Judging by the annual complaints here about hospital overcrowding during the winter months, I'm sure that we have little enough spare capacity. In fairness, if we do find ourselves in a position where 10% of the population is suffering from the virus at any one time, then any hospital service would struggle to cope. 

Obviously, all non-essential hospital treatment and procedures will presumably cease if the virus really takes hold. However, while the Italian article deals with choices between which virus sufferers to treat, you would have to fear that the virus will affect some essential treatments also and difficult choices will have to be made there too. Will there be capacity to administer chemotherapy, for example? That's just one example of the kind of essential treatments that the hospital service may not be able to continue to give in all cases. It will be a question both of there not being resources to treat all patients(whether suffering from the virus or something else) and also the fact that hospitals and hospital staff will be carrying the virus so bringing patients to hospital will inevitably expose them to the virus. At present, hospital staff are self isolating when they may be incubating the virus. However, what happens if the virus becomes more widespread? Presumably, they will no longer be able to self isolate because if they do, the staff shortages will simply be too great. In that scenario, they will obviously be a huge source of risk to all patients and many of those receiving non-virus related essential treatments are exactly the type of people who cannot afford to get the virus. 

They should be testing everyone with a fever too as per the WHO guidelines.

Maybe not, but I'd try to find a way at least. 90 years olds might not have much of a life before them, but they had a life behind them and this is just as valid. Living to such a great age only to be viewed as a burden thus neglected. Makes one ask the question as to what is the point of living in the first place. 

To have fun and experience as much as you possibly can.

And, if you have kids, to help guide them to become what makes them happy.

Happiness and fun is everything in life.

By the way, MODS, two of my posts in this thread have disappeared. 

That is a very interesting couple of points, Retron. I'll add my 5p-worth to illustrate what an ethical minefield this is.

Information so far indicates that the young are less affected by the virus than the old. Therefore the young that ARE affected could be Covid-19 vulnerable - and we have no idea yet if they will recover AND show adequate levels of immunity. You could argue this group of younger people were therefore not really in the category of "younger AND fitter" and should have only a basic level of support.

We also know that smokers are less likely to survive - so why not have a "sorry, no smokers" policy?

I had a costly and complicated medical procedure a year ago which should enable me now to have more years of quality productive life. Should we now say - Ok - write that cost off - if we had known he would get Covid-19 we would have let him croak last year. DNR.

The weasel words "productive life" sort of imply that a pensioner who is living a full and stimulating retirement earned through a useful career is somehow less worthy than a youngster at the start of theirs - but underneath that is a sense that you have squeezed a lifetime's taxes out of the oldies, now it's time to start harvesting the youngsters!

I realise that these are dilemmas that face medics every day in one way or another. FWIW I would be sad to croak now when I am enjoying myself and making a lot of productive contributions in a voluntary way! I'll be furious I went through last year's frightful ordeal only to be sacrificed on the Covid altar this spring - even if I understood and agreed that a youngster should have my slot.

R

Of course everyone would 'try to find a way' but the point is what choice do you make when there's no option but to make a choice?

The point of living isn't the question, is it? The reason for wanting to live into your 80s or 90s in ill health or with a poor quality of life is a much better question. Why do we assume that living longer and longer is a 'must'?  Living a good life is one thing; surely just existing is different?  I don't think we're very good as a society in confronting this issue - probably because it's not a question that has been particularly relevant until the last half century (with rapid advances in life expectancy).

A well written post Roger, but just to remind everyone that Italian doctor didn't say that he is just using age to decide, they also take into account the chance of survival.

Great post Roger. 

I am thinking of my own mother too who is now in her late 60s. As full of zest and life (and bossiness ) as she always was. Disposed of she will not be, and woe onto those who dare attempt it. 

Why 7 days? And anyone with a hard on should self isolate for 7 hours.

Thank you to Chunky and Roger - some interesting replies there!

As Saint says, the point of life is to make the most of things, to enjoy yourself while you can and - if possible - do some good for the world. If you get the opportunity to do something, do it if you can for you never know what's around the corner. Some would also say the point is to have children, so that you can pass on what you've earned (I would disagree with that myself, as I don't want children - I would rather everything I have go to the local community, e.g. to buy some fields and form a community woodland, that sort of thing).

I used the "productive life" phrasing deliberately, as it implies what you've written in bold: the value to the economy of a younger person, in terms of taxation potential, not to mention potential children (more revenue) is much greater than someone who's towards the end of their life, in retirement. It is, I feel, one of the criteria that's used to judge whether someone is more worthy of being saved than someone else. rightly or wrongly.

The bit about the procedure being written-off is pertinent too. In 2012 and 2013, my dad had two cataracts done on the NHS. The following year he had a hernia op - he'd been on about it for 5 years and finally his time came (it was botched, involving me racing him to A&E at half five in the morning, but that's another story). Yet a couple of years after that, having passed the magic age of retirement, he was treated as a disposable item by the same NHS. It was clear from the way they treated him that they didn't expect him to survive more than a month after diagnosis of lung cancer, as he told me himself!
So, in that regard, the NHS seems willing enough to "write-off" past expenditure. (My dad was a smoker too, but gave up in 1990. He said he regretted ever taking up the habit, as it ended up killing him, albeit 26 years later).

Anyway, I'd hope that nobody croaks here (to borrow Roger's phrase), but I do find it interesting how the older generation seem to be more philosophical about the whole thing. I know myself that as one gets older death becomes more common, both in terms of your relatives and in terms of thoughts about your own. As the song goes, "enjoy yourself, enjoy yourself, it's later than you think".

EDIT: And FWIW, based on my family history, I suspect I'll be dead by 70. That gives me less than 30 years to enjoy myself... and by gum, I will!

Ethical minefield is right.  But these are questions that ought to be confronted and answered calmly and thoughtfully when there's no pressure to address them.

I agree that it is a lot more nuanced than a simple 'young=worth saving v old=not worth saving' 

Thanks, Xioni. Yes - I should have picked up on that - but was focused on theoretical dilemmas rather than criticising the fascinating dialogue.

I should also have added - I am conscious of a lot of folks in care who might be only too glad of a merciful release and who might well opt for a DNR decision, given the chance. That too is a major ethical question, which I won't go into further here. As you get older you realise that almost everyone is touched by such issues, directly or indirectly.

Roger

I listened to their update today. They were v positive about what China, SK, Singapore and Japan have achieved and are hopeful that it can also be contained elsewhere. The key though is for governments to act fast if things go downhill.

It would be interested to know the duration of care for that 70%. Recoveries are great, but if taking 6-7 weeks it could cause massive issues.

The WHO have said it can take up to 6 weeks to recover which includes having 2 consecutive negative tests. 

South Korea has proven it is possible to stop it before it gets this bad.

However it needs extraordinary measures.

Spain is probably now as bad as Italy and we should stop all travel to and from it.

France and Germany are likely to follow.

We are not there yet but we must stay vigilant.

Digital triage is operational at Chichester and Worthing hospitals from today - timing wrt coronavirus is coincidental but it offers the possibility of rapid identification of any covid sufferers who turn up at A&E (4 minutes is claimed) instead of sitting around in the waiting room for half an hour infecting everyone else. The receptionist will still be there in case of problems.

https://www.expressandstar.com/news/uk-news/2020/03/07/patients-at-two-aes-to-be-triaged-by-tablet-from-monday/

I wonder how far people presenting at A&E can be trusted not to game the system for early encounter with doctor?

Rasputin/Cummings spent years living in Russia, which is covering it up more than anyone else. Putin must be thinking the same. Kill off lots of old peasants

But the danger of playing with fire is you might end up burning the house down