This message was posted on the social networks of Daniele Macchini, M.D., an Italian ER doctor at the Humanitas Gavazzeni Clinics in northern Italy. Dr. Macchini gives us an important testimony on the coronavirus and the experience of the doctors who are in the trenches as they tackle this emergency.
I have translated the message and at times simplified the structure to make it more accessible to the English-speaking reader.
This is one of the most important messages you will ever read. – Hilary Jacobson March 8, 2020
Dr. Macchini writes:
Predictably, within the emails that I daily receive from my healthcare department, I find a paragraph entitled “acting with social responsibility” that outlines recommendations as to how we should act and speak about the coronavirus.
After thinking it through, as to if and what I can write regarding the facts on the ground, I find that silence is not responsible. I will therefore write and try to convey to people who are not involved in “the work” of medicine, and whose lives are far away from our daily reality, what we are experiencing in Bergamo during these days of the pandemic.
I understand the need to not create panic, but if the significance of this danger is not communicated powerfully and clearly to people – then, for the people who loudly complain about not being able to go to the gym or soccer tournaments, I shudder.
I understand the economic consequences of speaking openly, and I am worried about that. But even accepting the risk of literally devastating our National Health System from an economic point of view, I allow myself to sound the alarm about the health tragedy that has spread throughout the country.
I find it nothing less than chilling, for example, that quarantines for the municipalities of Alzano Lombardo and Nembro have yet not been established.
During the previous week, when our “enemy” was still in the shadows, the hospital wards were slowly emptied; elective surgeries postponed; even persons receiving intensive therapies were removed, to create as many empty beds as possible. Then containers arrived to create more spaces so as to reduce the risk of infections.
This rapid transformation produced in the corridors of the hospital an atmosphere of surreal silence and emptiness that, at the time, we did not understand. We were waiting for a war to begin, a war that many (including me) were not so sure would ever arrive with the predicted ferocity. And all this was done in complete media silence. Several newspapers actually had the gall to say that private health care was doing nothing to get ready.
I still remember the nightshift a week ago. As I waited for a call from the microbiology lab, to hear the results of a swab on the first suspected Covid-19 patient in our hospital, I trembled about the consequences for us and the clinic. When I think about it now, now that I have seen all that is happening, my acute anxiety about one possible case seems ridiculous and unjustified.
The situation is now nothing short of dramatic. No other word comes to mind.
The war has literally exploded and the battles are uninterrupted day and night. One after another, the unfortunate citizens come to the emergency room. They have nothing like the complications of a flu! Let’s stop saying “it’s a bad flu.” In my two years working at this hospital, I have learned that the people of Bergamo do not come to the emergency room except in a true emergency. Now, too, they waited a week or ten days at home with a fever, without going out and risking contagion. They come because they can’t breathe, they need oxygen.
Drug therapies for this virus are few. The course mainly depends on our organism. We doctors can only support the body. It is mainly hoped that the body will eradicate the virus on its own, let’s face it. Antiviral therapies are experimental on this virus. We learn more about its behavior day after day. Staying at home until the symptoms worsen does not change the diagnosis of the disease.
Now, the drama has fully arrived. One after the other, all the departments that had been emptied fill up. The display boards with the names of the patients, usually printed with different colors that indicate the operating unit they belong to, are now all printed in red with the same cursed diagnosis: bilateral interstitial pneumonia.
Now, tell me please, which flu virus causes such a tragedy?
Here’s the difference: in classical flu, apart from infecting a much smaller number spread over several months, the cases are less frequently severe. The complications derive not from the virus, but only after the VIRUS destroys the protective barriers of the respiratory tract, allowing BACTERIA to invade the bronchi and lungs, and causing the more serious cases.
Covid-19 may have a mild effect in many young people, but in many elderly people (and not only) SARS develops because the virus arrives directly in the alveoli of the lungs and infects them, making the lungs unable to perform their function. The resulting respiratory failure is often serious; after a few days of hospitalization, the oxygen administered may not be enough.
To me as a doctor, it is not reassuring that the most serious cases are mainly elderly people with underlying health conditions. The elderly represent the largest population in our country, and it is difficult to find anyone above 65 years of age who does not have high blood pressure or diabetes. If you could only see the young people who also end up intubated and in intensive care, pronated or worse in an ECMO (a machine for the worst cases, which extracts the blood, re-oxygenates it and returns it to the body, waiting for the organism, hopefully, to heal your lungs), any sense of easy-going complacency regarding the safety of the young is gone.
And while people on social networks pride themselves on not being afraid, and ignore the warnings and safety instructions, protesting they are inconvenienced and that their normal lifestyle habits are in crisis, the epidemiological disaster of their lifetime is occurring.
For us on the ground—we are no longer surgeons, urologists, orthopedists; we are only doctors, a single team facing this tsunami that has overwhelmed us. The cases multiply. We have arrived at the rate of 15-20 hospitalizations a day all for the same reason. The lab results come back one after the other: positive, positive, positive.
Suddenly the emergency room is collapsing; more help is needed and a request is sent out. After a quick meeting to show how the software works, they stand next to us warrior-doctors on the front. The reasons for admittance submitted to the software are always the same: fever and respiratory difficulty, fever and cough, respiratory insufficiency, etc. Exams and radiology always return the same verdict: bilateral interstitial pneumonia, bilateral interstitial pneumonia, bilateral interstitial pneumonia. All who arrive in the ER must be hospitalized. Some are still able to be intubated and sent to intensive care. For others it is too late …
Intensive care is now full; where the wards end, more are created. Each room is valued like gold: even operating rooms have suspended their non-urgent activity and become spaces for intensive care that did not exist before.
I find it incredible—and I speak for HUMANITAS Gavazzeni (where I work)—that it was possible in such a short time to put in place a deployment and a reorganization of resources so finely designed as to prepare for a disaster of this magnitude. Every organization of the beds, wards, staff, work shifts and tasks is reviewed, day after day, to try to give everything and even more to the patients.
Those wards that previously looked like ghost towns are now overflowing. Doctors are exhausted. The staff is exhausted. I have seen fatigue on faces that previously didn’t know the meaning of the word, despite their already grueling workloads. Overtime is habitual. I see solidarity from all. We defend patients from the red tape of the hospital. We offer assistance to our internist colleagues, “What can I do for you now?” Doctors move beds and transfer patients, they administer therapies, all the kinds of tasks usually done by the nurses. I see nurses with tears in their eyes because we cannot save someone, or when the vital signs of several patients at the same time reveal a fate that has already been marked.
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 see my son, but for almost 2 weeks now I have neither seen 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 must content myself with some photos of my son that I view between tears, and a few video calls.
So you who say you are inconvenienced—you cannot go to the theater, museums or gym—try to have mercy on the myriad of older people you could exterminate. It is not your fault, I know, but the fault of those who put it into your head that the pandemic is exaggerated. Even this testimony may seem like an exaggeration to you. But please, listen to us: try to leave the house only to do indispensable things. Do not go en masse to stock up in supermarkets: that is the worst thing you can do because you risk contact with infected people. You can go shopping as you usually do, in increments, quickly. If you have a simple mask (even those that are used to do certain manual work) put it on. Don’t look for the medical masks. Those should be reserved for doctors and nurses, and we are beginning to struggle to find them.
Oh yes, because of the shortage of safety devices, I and many other colleagues are certainly exposed in spite of all the means of protection we still have. Some of us have already become infected despite the protocols. Some infected colleagues have infected their relatives and some of their family members are already struggling between life and death.
Try to make sure you stay away from crowded places. Tell your family members who are elderly or with other illnesses to stay indoors. Bring them the groceries please.
We doctors have no alternative. It is our job. Even though what I do these days is not the job I’m used to do, I do it anyway and I do so willingly it as long as it adheres to the same basic principles of healing: try to make sick people better and heal, and alleviate suffering and pain for those who unfortunately cannot heal.
I do not value the words of people who declare us to be heroes, and who, until yesterday, were ready to insult and report us. These people will continue to insult and report us as soon as everything is over. People forget everything quickly.
And we’re not heroes. It is our job. We risked something bad every day before this: when we put our hands inside a belly full of blood, not knowing if he has HIV or hepatitis C; and when we do it, even knowing that he has HIV or hepatitis C. When we open with anguish the results of the tests, hoping for good results instead of infection. It doesn’t matter if our emotions are beautiful or ugly, we must take them home with us. We simply earn our living this way.
We just try to make ourselves useful for everyone.
Now consider this:
With our actions, we doctors take on responsibility for the life and death of a few dozen people.
But with your actions, you carry responsibility for many hundreds and thousands more.
Please share this message.
We must spread the word to prevent here what is happening in Italy.
Translated by Hilary Jacobson, http://mother-food.com
Thank you. God have mercy on you and your family and colleagues. God bless Italy.
God bless from ms . We are praying and listening to u . Thank you!! Bethany keep your spirits up!!
Thank you for your letter❤I pray for you and all the staff in thecworld handling this virus. Thank you Lord that you turn people to You in this time in Jesus name🕇🕇
God bless you all. It is just starting here and many are ignoring the call to isolation. I fear for America. We are a very ungrateful nation.
You medical personal are wonderful, i do homecare and cannot do my job now because I’m quarantined, didnt know the mans wife was sick until 8 days after
Bless and your fellow staff bless the people in my most favourite place Italy full of love and my aunts family that live in Rome be safe and everyone keep strong
Touching testimonial. Best wishes and prayers to the wonderful folks in Italy. Thanks for also taking the time to warm us and guide us. Hearfelt gratitude.
From a nurse in Invercargill New Zealand to all the rest of my colleagues out there, together we will beat this. When the crisis is over. Cuddle your loved ones and your pets, know you are amazing . Thanks for sharing.
Please read and share this and stay safe
I thank you for your honesty…I will pass this on to my 1,000 + friends and loved ones…May God our father wrapped his wings tightly around you your family and all his children….
Your words are amazing just like your work ethic and commitment to humanity. God bless all of and your families. A big thank you from the other side of the world.
God bless you, your colleagues and the work you do all in the name of helping and saving the lives of the public. Thank you for your service genuinely. Sincerely, Clinton Jerkovich.
I do n’t have the words to convey the gratitude I feel for all health care workers, and everyone else that works in the hospital…no matter what their job is.
I only say that SERVICE TO HUMANITY IS THE SUPREME WORK OF LIFE what U all Doctors r doing. GOD himself can’t come so He has sent U.
A BIG SALUTE TO U.
God bless! Thank you, and thank you for sharing the information.
I am confident that everyone is working for the greater good of all citizens. Many blessings and thank you for caring enough to share your intimate thoughts and expertise knowledge with us all.
Thank you Doctor for letting us know the real truth. And God be with you all. God Bless
Thanks for sharing, thanks to all the medical professionals who put their lives on the line. I have never seen this magnitude of seriousness where your life is on the line with every patient you treat, God bless you!
Thank you, Hilary. From a LLL and IBCLC in Clovis, CA.
As a retired Critical Care Nurse, I feel for all of you, Drs, Nurses and the patients. You are heroes. In the U.S., we are only beginning with this horrible virus. God help Italy and all the countries struggling with this pandemic.
Sending you prayers for strength.
Thankyou so much for your openness and honesty. May God give you the strength to carry on. You and your family are in our prayers.
Pray for all of you
You are sent by God … I pray that He watches over you and all those who believe in helping others.
That’s an amazing post from an amazing person. Thank you for your service, your passion to help and your bravery in spite of the dangers. We need 1,000,000 Daniele Macchinis to carry us forward. I wish you all the best.
May god bless you and your family and my prayers are always with you and your staff! Keep your faith in god for he has a great plan ahead of you all!!! Wishing you and praying 🙏 for all this to disappear.. And for everyone to keep the faith..
Thank you for posting and put your trust in God he has a plan for all of us.
Everyone reading this comment if we just pray and trust in God then God will protect us through this virus. God bless this doctor and all of you.
I don’t know what to say, but I thank you for your honesty, courage, and integrity. We are listening; we will take precautions in whatever way we can. We know it’s coming soon. I pray for you and all those impacted by this.
From a Hospice nurse, CA
Thank you. Many needed to hear this.
Thank you thank you and God bless
May we all get through this be well
Thank you Hilary, I’m with you all the way. Bless you. I am doing everything you said, here in Australia. Our prime minister is sadly stupid, allowing people to gather, and similarly, people are underestimating the urgency….A sad time. Very sad. God bless you.
May the leaders of your country soon find the courage to step up and protect you and your citizens from what is looking to be grave times.
May God Bless and watch over you all.
Thank you for all you are doing, job or not & for this statement.
May the dedication of all frontline medical staff be remembered with gratitude for all they do daily and are doing to confront this global scourge. Let us humbly stand up and be responsible,caring humans in whichever way we can going forward. Carers around the world – thank you.
as a medical personnel, i can relate on what you have been going through… and i do appreciate your work and i hope that all will be ok soon.. i am praying for your safety and also for the safety of all.. God bless us all. Prayer is the only thing that can keep us strong now and unite us now…
Dear Lord, bless your children that are taking care of your sick children and give them the strength to get thru every day of this too. Amen.
May God be with you and keep you and those you love!
Thankyou this has helped put this in total perspective for me now. I no longer have doubts about the seriousness of the situation. Very good advice.
My thoughts & prayers are with you all! Your humanity & dedication in ER is looks amazing & hope you’ll be able to visit your loved ones soonest as possible!
Take care!God bless you!!
Thank you to all medical Drs and nurses for your love and compassion. I pray God’s protection and blessings on you all! Thank you Hilary for posting this!
Thanks for sharing this, Hilary, and to the Italian doctor for explaining the reality about all the amazing and compassionate work all the medical staff are doing to combat this virus. I can only hope prime ministers, premiers and world leaders take the advice and information on board and begin to treat the situation our world is facing with the urgency required.
Thank you Hillary and. Daniele Macchini, M.D.
God bless you, the medical staff and all involved. God please guard your children with healings and your mercy and grace
GOD BLESS ITALY
GOD BLESS AMERICA
GOD BLESS OUR HEALTH CARE
i am in the Tampa Bay area and i see that our beached are overcrowded but the city leaders of the area(most specifically Clearwater Beach will not make the beaches off limits. i fear my area of
Florida will be hit hard because of the countless spring breakers who are young people and think they are invincible. God Help us all if they continue their partying and selfish ways. We pray for you in Italy and we will in return need your prayers as well. Please stay safe and keep us posted when you are able to.
I saw an article yesterday showing a shocking number of young people whose lungs were severely damaged by the disease, and the doctors puzzling about way. I wonder if the vaping habit in the US will make young people highly vulnerable to a severe form. We learn more every day. Stay safe everyone.
Dziękuję za przestrogę, dziękuję za oddanie swoim pacjentom. Jestem dla Was pełna podziwu .Zyczę dużo zdrowia Panu , tym, którzy wraz z Panem walczą z wirusowi , oraz wszystkim lekarzom, pielęgniarkom, całemu personelowi we Włoszech i na całym świecie
God bless you..Thank you for opening up our minds and telling us your truths..
Wake up call for some ..
Thank you for taking the time to let the world know your experience.
We do want to thank you for all the medical staff are doing around the world.
We are praying for all of us in Australia, for the world as this strange virus sweeps all our nations.
Hilary, thank you for your diligence and insight in translating Dr. Macchini’s message to help spread the word to the English speaking world. Not only has he made an incredible difference in his bravery to post but also you have. Thank you again. I’ve shared on my fb wall and emailed to friends. God Bless. Amy in Arkansas
Thank you for sharing, God Bless us all, May we all come together as one and stop this terrible virus🙏🙏🙏🙏😢
Thank you for your warning and the description you’ve given of the gravity of this situation. I have the utmost respect for those in the caring professions, medical personnel, etc. I will pray for this situation in Italy and around the world, as well as here in the U.S. , and for exceptional strength for medical professionals all over the world.
Please stay safe…….and thank you for holding the from lines of this new ‘war’.