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.

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