Facebook group, most of the population would be horrified at the very idea of restricting access

    What do they think NHS waiting lists are for then?

  8. oooh, john77, I don’t think Trump was demented. A bad-tempered, impatient, infantile narcissist with a short attention span perhaps, but perfectly sane.

    And their best President in yonks on criterion number one: he started no wars.

  9. IIRC Army medics are trained to ignore the screamers and check the silent ones first. Some of them will be dead, others will need immediate resuscitation and can be saved. If you are conscious enough to scream they’ll get round to giving you morphine once the critically injured are medivacced. Priorities, see? Saves more lives.
    However, screaming may be useful in UK A&E. NHS PR probably privileges big cry babies.

    I also assume there will be different protocols in emergency medicine, infectious disease management, chronic conditions, palliative care, DNR and hospice regimes. Quite right too.

    Opponents of the Great Barrington Declaration argue that it creates a two tier society, with the vulnerable not enjoying the freedom of the healthy. This is nonsense. We already live in a multi tier society. Parents of small children do not have the privilege of a spur of the moment decision to join a stag do in Bratislava. Old codgers with dodgy hips can’t take ski holidays. Teenagers can’t buy alcohol, and so on and on. And money, and beachfront property, and no you can’t have a pony. (Unless it’s a cockney one.)

  10. Wife worked in ICU for over 20 years in multiple countries and this is standard practice, they constantly triage ICU and decide who does or doesn’t get a bed

  11. So Much For Subtlety

    Esteban January 13, 2021 at 11:38 am – “SMFS – we seem to be reading this differently.”

    We do. But hospitals can already triage. They can already prioritise some patients over others if resources are scarce. So I was trying to say that the Italians do not need new laws for this.

    But they are getting new laws. To do what? It looks like it will allow them to leave people to die even if they could have saved them. Even if they had the resources on hand.

  12. Bloke in North Dorset

    “So I was trying to say that the Italians do not need new laws for this.”

    In a country that jails scientists for failing to predict the strength of an earthquake it might be a good idea, though.

  13. @philip no, opponents of the Great Barrington declaration know that it is nonsense. It assumes we can do the impossible – shield the vulnerable – even though we know no effective way to do that. It also advocates the approach called “herd immunity” which was discredited before the declaration was drawn up. There are plenty of people who would recover from Covid with major medical assistance, but if they all fall ill at the same time we do not have the resources to treat them simultaneously. Thus the idea that the relatively healthy can be allowed to catch the disease is hopelessly unrealistic.

  14. So Much For Subtlety

    the Great Barrington declaration know that it is nonsense. It assumes we can do the impossible – shield the vulnerable – even though we know no effective way to do that.

    We can be pretty sure that sending the sick back to Old People’s Homes is one way not to do it. But that is what our governments did.

    It also advocates the approach called “herd immunity” which was discredited before the declaration was drawn up.

    Citation needed. Discredited is one of these words like debunked which seems to only mean the Left does not want to talk about it. We are heading for herd immunity whatever we do. Even China is.

    There are plenty of people who would recover from Covid with major medical assistance, but if they all fall ill at the same time we do not have the resources to treat them simultaneously.

    Citation needed. So far what we know is the models grossly over stated the need for medical facilities. We did not need ventilators. In fact ventilators were killing people. All we really need is time and putting people on their face. We built these massive emergency hospitals in Britain and America …. and they stood empty.

    Thus the idea that the relatively healthy can be allowed to catch the disease is hopelessly unrealistic

    And yet here we are. The only solution on offer.

  15. @SMFS the approach called “herd immunity” is not merely achieving herd immnunity. It is also the method by which this is achieved. The declaration, as with other similar positions, advocates letting large numbers of people fall ill in a short period. This is in contrast to other methods of achieving herd immunity, such as minimising cases until people can be vaccinated. The discredited part is the part which assumes the disease is so minor that its practical to let large numbers of people catch it. The death statistics alone prove that this is not the case – and that’s with only a small fraction of the population catching it.

    Your assertion that “All we really need is time and putting people on their face.” is completely absurd. People can lie face down at home in their own beds, and time passes just as easily at home as in hospital, so what you’re claiming is that nobody needs to go to hospital. The reality is that there are treatments that make a big difference. While intubated full ventilation is not as useful as first thought, less invasive provision of oxygen has proven useful.

    You say “And yet here we are. The only solution on offer”. Have you not read anything about strategies used in other countries? China, Australia, New Zealand etc have proven that it is entirely possible to pursue a strategy of complete suppression and make it work. As a collection of islands, the UK should be ideally placed to make such a strategy work also.

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