Hundreds of thousands of Italians stepped onto the balconies of their apartments on Saturday at 12 p.m. to applaud: The long-lasting applause was for medical staff across the country, who are doing almost superhuman things these days to help the ever increasing number of Covid 19 patients and to keep them alive in the overloaded intensive care units. Doctors, nurses, nurses, medical assistants, medical students: They have long since become the new heroes of Italy.
Especially in the Lombardy provinces of Bergamo and Brescia, which are now the two most important sources of infection in the country, the situation is becoming more and more dramatic every day: Despite the drastic quarantine measures that have been imposed by the government in recent days, the number is increasing of the infected rapidly. Around 300 new cases are reported every day from the province of Bergamo; around 250 in Brescia; Around one in ten of them require intensive care or at least need additional oxygen. In a single week, the two provinces mourned more than 400 deaths, in Bergamo up to 61 per day. The situation in the Veneto region is not much better. “We are at war,” said regional president Luca Zaia, referring to the emergency in the hospitals.
Decision about life and death
Medical staff in many hospitals in Northern Italy has to get used to a new abbreviation: “NCR”. This stands for “non candidabili alla rianimazione” – and means something like: cannot be included in the resuscitation. The lack of beds in the intensive care units has meant that doctors have to make decisions about life and death in certain cases: “If someone is between 80 and 95 years old and has major breathing problems, we reserve the few remaining places for patients with larger ones The same applies if a person infected with the virus has an insufficiency in three or more vital organs, “emphasizes anesthetist Christian Salaroli from Bergamo. These patients usually come directly to palliative care,
The staff in the hospitals, who work 18-hour shifts due to the steadily growing number of Covid-19 patients and can hardly take a day off, has reached the limit of their physical and mental capacity. “The patients who look at us with fearful eyes break my heart,” said the Milan nurse Maria Cristina Settembrese to the “Corriere della Sera”. She told of a 48-year-old Covid-19 patient who was about to be intubated and put under anesthesia: “He shook my hand and said: Swear I’ll wake up again. I have two children.” You had to think about him all day; her protective mask was wet with tears.
5,200 intensive care places
The healthcare system in Italy, which is actually one of the best in the world, was not sufficiently prepared for the corona crisis, at least with regard to intensive care medicine: only 5,200 places in intensive care units are available for 60 million people across the country. In Germany, with its 80 million inhabitants, there are around 30,000. Things are even worse in southern Italy: If the number of cases in the Mezzogiorno also increases massively – which luckily they are not yet doing – according to unanimous expert opinion, a medical disaster is imminent. In the most affected northern Italian regions of Lombardy, Veneto and Emilia-Romagna, health authorities are keen to increase the number of available intensive care beds. Most of the time this happens through the reorganization of the hospitals,
Lack of staff and material
But there are limits to the closure of existing departments in favor of Covid 19 patients: medical care for the other patients must also be guaranteed. For this reason, the establishment of field hospitals is now being considered. In the next few days, a new hospital for 200 lung patients from the Corona crisis will be built on the exhibition center in Brescia. The regional president of Lombardy, Attilio Fontana, is planning the same at the Milan exhibition center. It should offer space for 500 patients. But national civil protection is slowing down: Neither the necessary facilities such as respirators are available, nor is it possible to recruit enough short-term medical personnel who could be deployed in these field hospitals.
There is also another enormous problem that will soon arise in other countries as well: Numerous doctors and nurses in Italy are now infected and fail; some have already died. “I feel like a soldier who loses his comrades,” says Giuseppe Remuzzi, who had headed the Giovanni XXVIII medical clinic in Bergamo until two years ago. One of his former senior physicians is in critical condition on pneumology, two other colleagues are intubated. “If I have to watch the long-term employees and friends fall as the enemy advances, then I feel like crying. It’s almost unbearable,” Remuzzi emphasizes. Altogether, 77 doctors tested positive for the coronavirus in the province of Bergamo alone.
The creation of new places in intensive care medicine is a race against time: According to an Italian study published in the British science journal “Lancet” these days, the number of infected people in Italy is expected to peak in about three to four weeks; by that time, at least 4,000 new beds were required in intensive care units. The government of Giuseppe Conte announced loans to hire 20,000 people in the health sector a week ago, and another loan will soon be granted to provide 5,000 additional ventilators. But the anxious question is: Can the 4,000 spaces required be made available in good time? And above all: will they be enough?