Testimony of a surgeon working in Bergamo, in the heart of Italy’s coronavirus outbreak
«In one of the non-stop e-mails that I receive from my hospital administration on a more than daily basis, there was a paragraph on “how to be responsible on social media”, with some recommendations that we all can agree on. After thinking for a long time if and what to write about what’s happening here, I felt that silence was not responsible. I will therefore try to convey to lay-people, those who are more distant from our reality, what we are experiencing in Bergamo during these Covid-19 pandemic days. I understand the need not to panic, but when the message of the danger of what is happening is not out, and I still see people ignoring the recommendations and people who gather together complaining that they cannot go to the gym or play soccer tournaments, I shiver. I also understand the economic damage and I am also worried about that. After this epidemic, it will be hard to start over.
Still, beside the fact that we are also devastating our national health system from an economic point of view, I want to point out that the public health damage that is going to invest the country is more important and I find it nothing short of “chilling” that new quarantine areas requested by the Region has not yet been established for the municipalities of Alzano Lombardo and Nembro (I would like to clarify that this is purely personal opinion). I myself looked with some amazement at the reorganization of the entire hospital in the previous week, when our current enemy was still in the shadows: the wards slowly “emptied”, elective activities interrupted, intensive care unit freed to create as many beds as possible. Containers arriving in front of the emergency room to create diversified routes and avoid infections. All this rapid transformation brought in the hallways of the hospital an atmosphere of surreal silence and emptiness that we did not understand, waiting for a war that had yet to begin and that many (including me) were not so sure would never come with such ferocity (I open a parenthesis: all this was done in the shadows, and without publicity, while several newspapers had the courage to say that private health care was not doing anything).
I still remember my night shift a week ago spent without any rest, waiting for a call from the microbiology department. I was waiting for the results of a swab taken from the first suspect case in our hospital, thinking about what consequences it would have for us and the hospital. If I think about it, my agitation for one possible case seems almost ridiculous and unjustified, now that I have seen what is happening. Well, the situation is now nothing short of dramatic. No other words come to mind. The war has literally exploded and battles are uninterrupted day and night. One after the other, these unfortunate people come to the emergency room. They have far from the complications of a flu. Let’s stop saying it’s a bad flu. In my two years working in Bergamo, I have learned that the people here do not come to the emergency room for no reason. They did well this time too. They followed all the recommendations given: a week or ten days at home with a fever without going out to prevent contagion, but now they can’t take it anymore. They don’t breathe enough, they need oxygen. Drug therapies for this virus are few.
The course mainly depends on our organism. We can only support it when it can’t take it anymore. It is mainly hoped that our body will eradicate the virus on its own, let’s face it. Antiviral therapies are experimental on this virus and we learn its behavior day after day. Staying at home until the symptoms worsen does not change the prognosis of the disease. Now, however, that need for beds in all its drama has arrived. One after another, the departments that had been emptied are filling up at an impressive rate. The display boards with the names of the sicks, of different colors depending on the department they belong to, are now all red and instead of the surgical procedure, there is the diagnosis, which is always the same: bilateral interstitial pneumonia. Now, tell me which flu virus causes such a rapid tragedy.
Because that’s the difference (now I get a little technical): in classical flu, besides that it infects much less population over several months, cases are complicated less frequently: only when the virus has destroyed the protective barriers of our airways and as such it allows bacteria (which normally resident in the upper airways) to invade the bronchi and lungs, causing a more serious disease. Covid 19 causes a banal flu in many young people, but in many elderly people (and not only) a real SARS because it invades the alveoli of the lungs directly, and it infects them making them unable to perform their function. The resulting respiratory failure is often serious and after a few days of hospitalization, the simple oxygen that can be administered in a ward may not be enough. Sorry, but to me, as a doctor, it’s not reassuring that the most serious are mainly elderly people with other pathologies. The elderly population is the most represented in our country and it is difficult to find someone who, above 65 years of age, does not take at least a pill for high blood pressure or diabetes.
I can also assure you that when you see young people who end up intubated in the ICU, pronated or worse, in ECMO (a machine for the worst cases, which extracts the blood, re-oxygenates it and returns it to the body, waiting for the lungs to hopefully heal), all this confidence for your young age goes away. And while there are still people on social media who boast of not being afraid by ignoring the recommendations, protesting that their normal lifestyle habits have “temporarily” halted, the epidemiological disaster is taking place. And there are no more surgeons, urologists, orthopedists, we are only doctors who suddenly become part of a single team to face this tsunami that has overwhelmed us.
The cases multiply, up to a rate of 15-20 hospitalizations a day all for the same reason. The results of the swabs now come one after the other: positive, positive, positive. Suddenly the emergency room is collapsing. Emergency provisions are issued: help is needed in the emergency room. A quick meeting to learn how the to use to emergency room EHR and a few minutes later I’m already downstairs, next to the warriors on the war front. The screen of the PC with the chief complaint is always the same: fever and respiratory difficulty, fever and cough, respiratory insufficiency etc … Exams, radiology always with the same sentence: bilateral interstitial pneumonia. All needs to be hospitalized. Some already needs to be intubated, and goes to the ICU. For others, however, it is late. ICU is full, and when ICUs are full, more are created. Each ventilator is like gold: those in the operating rooms that have now suspended their non-urgent activity are used and the OR become a an ICU that did not exist before. I found it amazing, or at least I can speak for Humanitas Gavazzeni (where I work), how it was possible to put in place in such a short time a deployment and a reorganization of resources so finely designed to prepare for a disaster of this magnitude. And every reorganization of beds, wards, staff, work shifts and tasks is constantly reviewed day after day to try to give everything and even more. Those wards that previously looked like ghosts are now saturated, ready to try to give their best for the sick, but exhausted. The staff is exhausted. I saw fatigue on faces that didn’t know what it was despite the already grueling workloads they had. I have seen people still stop beyond the times they used to stop already, for overtime that was now habitual. I saw solidarity from all of us, who never failed to go to our internist colleagues to ask “what can I do for you now?” or “leave that admission to me, i will take care of it.” Doctors who move beds and transfer patients, who administer therapies instead of nurses. Nurses with tears in their eyes because we are unable to save everyone and the vital signs of several patients at the same time reveal an already marked destiny. There are no more shifts, schedules.
Social life is suspended for us. I have been separated for a few months, and I assure you that I have always done my best to constantly see my son even on the day after a night shift, without sleeping and postponing sleep until when I am without him, but for almost 2 weeks I have voluntarily not seen neither my son nor my family members for fear of infecting them and in turn infecting an elderly grandmother or relatives with other health problems. I’m happy with some photos of my son that I look at between tears and a few video calls. So you should be patient too, you can’t go to the theater, museums or gym. Try to have mercy on that myriad of older people you could exterminate. It is not your fault, I know, but of those who put it in your head that you are exaggerating and even this testimony may seem just an exaggeration for those who are far from the epidemic, but please, listen to us, try to leave the house only to indispensable things. Do not go en masse to make stocks in supermarkets: it is the worst thing because you concentrate and the risk of contacts with infected people who do not know they are infected. You can go there without a rush. Maybe if you have a normal mask (even those that are used to do certain manual work), put it on. Don’t look for ffp2 or ffp3. Those should serve us and we are beginning to struggle to find them. By now we have had to optimize their use only in certain circumstances, as the WHO recently recommended in view of their almost ubiquitous running low. Oh yes, thanks to the shortage of certain protection devices, many colleagues and I are certainly exposed despite all the other means of protection we have. Some of us have already become infected despite the protocols. Some infected colleagues also have infected relatives and some of their family members are already struggling between life and death. We are where your fears could make you stay away. Try to make sure you stay away.
Tell your family members who are elderly or with other illnesses to stay indoors. Bring him the groceries please. We have no alternative. It’s our job. Indeed what I do these days is not really the job I’m used to, but I do it anyway and I will like it as long as it responds to the same principles: try to make some sick people feel better and heal, or even just alleviate the suffering and the pain to those who unfortunately cannot heal. I don’t spend a lot of words about the people who define us heroes these days and who until yesterday were ready to insult and report us. Both will return to insult and report as soon as everything is over. People forget everything quickly. And we’re not even heroes these days. It’s our job. We risked something bad every day before: when we put our hands in a belly full of someone’s blood we don’t even know if they have HIV or hepatitis C; when we do it even though we know they have HIV or hepatitis C; when we stick ourselves during an operation on a patient with HIV and take the drugs that make us vomit all day long for a month. When we read with anguish the results of the blood tests after an accidental needlestick, hoping not to be infected. We simply earn our living with something that gives us emotions. It doesn’t matter if they are beautiful or ugly, we just take them home. In the end we only try to make ourselves useful for everyone. Now try to do it too, though: with our actions we influence the life and death of a few dozen people. You with yours, many more. Please share and share the message. We need to spread the word to prevent what is happening here from happening all over Italy.»