Italy struggles to make room for onslaught of virus patients

Three weeks into Italy’s coronavirus crisis, Dr. Sergio Cattaneo has seen an unused ward outfitted into an intensive care unit in six days, a hospital laundry room converted into a giant stretcher-filled waiting room and a tented field hospital erected outside to test possible new virus patients.

But Cattaneo, head of anesthesiology and intensive care at the public hospital in Brescia in northern Italy, still can’t get his head around the curve — the upward slope of new infections in Italy that tracks almost exactly the trajectory of cases in Wuhan, China, where the global pandemic began three months ago.

“What is really shocking — something we had not been able to forecast and brought us to our knees — is the quickness the epidemic spreads,” Cattaneo told The Associated Press during an exclusive tour of Brecia’s newest ICU. “If the spreading of this epidemic is not put under control, it will bring all hospitals to their knees.”

Cattaneo’s new ICU added six more beds to the hospital’s capacity, bringing to 42 the number of ICU beds dedicated to the virus. Across the Lombardy region, local authorities are pushing ahead with plans to build a 400-bed ICU field hospital at the Milan fairgrounds, even though the civil protection agency has warned that it doesn’t have the ventilators or personnel to staff it, and that time is running out.

“The secret has been — and this should be a strong message for foreign countries — to act early on this, in order to avoid — like in our case — having to chase after it day after day,” Cattaneo said.

Brescia, an industrial city of nearly 200,000 east of Milan and the capital of a province of 1.2 million, is second only to nearby Bergamo in positive cases in Lombardy, the epicenter of the pandemic in Europe.

For the past two days, Brescia actually outpaced Bergamo in the number of new infections, on Tuesday adding another 382 positive tests for a total of 3,300 and suggesting that it is becoming Lombardy’s hottest hot spot.

Indeed, seven of Brescia’s deaths this week were among residents of the same nursing home in Barbariga, where another eight elderly people tested positive, local media reported. While many people suffer relatively mild symptoms from the virus, the mortality rate in Italy in people over 80 is 22 percent, according to statistics from the National Institutes of Health.

By Tuesday, Italy recorded 31,506 positive cases and 2,503 deaths, more than anywhere outside China.

It has been a race against time for Lombardy to add more ICU beds than the patients who need them, not an easy task given that 10 percent of all Italy’s infected require ICU admission, primarily for respiratory help.

Nearly all admitted patients have interstitial pneumonia, a disease in which the lace-like tissue of the lungs’ alveoli become inflamed, leading to progressive respiratory failure, according to Giovanna Perone, director of Brescia’s emergency services.

“In the last few days, the number of people arriving here on their own and reporting such symptoms has increased,” Perone said outside the civil protection tents where walk-in patients are tested and then sent to the hospital’s converted laundry room to await the results.

The onslaught of infections has completely overwhelmed the public health system in Italy’s prosperous north, prompting regional officials to beg retired doctors to come back to work and to accelerate graduation dates for nurses and specialists.

“I ask you from my heart, we need your competency, your experience, your efficiency,” said Giulio Gallera, Lombardy’s chief healthcare official. “Give us a hand.”

The 25 billion euro aid package the Italian government approved Monday, aimed at bolstering both the health care system and helping businesses, workers and families weather the economic hit, also contains provisions to hire 10,000 more medical personnel.

Already Lombardy this week has received 2,200 responses to a “help wanted” sign on its Facebook page, and hired over 1,000 people, Gallera said.

Italy’s medical personnel also complain about critical shortages of gear, including protective masks and glasses. Italy’s national federations of doctors and nurses issued a joint alarm Tuesday over the more than 2,300 medical personnel who have been infected, 1,900 of them doctors and nurses. The two groups demanded adequate protective masks, gloves and other equipment as a matter of national security for the 900,000-strong medical workforce in Italy.

“We have to redefine the priorities in the fight,” said Filippo Anelli, head of the doctors’ federation. “It’s unfathomable, unworthy of a civil society and puts public health at risk.”

Italy’s civil protection agency has blasted countries for failing to follow through on orders of protective masks, including 20 million that were under contract but were never delivered. Civil protection chief Angelo Borrelli has named India, Russia, Romania and France as countries that have blocked exports of the specialized masks, which Italy doesn’t produce domestically.

“What we’re seeing is a closure of borders to exportation,” he lamented this week.

Prisoners are being put to work to make surgical masks, since there’s a shortage of them, too. The Justice Ministry estimates that inmates could produce as many as 10,000 a day.

The shortages, as well as the 12-hour shifts that sometimes last for 18, are taking a toll on the health care workers still standing. State-run RAI television runs near-nightly interviews with doctors and nurses on the front line, making urgent, exhausted appeals for Italians to just stay home.

“Family life has changed too of course because we either live in self-isolation at home, out of fears of creating problems, or even sleeping elsewhere in some cases,” said Fabio Arrighini, nursing coordinator for Brescia’s health care emergency service.

(image credit: AP)