An Italian Doctor Reveals the Facts on the Ground
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