Official guidance has been issued to NHS intensive care doctors on how to decide which coronavirus patients should get critical care. The guidance was issued by National Institute for Health and Care Excellence (NICE) yesterday and provides an “algorithm” to help doctors decide who should be admitted to critical care and who should not. In Italy there has been controversy as - with hospitals overwhelmed - doctors have reportedly been forced to discriminate between patients based crudely on age alone. The UK has about half the number of critical care beds per head of population as Italy and intensive care doctors here have been calling for central guidance on triage to be issued for several days. The NICE guidance does not categorise potential patients by age but instead asks doctors to score patients on a nine-point “clinical frailty scale” [CFS] .

At one end of the scale, with a score of one, are the “Very Fit” - people who are “robust, active, energetic and motivated”, and who “exercise regularly”. At the other end, with a score of nine, are the “Terminally ill”. The NICE algorithm divides patients at a score of five, the “Mildly Frail”. Those with a score of less than five who would like critical care are considered well enough to benefit, subject to a review of any underlying conditions and the severity of their illness. Those scoring over five are put through a process where doctors must decide if critical care is “considered appropriate” before proceeding. “For patients with confirmed Covid-19, decisions about admission to critical care should be made on the basis of medical benefit, taking into account the likelihood that the person will recover to an outcome that is acceptable to them and within a period of time consistent with the diagnosis,” says NICE.

Intensive care doctors use frailty scales in normal times to assess patients. But the new triage guidance also provides them with mortality data for patients suffering from pneumonia in critical care beds compared to a regular ward. This data is banded by age as are similar mortality tables for patients with and without underlying heart and lung conditions. These data will help doctors make better informed decisions beyond the patient's frailty score on the “medical benefit” of their receiving critical care.