Agonizing Decisions Being Made in Spains Virus Hot Spots

ZARZA DE TAJO, Spain—Raquel Fernández watched as cemetery workers lowered her grandmothers casket into the grave and placed it on top of the coffin of her grandfather, buried just three days earlier.

Eusebio Fernández and Rosalía Mascaraque, both 86, are two of Spains more than 10,000 fatalities from the pandemic caused by the CCP (Chinese Communist Party) virus, commonly known as novel coronavirus.

Like thousands of other elderly victims in Spain, their deaths this week illustrate one of the darkest realities of the crisis: Doctors at overburdened hospitals in need of more resources are having to make increasingly tough decisions on who gets the best care, and age appears to matter more than ever.

“Due to a lack of resources in this country, they wont put an 86-year-old person on an assisted breathing machine. Its simply that cruel,” said Fernández, a nurse. “My grandparents fought all their lives to be happy and build their strength so they could grow old with dignity, so of course this moment is very painful, and it is difficult for us to cope with.”

Her grandparents fell ill with a fever and cough. After staying home for several days as health authorities recommended, their son rushed them to a hospital in Torrejón, east of Madrid, on March 25.

Two days later, Eusebio died of respiratory failure after testing positive for the virus. Rosalía died 48 hours later but her test was inconclusive. Neither was put in an intensive care unit or on a ventilator, Fernández said.

She said her grandmother had a heart condition, but that she believed her grandfather was in excellent health and should have been given more of a fighting chance.

“I understand that between someone who is 30 or 40 years old and my grandfather, they will not choose my grandfather, but if this had happened in another moment, in a health care system that claims to be among the best in the world, this would not have happened,” she said.

The CCP virus causes mild or moderate symptoms for most people, but for some, especially older adults and people with existing health problems, it can cause more severe illness or death.

Spain overtook Italy for the first time on Friday for the number of confirmed coronavirus cases, but the overnight death toll fell from the previous day, providing a small glimmer of hope.

With a total 117,710 confirmed cases, Spain is now second in the number of infections outside of China, only to the United States, which has a population some seven times larger. Spains total death toll now stands at 10,935, second only to Italys 13,915 fatalities outside of China.

Agonizing life and death decisions are being made in Madrid and northeast Catalonia, the main hot spots for the outbreak.

Spains Health Minister Salvador Illa said care is being given “based on each patients case profile, not their age.”

But two weeks ago, workers in Madrids hardest hit hospitals told The Associated Press that patients over 80 were not given priority for ICU beds because of their lower chance of survival.

On Wednesday, guidelines of Catalonias medical emergency response service distributed to hospitals and seen by the AP recommended that virus patients over 80 not be intubated. The document said staff should “offer resources to those patients who can most benefit from them as far as years of life to be saved (and) avoid hospitalizations of people with scarce chances of survival.”

Dr. Xavier Jiménez Fàbregas, medical director of Catalonias medical emergency system that distributed the guidelines, told AP that age is just one of many factors. He said the guidelines were accepted ethical practices being applied to this crisis, “given the elevated number of patients with respiratory failure.”

The Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care issued 15 ethical recommendations in deciding ICU admissions if beds were in short supply. They called for wartime, triage-type decisions to benefit those with a better hope of survival, not on a first-come, first-served basis.

Guidelines previously developed by New York states health department exclude some seriously ill people from receiving limited ventilators in major emergencies but note that making old age an automatic disqualifier would be discriminatory. The plans add, however, that given the “strong societal preference for saving children,” age could be considered in a tie-breaker when a childs life is at stake.

Recommendations published this week by German medical associations in response to COVID-19 also say age alone shouldnt be a deciding factor. Among the situations where they said intensive care should not be provided if availability is in short supply: if the patient needs permanent intensive care to survive.

Experts also say hospitals must calculate how long a patient might need a hospital bed or ventilator and how many more lives the machine might otherwise save.

In hard-hit areas of France and Spain, patients “are hospitalized only when there is a chance to save them,” said Marc Bourquin of the French Hospital Federation.

Spanish doctors and nurses say they do not dispute that they offer the best care possible to every patient, but they said lack of ventilators and ICU beds amid increased demand have forced them to raise the bRead More – Source

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