The doctors and nurses attending to afflicted patients and those suspected to have the disease-they are the gallant warriors, the unsung heroes in this modern-day global war against this virus
By Henrylito D. Tacio
A “tsunami that has swept us all.” That was how Dr. Daniele Macchini likened the coronavirus disease 2019 (Covid-19), which has infected close to 113,000 people around the world and resulted in more than 4,000 deaths.
Dr. Macchini is a doctor who is at the forefront of the Covid-19 outbreak in Bergamo, Italy, which has been the most affected country outside of China. As of this writing, more than 7,000 Italians have been infected and killed at least 643 others.
The Geneva-based World Health Organization (WHO) reported that one-fifth of Italians infected with the virus need hospital treatment which “could be enough to overwhelm healthcare systems if the epidemic spreads.”
So much so that on March 9, Prime Minister Giuseppe Conte placed all of Italy and its 60 million people under lockdown in an attempt to contain SARS-Cov-2, the virus that causes Covid-19. The drastic measures, CNN reports, include “blanket travel restrictions, a ban on all public events, the closures of schools and public spaces such as movie theaters, and the suspension of religious services including funerals and weddings.”
Dr. Macchini, an intensive care unit physician, wrote in his Facebook account where, to quote the words of Ceri Parker, the commissioning editor of Agenda, “he issued an emotional warning on the reality that could await elsewhere if complacency wins.” The physician said he understood “the need not to create panic,” but felt “the message of the danger of what is happening” was not reaching people.
“I still see people ignoring the recommendations and people who gather together complaining that they cannot go to gym or play soccer tournaments, I shiver,” he wrote. “I also understand the economic damage and I am also worried about that. After this epidemic, it will be hard to start over.”
In Bergamo, a city near Milan, local media reports there were 1,245 cases of Covid-19. “After thinking for a long time if and what to write about what is happening to us, I felt that the silence was not all responsible,” he wrote.
After posting his first-hand account experience the fight against the dreaded virus, an Italian newspaper picked it up. On Twitter, Dr. Silvia Stringhini, an epidemiologist and researcher based at the Geneva’s University’s Institute of Global Health, translated the post. In the beginning, it was business unusual. “I myself looked with some amazement at the reorganization of the entire hospital in the previous week, when our current enemy was still in the shadows: the wards slowly ‘emptied,’ elective activities interrupted, intensive care unit freed to create as many beds as possible,” Dr. Macchini wrote.
“Containers arriving in front of the emergency room to create diversified routes and avoid infections. All this rapid transformation brought in the hallways of the hospital an atmosphere of surreal silence and emptiness that we did not understand, waiting for a war that had yet to begin and that many (including me) were not sure would never come with such ferocity.”
Then, it happened. “I still remember my night shift a week ago spent without any rest, waiting for a call from the microbiology department,” he recalled. “I was waiting for the results of a swab taken from the first suspect case in our hospital, thinking about what consequence it would have for us and the hospital. If I think about it, my agitation for one possible case seems almost ridiculous and unjustified, how that I have seen what is happening.”
It was more dramatic that he expected. “No other words come to mind,” he said. “The war (we were waiting) has literally exploded and battles are uninterrupted day and night. One after the other, these unfortunate people come to emergency room. They have far from the complications of a flu.”
Dr. Macchini has been working at the Bergamo hospital for two years and he learned that these people do not come to the emergency room for no apparent reason. “They did well this time, too,” he wrote. “They followed all the recommendations given: a week or ten days at home with a fever without going out to prevent contagion, but now they can’t take it anymore. They don’t breathe enough, they need oxygen. Drug therapies for this virus are few.”
What follows next seems to be a script lifted from a Hollywood thriller: “Staying at home until the symptoms worsen does not change the prognosis of the disease. Now, however, the need for beds in all its drama arrived. One after another, the departments that had been emptied are filling up at an impressive rate. The display boards with the names of the (sick people), of different colors depending on the department they belong to, are now all red and instead of the surgical procedure, there is the diagnosis, which is always the same: bilateral interstitial pneumonia.”
Covid-19 is not just an ordinary flu. It’s totally new and mindblogging. “Covid-19 causes a banal flu in many young people,” Dr. Macchini wrote, “but in many elderly people, it invades the alveoli of the lungs directly, and it infects them making them unable to perform their function.”
“The resulting respiratory failure is often serious and after a few days of hospitalization, the simple oxygen that can be administered in a ward may not be enough,” he continued. “Sorry, but to me, as a doctor, it’s not reassuring that the most serious are mainly elderly people with other pathologies. The elderly population is the most represented in our country and it is difficult to find someone who, above 65 years of age, does not take at least a pill for high blood pressure or diabetes.”
Even the non-elderly people are not safe from Covid-19. “I can assure you that when you see young people who end up intubated in the intensive care unit, pronated or worse, in ECMO (a machine for the worst cases, which extract the blood, reoxygenates it and returns it to the body, waiting for the lungs to hopefully heal), all this confidence for your young age goes away.”
In the face of Covid-19, there are no more specializations among physicians. “There are no more surgeons, urologists, orthopedists,” he wrote, “we are only who suddenly become part of a single team to face” on what he calls as epidemiological disaster.
If you have watched ER, an American medical drama television series that aired on NBC from 1994 to 2009, you may be able relate with this scenario: “The cases multiply, up to a rate of 15- 20 hospitalizations a day all for the same reason. The results of the swab now come one after the other: positive, positive, positive. Suddenly the emergency room is collapsing. Emergency provisions are issued: help is needed in the emergency room. A quick meeting to learn how to use the emergency room and a few minutes later I’m already downstairs, next to the warriors of the war front.”