Letters from Italy-CV19

From Jason Van Schoor:
https://threader.app/thread/1237142891077697538

Italian intensive care physician provides a warning to the rest of the world on how rapid increase in cases overwhelmed their hospitals.

From a well respected friend and intensivist/A&E consultant who is currently in northern Italy:
1/ ‘I feel the pressure to give you a quick personal update about what is happening in Italy, and also give some quick direct advice about what you should do.

2/ First, Lumbardy is the most developed region in Italy and it has a extraordinary good healthcare, I have worked in Italy, UK and Aus and don’t make the mistake to think that what is happening is happening in a 3rd world country.

3/ The current situation is difficult to imagine and numbers do not explain things at all. Our hospitals are overwhelmed by Covid-19, they are running 200% capacity

4/ We’ve stopped all routine, all ORs have been converted to ITUs and they are now diverting or not treating all other emergencies like trauma or strokes. There are hundreds of pts with severe resp failure and many of them do not have access to anything above a reservoir mask.

5/ Patients above 65 or younger with comorbidities are not even assessed by ITU, I am not saying not tubed, I’m saying not assessed and no ITU staff attends when they arrest. Staff are working as much as they can but they are starting to get sick and are emotionally overwhelmed.

6/ My friends call me in tears because they see people dying in front of them and they con only offer some oxygen. Ortho and pathologists are being given a leaflet and sent to see patients on NIV. PLEASE STOP, READ THIS AGAIN AND THINK.

7/ We have seen the same pattern in different areas a week apart, and there is no reason that in a few weeks it won’t be the same everywhere, this is the pattern:

8/ 1)A few positive cases, first mild measures, people are told to avoid ED but still hang out in groups, everyone says not to panick
2)Some moderate resp failures and a few severe ones that need tube, but regular access to ED is significantly reduced so everything looks great

9/ 3)Tons of patients with moderate resp failure, that overtime deteriorate to saturate ICUs first, then NIVs, then CPAP hoods, then even O2.
4)Staff gets sick so it gets difficult to cover for shifts, mortality spikes also from all other causes that can’t be treated properly.

10/ Everything about how to treat them is online but the only things that will make a difference are: do not be afraid of massively strict measures to keep people safe,

11/ if governments won’t do this at least keep your family safe, your loved ones with history of cancer or diabetes or any transplant will not be tubed if they need it even if they are young. By safe I mean YOU do not attend them and YOU decide who does and YOU teach them how to.

12/ Another typical attitude is read and listen to people saying things like this and think “that’s bad dude” and then go out for dinner because you think you’ll be safe.

13/ We have seen it, you won’t be if you don’t take it seriously. I really hope it won’t be as bad as here but prepare.

From Wander Italy with Anna, Face Book post:
https://www.facebook.com/wanderitalywithanna



A few minutes ago the whole country was declared a ‘red zone’. They just announced that we are on national lockdown as of tomorrow morning. This is historic. In recent history no industrialized economy has had to go through something like this.

We are doing fine. We are following the Italian government’s ‘I Stay Home’ decree, which calls for people to only leave the house if absolutely necessary.

At the beginning of this, we didn’t take it seriously. Then we complained that the media was overdoing it and creating hysteria (and they were, in many ways). Then we vowed to not be affected by it, that the economy needed to come first and we needed to keep living our normal lives. That’s when it became clear that this thing spreads super easily, and kills more than we thought. 460 people dead in a few days. And no, it’s not only old people. There’s some people in their 40s and 50s too. But most importantly, since when a grandparent is worth less than us? That narrative is horrible and needs to stop.

The big problem is that the virus spreads fast, and that means that even if few require hospitalization, if too many catch it, hospitals get overwhelmed. People show up in hospitals unable to breathe and need respirators, which are numbered. Each person requires that respirator for at least 6/8 days, (our patient 1 was on it for 3 weeks), which means that people who come after can’t be treated.

We have one of the best public healthcare systems in the world, and the epicenter of the epidemic is Milan, one of the richest regions in the developed world, with some of the best hospitals in Europe, and yet they are completely overwhelmed. Today they announced that they will need to choose who to treat and who they will let die. It’s like a war.

I’m so sad for Italy. We don’t deserve this. Our economy will be hit hard, but the government has had the courage to take dramatic, if very unpopular steps. Yet I see so much inaction globally, so many European neighbors not doing very much, and the US seems completely unprepared for this. Yet this thing is coming and will be much worse everywhere soon.

Please, start thinking about it. Realize this IS a thing. China would not have built hospitals in a few days if it wasn’t necessary. And Italy wouldn’t be risking its entire economy and millions of livelihoods if it wasn’t serious. Everyone can do their bit by taking precautions. If we all do our part this thing can be over sooner.

PS. This is what Rome looks like tonight (I didn’t take the pictures, I am in Naples and I promise I’m staying home)

Italian doctor at heart of illness shares chilling coronavirus thoughts
https://nypost.com/2020/03/10/italian-doctor-at-heart-of-illness-shares-chilling-coronavirus-thoughts/?fbclid=IwAR0ywfUM0XBcdyT-jvHt5rRTm3B9eVU2JpxgbcLp2219c8b0M0sBmhQ-cwc

An Italian doctor at the heart of the coronavirus outbreak that has placed the country under lockdown has painted a grim picture of the deadly illness — likening it to a “tsunami that has swept us all.”

Dr. Daniele Macchini, who works at the Humanitas Gavazzeni hospital in the northern city of Bergamo, warned in a lengthy post on Facebook about the dangers of complacency in the relentless war against the insidious virus.

Italy, where more than 460 people have been killed and 9,172 others infected by the virus, has imposed unprecedented national restrictions on its 60 million inhabitants.

Dr. Daniele Macchini, who works at the Humanitas Gavazzeni hospital in the northern city of Bergamo, warned in a lengthy post on Facebook about the dangers of complacency in the relentless war against the insidious virus.

Italy, where more than 460 people have been killed and 9,172 others infected by the virus, has imposed unprecedented national restrictions on its 60 million inhabitants.

“All this rapid transformation brought an atmosphere of silence and surreal emptiness to the corridors of the hospital that we did not yet understand, waiting for a war that was yet to begin and that many (including me) were not so sure would ever come with such ferocity,” he said.

“I still remember my night call a week ago when I was waiting for the results of a swab. When I think about it, my anxiety over one possible case seems almost ridiculous and unjustified, now that I’ve seen what’s happening. Well, the situation now is dramatic to say the least,” Macchini added.

“The war has literally exploded and battles are uninterrupted day and night. But now that need for beds has arrived in all its drama. One after the other the departments that had been emptied fill up at an impressive pace.

“The boards with the names of the patients, of different colors depending on the operating unit, are now all red and instead of surgery you see the diagnosis, which is always the damned same: bilateral interstitial pneumonia.”

The doctor urged people not to describe Covid-19 as a bad case of the flu.

“Now, explain to me which flu virus causes such a rapid drama. … And while there are still people who boast of not being afraid by ignoring directions, protesting because their normal routine is ‘temporarily’ put in crisis, the epidemiological disaster is taking place,” he said.

“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.

“Cases are multiplying, we arrive at a rate of 15-20 admissions per day all for the same reason. The results of the swabs now come one after the other: positive, positive, positive. Suddenly the E.R. is collapsing.”

Describing every available ventilator as “gold,” Macchini said the doctors and nurses working at his side are exhausted.

“I saw the tiredness on faces that didn’t know what it was despite the already exhausting workloads they had. I saw a solidarity of all of us who never failed to go to our internist colleagues to ask, ‘What can I do for you now?’

“Doctors who move beds and transfer patients, who administer therapies instead of nurses. Nurses with tears in their eyes because we can’t save everyone, and the vital parameters of several patients at the same time reveal an already marked destiny.

“There are no more shifts, no more hours. Social life is suspended for us. We no longer see our families for fear of infecting them. Some of us have already become infected despite the protocols,” he said.

Macchini noted that some of his colleagues have become infected themselves and then infected their relatives who “are already struggling between life and death.”

“So be patient, you can’t go to the theater, museums or the gym. Try to have pity on the myriad of old people you could exterminate,” he said.

“I finish by saying that I really don’t understand this war on panic. The only reason I see is mask shortages, but there’s no mask on sale anymore. We don’t have a lot of studies, but is panic really worse than neglect and carelessness during an epidemic of this sort?”

Meanwhile, another doctor in Bergamo told the newspaper Corriere della Sera that doctors are forced to choose whom to treat on the basis of their chances of survival.

“We can’t attempt miracles. It’s the reality,” anesthesiologist Christian Salaroli said, according to Sky News.

Coronavirus ‘worse than a bomb’ on Italy, says doctor coordinating response

Giacomo Grasselli - a senior Italian government health official who is coordinating the network of intensive care units in Lombardy - explains the “critical” situation in Italy, brought about by the Covid-19 outbreak

Italians trapped at home issue a grave warning to the world amid coronavirus panic
https://thenewdaily.com.au/news/world/2020/03/17/italians-warning-video-coronavirus/

Quarantined Italians have confessed their deep regret over failing to heed coronavirus warnings and have revealed what advice they would give their future selves had they known then what they know now.

The video, which has racked up more than two million views in just two days, features recorded messages from people who don’t want other countries to follow Italy down the same fateful path that caused a nation of 60 million to be confined to their homes.

The caption for the video reads: “It is believed nations like the US, England, France, Spain and Germany are about 9 to 10 days behind Italy in the COVID19 progression. We asked people from all around Italy to record a message to themselves of 10 days prior.” ---CONTINUED---

Coronavirus: Italy's hardest-hit city wants you to see how COVID-19 is affecting its hospitals
https://news.sky.com/story/coronavirus-they-call-it-the-apocalypse-inside-italys-hardest-hit-hospital-11960597

Staff frantically wave us out of the way, pushing gurneys carrying men and women on mobile respirators - it's not chaos, but it is hectic.

They rush past wards already rammed with beds all filled with people in terrible distress - gasping for air, clutching at their chests and at tubes pumping oxygen into their oxygen-starved lungs. ---CONTINUED with video ---