COVID-19 in Italy: Ageism and Decision Making in a Pandemic

TheWorld Health Organization declared the COVID-19 situation as a pandemic onMarch 11, 2020.1 To date, Italy is the country after China that has beenmost severely hit by this humanitarian and public health tsunami. Projections are even suggesting that the number of deaths due to SARS-CoV-2 in Italy will continue to increase in the near future, leaving us the sad world record of casualties. What has happened in Italy during these last few weeks? On February 22, a “red zone” was defined by the government to quarantine a group of several towns in the Lombardy region, just a few hours after the diagnosis of the first case in Italy. This area, where about 50,000 persons live, included Codogno (where patient 1 was identified), Castiglione D’Adda, and Casalpusterlengo. On March 8, the red zone was extended to the entire region of Lombardy (about 10 million people) and several surrounding provinces in a new attempt to prevent the uncontrolled diffusion of the virus to the rest of the country. The following day, the entire country was transformed into a “red zone.” OnMarch 21, a complete lockdown of Italy was ordered by the government as a drastic and unprecedented countermeasure against the coronavirus. Behind this story of the Italian crisis is the drama of a health care system close to collapse. The exponential increase of patients admitted to emergency departments with fever and/or respiratory symptoms resembled themountingwave of a tsunami. It soon became evident how inadequate the availability of beds was to face the continuous flow of patients. The situationwas aggravated by the need to isolate patients with COVID-19, given the high contagiousness of the virus. At the same time, intensive care units started to saturate, and the number of devices for ventilating patients suddenly appeared insufficient to address the growing demand. Furthermore, health care professionals started falling sick (sometimes even dying) as consequence of their untiringwillingness to serve the community, as well as the infrastructural unpreparedness for the enormity of the outbreak. Our world was completely subverted by the emergency. No plans or protocols had the time to be tested and verified, at least on a large scale. The rapidity of the evolving scenario made it necessary to adopt easy and pragmatic solutions even for critical and delicate matters. Not surprisingly, the usual, despicable age criterion started to be