The media shouldn’t extrapolate from a few remarks
Immersed in the Covid-19 pandemic, many people are jittery and on the verge of panic. Including the media.
This is a cautionary tale about how not to report unfamiliar and rapidly unfolding events. Like the virus itself, it begins in the Netherlands, spreads to Spain and then to the English-speaking world.
In early March leading Dutch epidemiologist Frits Rosendaal called attention of his countrymen to the urgent need for measures to combat the coronavirus.
Dr Rosendaal is Chief Epidemiology of Leiden University Hospital. But he is also a visiting professor at the Policlinico of Milan, so he was well acquainted with the dire figures of infections and deaths from Italy.
In one interview, he said that the Dutch experience did not exactly parallel the Italian experience for a number of reasons.
“In that context,” he told BioEdge via email, “I also remarked that there are cultural differences in the age of patients admitted to intensive care.”
This was reported in the Spanish newspaper El Confidencial as follows:
The collapse of hospitals in Italy and Spain, Rosendaal believes, is due to the “cultural position” of the elderly in our societies, which they are trying to save at any cost. Meanwhile, in Flemish and Dutch hospitals, they are selected with a magnifying glass, even though the health system is not yet saturated. Doctors in the Netherlands and Flanders are giving directives and guidelines to their hospitals so that they think twice about transferring elderly people infected with the coronavirus to a medical centre in order to “prevent their suffering” and not to saturate the hospitals.
This provoked a storm on social media. One popular Spanish site compared his position to Nazi eugenics.
Rosendaal complains that he meant nothing of the kind. In any case, he had never mentioned Spain – only Italy. His remarks, however, fed into a very active debate in Spain over euthanasia. They were fueled by hostility between the two governments over the possibility of issuing EU “coronabonds”. The Netherlands is not keen – and the Spanish still squirm at the words of a former Dutch finance minister who accused southern countries in the EU of squandering funds on “schnapps und frauen”, wine and women.
Rosendaal told BioEdge:
The reality is that we so far manage with our intensive care [IC] capacity in this country. This may change, I do not know, we are racing in making new beds with ventilation machines against the rising number of patients who need it.
Not a single person has been denied any treatment, including IC, because of advanced age, since there was no necessity to triage.
And still, most very old people who die of Covid-19, die at home or in the nursing homes they live in…
Part of that, but now I step outside my expertise, is our societal culture where family ties may be different than in southern European countries, evidenced by, for instance, very few old people living in with their family.
Part of it may be the organisation of our health care, which is centred around general practitioners and home care … It is virtually impossible here to go to a specialist without seeing a GP first.
And thirdly, it is a different view on life and death, where quality of life is considered at par with quantity … In itself euthanasia is not a factor here, but it is a manifestation of the same viewpoint.
If it becomes necessary to triage patients because of a shortage of ventilators, Rosendaal believes that Dutch doctors will not discard the elderly. Doctors “are essentially very much alike everywhere,” he says.
… the bottom line will be that it will be as it has always been: what is the medical prognosis of this patient, what can he or she expect when treated in a certain way, what are the chances of success, what are the alternatives, what will be quality of life if the patent survives, etc etc.
Michael Cook is editor of BioEdge
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