Faced with tough choices, Italy is prioritizing young COVID-19 patients over the elderly. That likely 'won't fly' in the US.

In this Saturday, Feb. 29, 2020 file photo, paramedics work in a tent that was set up outside the hospital of Cremona, northern Italy.

  • Epidemics force medical professionals to make tough choices, including which lives to save first.
  • In Italy, where more than 9,000 people have been diagnosed with COVID-19, doctors are prioritizing the young and otherwise healthy patients over the older people who are less likely to recover.
  • A NYC medical ethicist told Insider the medical community in the US will also have to make decisions about who to prioritize if hospitals become overwhelmed.
  • Choosing patients simply based on their age, however, "would not fly," he said.
  • Visit Business Insider's homepage for more stories.

With the number of coronavirus patients continuing to rise everyday, the medical community in New York City is having discussions about what to do if hospitals in the US become overwhelmed.

In Italy, where more than 9,000 people have already been diagnosed with COVID-19, doctors are scrambling to secure resources and treat patients. They have been forced to prioritize the young and otherwise healthy over the elderly and frail.Advertisement

"It's very hard to just prioritize the young over the old. That would not fly in the US," Arthur Caplan, head of the Division of Medical Ethics at NYU School of Medicine in New York City, told Business Insider. "People would protest the idea that young lives are worth more inherently than older lives."

Caplan said that hospitals, like NYU's Bellevue Hospital, have already begun discussing how to ration scarce resources if need be. While there hasn't yet been a hospital committee meeting that addressed what patients would get priority in treatment, he expects that to come up down the line.

Those conversations, which will likely vary by hospital and region, should not just touch on the age of the patients, but also their heath and a number of other factors, Caplan said.
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"If you had, let's say, an ICU that was overwhelmed, you're probably going to try and give some extra attention to healthcare workers because you need them to deliver care," he said. "The rationale isn't that they're more worthy, it's that they can contribute in the longer run to saving more lives."

When discharging a coronavirus patient, it would make sense to consider whether they are homeless before doing so, he said, because they might not have somewhere to safely quarantine and recover.In a crisis, hospitals will try to "maximize the chance of saving a life, and make sure that we save the most years of life," Caplan said.Advertisement

"In that way, younger people tend to have a huge priority, but not exclusively," Caplan said.

In fact, most people who are young with the coronavirus won't even be treated in US hospitals because they will likely recover at home.

"So what we're really talking about is the very sick young versus the sick elderly, who we know aren't likely to do well," he said. "It's not like every young person is going to get ahead of every old person." Advertisement

The coronavirus is far from the first time that hospital workers have had to grapple with who to treat at the expense of others.

In New York there are guidelines around how to allocate ventilators during a flu epidemic, Caplan said.

"They suggest that you may take someone who is desperately ill, and not likely to live, off that ventilator and put someone else with a much better chance on," Caplan said. "I'm not against that, but I will tell you that doctors hate to do that because they don't want to abandon their patient." Advertisement

That is a topic that will likely also have to be addressed when hospital committees meet to come up with coronavirus policies, Caplan said.

While it's important to have conversations about how to ration resources, Caplan is concerned that not enough people are thinking about how to share resources among institutions.

"I've been complaining that we also need a strategy for sharing. So if NYU Bellevue ... got overwhelmed, how do we direct patients to other hospitals in New York City or the VA?," he said. "You need to be thinking about that right now because the better solution to shortage is sharing, not rationing."Advertisement

The coronavirus outbreak has killed more than 4,000 people and infected over 116,000. It has spread to more than 100 countries.

The US has confirmed 28 coronavirus deaths: 23 in Washington state, two in Florida, two in California, and one in New Jersey.
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