‘Every ventilator becomes like gold’ – a doctor’s stark warning from Italy’s Coronavirus outbreak

As COVID-19, or the coronavirus, spreads across Europe, responses are mixed. While World Health Organization (WHO) guidance underscores the seriousness of the situation and some employers encourage people to work from home, for many people life simply continues as normal. But one doctor who is at the heart of the outbreak in Bergamo, northern Italy, has taken to social media to issue an emotional warning on the reality that could await elsewhere if complacency wins.

At the time of writing, Italy has quarantined 16 million people in its northern provinces until 3 April as it battles to contain an epidemic that has infected more than 7,000 people and killed at least 366 in the country. According to the WHO, one-fifth of people infected need hospital treatment – and this could be enough to overwhelm healthcare systems if the epidemic spreads.

Dr Daniele Macchini, an Intensive Care Unit physician in Bergamo, a city near Milan, shared his experience of working in a hospital where exhausted staff battle to save patients. His Facebook post was picked up in an Italian newspaper and translated on Twitter by Dr Silvia Stringhini, an epidemiologist and researcher based at the Geneva University’s Institute of Global Health.

Below is the text of the translation, which you can also read in the thread above. As context, 80% of people with coronavirus experience mild symptoms, but an acute form of the illness can lead to life-threatening pneumonia. The elderly are particularly vulnerable.

Dr Daniele Macchini’s post, translated by Dr Silvia Stringhini

“After much thought about whether and what to write about what is happening to us, I felt that silence was not responsible.

“I will therefore try to convey to people far from our reality what we are living in Bergamo in these days of Covid-19 pandemic. I understand the need not to create panic, but when the message of the dangerousness of what is happening does not reach people I shudder.

“I myself watched with some amazement the reorganization of the entire hospital in the past week, when our current enemy was still in the shadows: the wards slowly ’emptied’, elective activities were interrupted, intensive care were freed up to create as many beds as possible.

“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.

“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.

“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 colours 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.

“Now, explain to me which flu virus causes such a rapid drama. [post continues comparing Covid19 to flu, link here]. 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. 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.

“Reasons for the access always the same: fever and breathing difficulties, fever and cough, respiratory failure. Radiology reports always the same: bilateral interstitial pneumonia, bilateral interstitial pneumonia, bilateral interstitial pneumonia. All to be hospitalized.

“Someone already to be intubated and go to intensive care. For others it’s too late… Every ventilator becomes like gold: those in operating theatres that have now suspended their non-urgent activity become intensive care places that did not exist before.

“The staff is 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.

“Some of our colleagues who are infected also have infected relatives and some of their relatives are already struggling between life and death. So be patient, you can’t go to the theatre, museums or the gym. Try to have pity on the myriad of old people you could exterminate.

“We just try to make ourselves useful. You should do the same: we influence the life and death of a few dozen people. You with yours, many more. Please share this message. We must spread the word to prevent what is happening here from happening all over Italy.

“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 it panic really worse than neglect and carelessness during an epidemic of this sort?”

Fighting complacency

At the start of her thread, Dr Silvia Stringhini warned against a sense of complacency elsewhere in Europe.

“I may be repeating myself, but I want to fight this sense of security that I see outside of the epicenters, as if nothing was going to happen ‘here’. The media in Europe are reassuring, politicians are reassuring, while there’s little to be reassured of.”

So far, roughly 12,000 cases have been recorded on the continent. Following Italy, France and Germany are the worst-afflicted.

To protect yourself and others, World Health Organization advice is to wash your hands regularly with soap; avoid touching your face; cough or sneeze into the crook your arm or a tissue; keep a distance of 1 metre from other people; stay at home and call for medical advice if you experience symptoms of the virus.