Virus-Hit Lombardy On The Brink
You will have heard that the Italian government is planning to put the entire region of Lombardy, as well as the area around Venice, under a one-month quarantine, probably starting tomorrow. Someone irresponsibly leaked the plan to the Italian media, which irresponsibly reported it, and now people are fleeing Lombardy before the borders close.
The medical crisis in this, the wealthiest region of Italy, is overwhelming its ability to cope. Here’s an interview that went up tonight on Corriere della Sera, the Milan daily. I’ve translated it from Italian with DeepL. I’m not in the habit of posting entire articles, but I feel this is necessary for public health reasons. Read this and realize that this is coming for us very soon — but we have the power to slow it down if our leaders will get more blunt and urgent, and the rest of us will do our part:
“We are now forced to create intensive therapy in the hallways, operating theatres, waking rooms. “We’ve gutted entire hospital wards to make room for the seriously ill. One of the best hospitals in the world, the one in Lombardy, is one step away from collapse.”
Antonio Pesenti, 68 years old, is the coordinator of the Lombardy Region’s crisis unit for intensive care. Publicly praised by the scientist Alberto Mantovani as one of the best men of science in Italy, he is an ICU doctor with strong nerves, accustomed to governing every kind of emergency. But at nine o’clock on Saturday evening, after 17 days of non-stop work, his voice is broken by tiredness and worry: “If the population doesn’t understand that he has to stay at home, the situation will become catastrophic”.
You, together with your colleagues from the resuscitations, are the author of a very harsh letter addressed to Giuseppe Conte’s government: “The scientific projections are very alarming”. What do you mean by that?
The picture is so serious that it requires an increase in ICU posts up to ten times the current availability. The number of patients admitted to hospital on 26 March is expected to be 18,000 in Lombardy, of whom between 2,700 and 3,200 will require hospitalization in intensive care. Today there are already more than a thousand patients among those in intensive care and those who risk becoming worse from one minute to the next. We monitor the situation 24 hours a day.
In the letter he speaks of risks not only for coronavirus patients, but also for all the others: “In danger is the survival not only of Covid-19’s patients” – you write – “but also of that part of the population that in any case accesses the health system”.
So far in Lombardy ambulances have always arrived in 8 minutes, now they risk not arriving within an hour. An enormous danger for those who have a heart attack, and not only them.
In short, the emergency-urgency system in Lombardy is no longer able to guarantee ordinary standards.
Unfortunately, it’s the truth. I’m not saying this to alarm the citizens, but to make everyone understand that it’s not the time to go out, to go shopping or to go for a spritz, as we’ve been saying for days now. We need to change social relations, with the shops and neighborhood markets closed. In Milan, where I live, at least up to now there have been too many people around unnecessarily. You have to go out just to buy food.
The number of beds in intensive care is increasing every day, but it’s never enough.
We’re creating Covid-19 blocks everywhere. By now, all the major hospitals in Lombardy have been involved, at least fifty or so. As we know, infected patients cannot be mixed with others. It means having resuscitations where everything happens with special protection systems: from filtered air to doctors and nurses who always dress and undress in the presence of another person to check that the procedures are correct because all it takes is the slightest distraction to become infected.
In what conditions are you working?
We’re working covered up to protect ourselves from the virus. After 4 hours we are soaked by sweat, our movements are slowed down and we have to get out of resuscitation to hydrate ourselves. We’re doing everything we can, and more, but we have to stop the contagion. The only way is prevention.
In one of the last meetings with the intensive care doctors there are those who have not been able to hold back tears.
We’re used to dealing with any situation in cold blood for a living. But only those who are experiencing it on the front line can understand the drama of the events.
Is it plausible to think of transporting seriously ill people to the rest of Italy?
They are very complex patients to move. Both because of their physical condition and because of the protections that must be taken in order not to infect us. I see it as difficult.
Readers, stay home. If you are a government official, or head of a school or other institution, or a decision-maker at a company, consider strongly whether or not now is the time to tell your people to stay at home. There’s no way to keep coronavirus from coming to us now, but we still have the power to slow the rate of infection, and give our hospitals a better chance of managing the tsunami headed this way.
I do not understand what is stopping the president, governors, and others from acting now. What are they waiting for? By the time they feel pressured to make the inevitable self-quarantine calls, it may be too late to do much good for our health care system.
The White House overruled health officials who wanted to recommend that elderly and physically fragile Americans be advised not to fly on commercial airlines because of the new coronavirus, a federal official told The Associated Press.
The Centers for Disease Control and Prevention submitted the plan this week as a way of trying to control the virus, but White House officials ordered the air travel recommendation be removed, said the official who had direct knowledge of the plan. Trump administration officials have since suggested certain people should consider not traveling, but they have stopped short of the stronger guidance sought by the CDC.
The person who spoke to the AP on condition of anonymity did not have authorization to talk about the matter. The person did not have direct knowledge about why the decision to kill the language was made.
In a tweet, the press secretary for Vice President Mike Pence, Katie Miller, said that “it was never a recommendation to the Task Force” and called the AP story “complete fiction.”
I don’t believe that. Katie Miller might be telling the truth here, but at this point, I believe nothing this administration says.
UPDATE.2: In Lombardy, doctors warn the public that they might have to start administering triage treatment for coronavirus patients, only giving care those who have the greatest chance of survival. That means that old people will be allowed to die so what resources remain can be used to attempt to save younger patients. Read the story here, in Italian (Google Chrome offers a translation.)
Here’s an important tweet from a constructive thread by former FDA deputy commissioner:
2/n In last 10 days Italy diagnosed 95% of total cases they now report; South Korea 85%. 2 weeks ago, Italy had just 9 cases. 7 weeks ago, China reported 50 cases. The point: once the epidemics are discovered, they’ve been underway. Case counts grow quickly. Same likely true here
— Scott Gottlieb, MD (@ScottGottliebMD) March 8, 2020
Two weeks ago, only nine confirmed cases. Now Italy has quarantined its wealthiest province, whose health care system is on the brink of breaking down.
What will it look like in America two weeks from today?
President Donald Trump’s top economic adviser, Larry Kudlow, falsely claimed on Friday that the coronavirus “is contained” in the US. Another senior Trump official, counselor to the President Kellyanne Conway, made a similar though slightly less definitive claim, saying that the virus “is being contained.”
“In the US it is the opposite of contained,” said Harvard University epidemiology professor Marc Lipsitch, director of Harvard’s Center for Communicable Disease Dynamics. “It is spreading so efficiently in so many places that it may be difficult to stop.”
Don’t worry, President Trump, seeing the threat this pandemic crisis poses to the lives of thousands of Americans, to the US health care system, and, with the stock market plunging, to the overall economy, was in the White House over the weekend working hard to stay on top of the federal response. Oh, wait, he wasn’t:
President Donald Trump on Saturday headed to his golf course in West Palm Beach after saying earlier this week he’s ‘too busy’ to have his annual physical.
… Trump arrived at the Trump International Golf Club West Palm Beach at 9:21 a.m. on a sunny but breezy day.
Once you have lost credibility, you will never, ever get it back.