The healthcare system of Italy can not withstand the load of the epidemic

Italy, ROME. The mayor complained that the doctors were forced to make a decision not to treat very elderly people just leaving them to die. In another city patients with coronavirus pneumonia were sent home. In another place the nurse just fell on the floor wearing a mask from overwork, and her photo became the symbol of overloaded medical staff.

In less than three weeks, the coronavirus has overloaded the health care system throughout Northern Italy. He turned heavily affected region of Lombardy in the dark a glimpse of what awaits the country if they can’t slow the spread of the virus and “flatten the curve” of new cases — that allows us to treat patients without the possibility of hospitals.

If not, even hospitals in developed countries with the world’s best health services will be the usual quarantine chambers, forcing regular doctors and nurses make emergency decisions about who can live and who can die. Rich in Northern Italy already faces one of the versions of this nightmare.

“This is a war, “said Massimo Puoti, head of the division of infectious medicine in Milan, the Niguarda hospital, one of the largest in Lombardy, Northern Italy, in the heart of the epidemic of coronavirus in the country.

He said that the goal was to limit infection, to prevent an epidemic and to learn more about the nature of the enemy. “We need time“.

This week in Italy was adopted horrifying measures — restriction of movement and closure of all stores except pharmacies, food and other essential services. Unfortunately, all of these changes appointed very late to prevent a surge of new cases, which greatly burdened the ability of a reference health system.

Experience Italy at the present time underlines the need to act decisively, quickly and in the early stages — long before the number of cases will reach a critical level. By this time it may be too late to prevent the outbreak of new infections, if the system is out of control.

Since Italy seems to have crossed that threshold, her doctors found themselves in the unusual position of largely unseen by the developed European countries, has some of the most developed public health systems ever since the Second world war.

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Conventional doctors breaking into martial law. They are faced with issues of triage, as operations are cancelled, respirators become a rare resource, and officials propose to transform an abandoned exhibition space in a vast chamber of intensive therapy.

Hospitals install in their territory the inflatable, airtight tent with infectious diseases. In Brescia the patients crowd the corridors.

“We live in a system in which we ensure the health and right of every person to a cure, “said the Prime Minister, Giuseppe Conte Monday, announcing measures to hold the Italians in their homes.

“It is the Foundation, the support, and I would say, characteristic of our civilization system“, — he said. “And so we cannot afford to weaken our health”.

At the moment the Italian experts in the field of public health argue that the system, despite the serious problems, is working and that all the thousands of people passing tests, visits to emergency departments and intensive therapy, get it for free, maintaining the Central principle of the Italian democracy unchanged.

But before the Lombardy region has centralized its communication on Thursday and seemed to be gagged doctors and nurses, who were told about the conditions in reality had a disturbing picture of life against infection.

Photo one nurse, Helena Pagliarini who fell face down with a mask in a hospital in the Northern city of Cremona after 10 hours of continuous operation, has become a symbol of an overloaded health system in Italy:

“We are on the brink, physically and psychologically, “said Wednesday on Italian television colleague Francesca Mangatangi that took the picture, urging people to protect themselves, to avoid the spread of the virus. “Otherwise the situation gets out of control, if it even happened.”

Doctor of the hospital in Bergamo this week has published in social networks a graphical representation of the stress to the healthcare system the overwhelming number of patients.

“The war literally exploded, and battles are coming continuously day and night, “wrote Dr. Daniel McKinney, calling the situation “epidemiological catastrophe“which “shocked” doctors.

Fabiano Di Marco, head of pneumology at the hospital Papa Giovanni XXIII in Bergamo, where he fell asleep in his office, said Thursday that doctors literally “draw the line on the ground to separate the clean part from the dirty hospital”. Where everything they touch is considered to be contagious.

Giorgio Gori, mayor of Bergamo, said that in some cases, in Lombardy, the gap between resources and a huge influx of patients “compels doctors to decide not to intubate some very elderly patients,” in fact, leaving them to die.

“If there was more intensive treatment, he added, — would it be possible to save more lives”.

Dr. Di Marco appealed the approval of the mayor, saying that all received help, although he added: “Obviously, at this point, in some cases, it may happen that we will have a comparative assessment between patients.”

“In terms of a serious lack of health resources”, — stated in the guidelines, intensive assistance should be provided “to patients with better chances of success of recovery” and patients with “the best hope for life” should be given priority.

The guidelines also States that “in the interests of maximizing benefits for the greatest number” in intensive care can be restrictions on the reservation of resources for those who, first, “has a greater probability of survival, and secondly, who has more potential years of life.”

“No one is kicked out, but we suggest a criteria of priority, “said Dr. Petrini. “These elections are made at the usual time, but what is not normal is when you have to help 600 people at the same time“.

On Thursday, Giulio Haller, an official from the Lombardy region, responsible for emergency response, said that he hoped that the guidelines will never be used.
He also said that the region is working with the Italian civil protection Agency to explore the possibility of using the exhibition area, abandoned cancelled conventions as intensive care wards with 500 beds.

But, according to him, the region needs doctors and respirators.

“The outbreak has led to the fact that hospitals are experiencing stress, which has no precedent since the Second world war,” said Massimo Galli, Director of infectious diseases at the University of Milan, Sacco hospital, which treats many patients with coronavirus. “If the tide of new infections will continue to grow, attempts to build dams to hold it will become increasingly difficult”.

Dr. Galli noted that, although the government’s emergency decrees sought to increase the recruitment of thousands of doctors and health workers — including medical residents in their last years of training in medical school — it takes time to train new doctors, even those that were transferred from other departments.

Matteo Stokoe, Director of the hospitals of Sao Paulo and San Carlo in Milan, said that 13 members of its staff were home once given a positive test result for the virus. One of his primary physicians in the emergency Department have also been infected, he said, “after three weeks of continuous work, day and night.”

Dr. Puoti from Niguarda hospital said that the doctors kept distance from each other in the cafeteria, wore masks during meetings of the staff and avoided to gather in small rooms. However, according to him, some were infected, which created a risk of lack of staff.

“We try to maintain our level of work,” he said. “Because the epidemic will last a long time.”

He said that the hospital is trying to buy more respirators and preparing for the fact that patients will come not only from nearby cities but also because of the wave of infections in Milan.

Dr. Stocco said that this moment has already arrived.

According to him, Thursday afternoon in the emergency room appeared 50 people with breathing problems. The hospital has cancelled operations and transferred the beds and respirators for patients with coronavirus and doubled your possibilities of intensive therapy.

“The infection is here“, he said.

Carlo Palermo, President of the Association representing Italian doctors in government hospitals, said the system has been kept, despite the years of budget cuts.

He said that since about 50 percent of people who test positive for the virus was in need of some form of hospitalization in the system were obvious stress. But 10 per cent needing intensive care that requires two to three weeks in the hospital, “can weaken the ability of fast reaction”.

Many experts say that if the rich and expert health care system in Northern Italy will not be able to withstand the brunt of the outbreak, it is unlikely that the poorer South would be able to cope with the situation.

According to Dr. Palermo, if the virus will spread South with the same rate, “the system can not survive and we will not be able to provide assistance“.

Many experts warn that Italy for 10 days ahead of other European countries in the spread of coronavirus. German Chancellor Angela Merkel raised the alarm that about 70 percent of Germans can be infected with a virus.

Are you overwhelmed by the Italian system has resonated in the United States, where the President trump on Wednesday evening shut down flights to foreigners coming from Europe.

“The Italian disease is a European disease, and trump its decision is trying to avoid turning this disease in the U.S., “said Romano Prodi, former Prime Minister of Italy and President of the European Commission.