Italy’s Health Care System Groans Under Coronavirus — a Warning to the World

Giorgo Gori, the mayor of Bergamo, said that in some cases in Lombardy the gap between resources and the enormous influx of patients “forced the doctors to decide not to intubate some very old patients,” essentially leaving them to die.

“Were there more intensive care units,” he added, “it would have been possible to save more lives.”

Dr. Di Marco disputed the claim of his mayor, saying that everyone received care, though he added, “it is evident that in this moment, in some cases, it could happen that we have a comparative evaluation between patients.”

On Thursday, Flavia Petrini, the president of the Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care, said her group had issued guidelines on what to do in a period that bordered on wartime “catastrophe medicine.”

“In a context of grave shortage of health resources,” the guidelines say, intensive care should be given to “patients with the best chance of success” and those with the “best hope of life” should be prioritized.

The guidelines also say that in “in the interests of maximizing benefits for the largest number,” limits could be put on intensive care units to reserve scarce resources to those who have, first, “greater likelihood of survival and secondly who have more potential years of life.”

“No one is getting kicked out, but we’re offering criteria of priority,” Dr. Petrini said. “These choices are made in normal times, but what’s not normal is when you have to assist 600 people all at once.”

Giulio Gallera, the Lombardy official leading the emergency response, said on Thursday that he hoped the guidelines never needed to be applied.