terça-feira, 10 de março de 2020

EU leaders try to retake control of coronavirus response / Italian doctors on coronavirus frontline face tough calls on whom to save




EU leaders try to retake control of coronavirus response

After an extraordinary videoconference, top leaders promise coordinated action to contain virus and stabilize economies.

By DAVID M. HERSZENHORN, SARAH WHEATON AND JACOPO BARIGAZZI 3/11/20, 12:17 AM CET Updated 3/11/20, 12:20 AM CET

Europe's leaders on Tuesday moved to assert control over their initially haphazard response to the fast-spreading coronavirus epidemic, announcing an array of measures aimed at containing the disease, blunting an unfolding economic shock, and reassuring an increasingly panicked public.

But it was far from clear that any of it would work.

The new measures, including plans for a fast injection of €7.5 billion in assistance to health care systems, small businesses and other hard-hit sectors of the economy, were announced by Council President Charles Michel and Commission President Ursula von der Leyen, following an extraordinary videoconference between the EU's 27 heads of state and government, European Central Bank President Christine Lagarde, and the Eurogroup president, Mário Centeno.

In statements to the press following the nearly three-hour-long videoconference, Michel and von der Leyen aimed to project a new posture of confidence and close coordination between all of the EU's main power players.

Among the steps they announced were new daily conference calls between EU health ministers or EU ministers of the interior to coordinate national responses. Von der Leyen also said the Commission was now taking stock of available protective equipment and respiratory devices, as well as production and distribution capacity, to get emergency materials where they are most needed.

"We emphasized the need to work together and to do everything necessary and to act swiftly." — Charles Michel

And they said that in the days ahead, the EU would waive fiscal rules and other regulations, including on state aid to businesses, so that capitals could take the necessary action to prop up their battered economies, which will only contract further in the weeks to come.

But many of the measures lacked detail, and the fact that such statements were necessary at all only highlighted how uneven the responses across Europe have been so far, and the EU's failure to provide the initial steadying hand that capitals and citizens now expect from Brussels.

It was this unevenness — and complaints from some national leaders — that prompted Michel to organize the videoconference, in an effort to restore the EU's own image of itself as a pre-eminent crisis manager, even though most authority for health policy lies with the member states, and Brussels mainly has a coordinating role.

"We emphasized the need to work together and to do everything necessary and to act swiftly," Michel told reporters after the meeting. Michel said leaders "stressed the need for a joint European approach and a close coordination with the European Commission" and he issued a written statement laying out four top goals: limiting the spread of the virus; providing medical equipment; promoting research including for a vaccine; and addressing the socioeconomic fallout.

The few concrete measures put forward were announced by von der Leyen who said the Commission, in addition to its existing internal emergency response group, would assemble a team of epidemiologists and virologists to provide expert advice. She said the health ministers and interior ministers would consult daily and would offer to provide €7.5 billion in unspent funds to help speed up access to another €17.5 billion.

She also noted the Commission’s plans to take stock of protective gear and necessary medical equipment to improve distribution around the EU. However, there was no sign that Germany was backing away from its moves to restrict exports of protective equipment, nor France’s requisitioning of face masks. On Tuesday night, the industry association MedTech Europe said such unilateral moves could “create acute shortages in other parts of Europe.”

"The crisis we face because of coronavirus has both a very significant human dimension and a potentially major economic impact, and it is therefore essential that we act very decisively and collectively — first of all to contain the spread of the virus and help patients, and to counter the economic fallout," von der Leyen said, adding: "Let me be very clear: the Commission is working flat out on both fronts."

Von der Leyen said that by the end of the week, the Commission would develop concrete proposals regarding new flexibility in the bloc's fiscal rules, and would put them before a meeting of the Eurogroup on Monday. "We will use all the tools at our disposal to make sure that the European economy weathers this storm," von der Leyen said.

And in a bid to emphasize the message to citizens of the EU's largest and richest country, von der Leyen repeated her lines about the economic measures in her native Germany.

But even as the leaders worked to emphasize the new choreography between the EU and its member countries, developments continued to swirl in ways that suggested no one was fully in control.

Several EU countries said they had closed their representations in Brussels and that diplomats would work from home. And the European Parliament announced its next plenary session would be held in Brussels not Strasbourg, as was the case with an abbreviated plenary session this week.

While some in Italy had complained about a lack of solidarity from other EU countries, Beijing has stepped up with a robust aid package for Rome.

Germany's crisis management committee announced several new steps including intensified checks by the federal police along the country's southern borders. And across the Continent, an array of steps were taken by governments to limit large public gatherings, close schools and cancel major cultural events.

While some in Italy had complained about a lack of solidarity from other EU countries, Beijing has stepped up with a robust aid package for Rome. Following a phone call between Italian Foreign Minister Luigi Di Maio and his Chinese counterpart Wang Yi on Tuesday, Beijing agreed to send Italy some faces masks. According to a statement from the Chinese government, the country is also willing to send medical staff to help fight the outbreak, “if the Italian side needs it.”

Italian Prime Minister Giuseppe Conte tweeted that EU leaders had voiced "broad support" for Italy's quarantine measures.

"We must proceed with maximum coordination," he wrote. "Europe should adopt all the necessary tools to protect the health of its citizens and restore breath to the economy."

Officials said that during the videoconference, Lagarde had spoken three times to address concerns and convey the European Central Bank's willingness to take action, particularly to protect liquidity at a time when banks and other financial institutions are expected to become highly risk averse and capital could easily dry up.

German Chancellor Angela Merkel once again displayed her instincts as a trained scientist, speaking about the importance of containing the spread of the virus and especially protecting vulnerable populations, particularly the elderly. Merkel also noted that all EU economies will be hard hit by the epidemic and the EU must provide stability.

French President Emmanuel Macron, briefing journalists in Paris on Tuesday night, said the EU was prepared to act in unison.

"Every day there will be a call between health ministers and the Commission to compare notes on the evolution of the epidemic, coordinate measures in terms of confinement, freedom of movement, organizing our school systems," Macron said. "And we decided to have common organization and coordination in terms of gear. We decided to exchange information, set up common markets, to limit needs and have a collective response."

Macron added: "What we are going through is a real global crisis that needs a European and global coordination."

Lili Bayer, Maïa de La Baume, Jillian Deutsch, Judith Mischke, Rym Momtaz, Carmen Paun, Hans von der Burchard and Zosia Wanat contributed reporting.

Authors:
David M. Herszenhorn , Sarah Wheaton  and Jacopo Barigazz


Italian doctors on coronavirus frontline face tough calls on whom to save
With demand outpacing supply of beds and respirators, medical workers are told to prioritize younger patients.



By GRETA PRIVITERA 3/9/20, 10:38 PM CET Updated 3/11/20, 4:54 AM CET

Italian doctors are being told to conserve resources for patients who have the greatest chance of survival

MILAN — In Lombardy, the wealthy region at the heart of Italy's coronavirus outbreak, a shortage of beds and medical supplies is forcing doctors to make increasingly difficult choices.

As the number of infected keeps rising — the number of reported cases in Italy topped 7,900 Monday, more than 70 percent of them in Lombardy — hospitals are scrambling to increase the number of beds available in intensive care units. Some have closed entire wards to dedicate them to severe coronavirus cases. Others have transformed operating rooms into intensive care units. Doctors are working grueling shifts to cover for colleagues who fall ill.

With no clear sign of when the epidemic will spike, anesthesiologists and doctors are being called on to make increasingly tough calls on who gets access to beds and respirators when there are not enough to go around.

"It is a fact that we will have to choose [whom to treat] and this choice will be entrusted to individual operators on the ground who may find themselves having ethical problems," said a doctor working in one of Milan's largest hospitals.

Lombardy has some 900 beds available for patients needing intensive care, but in some provinces, particularly in Bergamo, Lodi and Pavia, hospitals are "near saturation," the doctor said.

"We are aware that the body of an extremely fragile patient is unable to tolerate certain treatments compared to that of a healthy person" — Luigi Riccioni, anesthesiologist

For now, the marching orders are: Save scarce resources for those patients who have the greatest chance of survival. That means prioritizing younger, otherwise healthy patients over older patients or those with pre-existing conditions.

"We do not want to discriminate," said Luigi Riccioni, an anesthesiologist and head of the ethical committee of Siiarti, the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care, who co-authored new guidelines on how to prioritize treatment of coronavirus cases in hospitals. "We are aware that the body of an extremely fragile patient is unable to tolerate certain treatments compared to that of a healthy person."

By issuing recommendations, Riccioni said he wants to ensure doctors and medical staff are not left alone "in front of such a difficult ethical choice."

"Many colleagues are afraid of the dizzying increase of the epidemic," he added.

The pressure on doctors is extremely high, with many feeling increasingly stressed, said Giulio Gallera, welfare councilor for Lombardy, who said he saw some practitioners cry over the dire situation in their hospitals. They are afraid they can't give everyone the care they need as demand outpaces resources, he said.

In an interview that went viral after it was published in the Italian daily Corriere della Sera Monday, Christian Salaroli, an anesthesiologist from a hospital in Bergamo, recounted scenes of wartime triage, where old patients have to be left by the wayside. “The choice is made inside of an emergency room used for mass events, where only COVID-19 patients enter. If a person is between 80 and 95 and has severe respiratory failure, he probably won’t make it."

The principle of "first come, first served" has been abandoned, said Mario Riccio, an anesthesiologist who works at a hospital in Cremona.

The government's decision on Sunday to place a number of regions in northern Italy, including Lombardy, under quarantine was a welcome move for health practitioners trying to keep up with the rapidly growing number of cases. On Monday night, Prime Minister Giuseppe Conte announced the extension of the total lockdown to the rest of the country.

But in a country where health policy is in the hands of regional authorities, some say Rome should have acted quicker and more decisively to make sure all regions were on the same page.

"We needed clearer messages and a less ambiguous text," Gallero said in an interview with Italian TV network La7, referring to the decree signed by the government on Sunday.

A leak of the draft document published in major newspapers a day earlier sparked panic in the region, as tens of thousands of people reportedly headed south to escape the quarantine measures.

Health experts are now bracing for the arrival of the virus in southern Italy, which has so far only registered fewer than 300 cases, said Giuseppe Sofi, an anesthesiologist at the Policlinico hospital in Milan.

Italy's northern and central regions are not only the richest of the country — they produce 40 percent of national GDP — they also have the best health care systems.

"In the south, we would risk a catastrophe," said Sofi.

Paola Tamma contributed reporting.

This article is part of POLITICO’s premium policy service: Pro Health Care. From drug pricing, EMA, vaccines, pharma and more, our specialized journalists keep you on top of the topics driving the health care policy agenda. Email pro@politico.eu for a complimentary trial.

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