This blog is written by Canadian journalist Donna Laframboise. Posts appear Monday & Wednesday.
Coronavirus has turned hospitals into war zones, say Italian doctors.
Doctors in northern Italy are warning their colleagues in other countries about an approaching COVID-19 tsunami. Medical personnel are sick, exhausted, and overwhelmed. There are too few beds, too little equipment, and too many patients. Decisions are being made about who lives and who dies that were unthinkable a month ago.
The testimony of an unnamed intensivist (a physician who specializes in caring for the critically ill) has been posted on Twitter by his/her British medical colleague, Jason van Schoor. Please read the full Twitter thread here.
The unnamed doctor, working in the Lombardy region, explains that this is “the most developed region of Italy,” with an “extraordinary” health care system. We’re told not to make the mistake of thinking what’s being described “is happening in a 3rd world country.”
Hospitals are now beseiged, “and numbers do not explain things at all,” this person declares. Normal medical care has been suspended. Operating rooms have been converted to intensive treatment units (ITUs). Doctors who specialize in orthopedics (bones) are being “given a leaflet and sent to see patients” struck down by this lung disease.
A clear pattern has emerged, says this person. At first, the hospital receives a few mild cases. The second wave consists of mostly moderately ill patients, with “a few severe ones” who require intubation (a tube inserted down their throat to help them breathe).
The third wave consists of “tons of patients with moderate” respiratory difficulties. Those patients soon deteriorate and fill up the intensive care unit. As their numbers grow, they consume all the non-invasive ventilation (NIV) resources. They use up all the CPAP machines, and require therapeutic oxygen.
Here’s the crucial point. According to this doctor, because hospitals are now running at 200% capacity, patients older than 65, and younger patients with additional health issues, are de-prioritized. If you have relatives with a “history of cancer or diabetes or any transplant,” says this doctor, no extraordinary measures will be taken to save their lives. Even if they are young.
Too many patients with a higher chance of survival are already competing for a limited number of ventilators.
Daniele Macchini is a surgeon at Humanitas Gavazzeni, a hospital in Bergamo. Located an hour’s drive northeast of Milan, tens of thousands of patients from outside Italy have been treated there.
He describes how his hospital reorganized in order to free up as many beds as possible. He, himself, wasn’t convinced such measures were necessary, but then things
exploded and the battles are uninterrupted day and night. One after the other the unfortunate poor people come to the emergency room…Let’s stop saying it’s a bad flu. In these 2 years I have learned that the people of Bergamo do not come to the emergency room at all…but now they can’t take it anymore. They don’t breathe enough, they need oxygen.
…One after another, the departments that have been emptied are filling up…Now, tell me which flu virus causes such a rapid tragedy…
While the most serious cases are “mainly elderly people with other pathologies,” Macchini says young people are also now in intensive care, being kept alive by ventilators. In his words, a “disaster is taking place:”
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…arrive at the 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…help is needed in the emergency room…Intensive care becomes saturated…The staff is exhausted…Nurses with tears in their eyes because we are unable to save everyone and the vital signs of several patients…reveal an already marked destiny.
There are no more shifts, schedules. Social life is suspended for us…I see neither my son nor my family members for fear of infecting them…please, listen to us, try to leave the house only to [do] indispensable things…Tell your family members who are elderly or with other illnesses to stay indoors. Bring [them] the groceries please…We must spread the word to prevent what is happening here in Italy.
Two weeks ago, Italy was establishing hundreds of field hospitals to screen patients (see the photo at the top of this post). Two days ago, the entire country entered an emergency lock down. Churches, schools, and universities are closed. Public gatherings and sports events have been cancelled. Travel is forbidden, with some exceptions. People have been told to stay home.