If we were to compare the Italian outbreak of Covid-19 to an earthquake, we would undoubtedly have to locate the epicenter of this earthquake at the Papa Giovanni XXIII Hospital in Bergamo, “a brand new state-of-the-art facility with 48 intensive care beds.”
This is at least how the doctors working at the hospital described it, as they used the venue of the most popular medical journal in the world, the New England Journal of Medicine, to publish their vivid and dramatic account of the situation in Lombardy. In just a few hours, their report was read all around the world.
“Our own hospital is highly contaminated,” the doctors write. “The situation here is dismal as we operate well below our normal standard of care. Wait times for an intensive care bed are hours long. Older patients are not being resuscitated and die alone without appropriate palliative care, while the family is notified over the phone, often by a well-intentioned, exhausted, and emotionally depleted physician with no prior contact.”
And the situation is even worse in the other hospitals in the province. “Most hospitals are overcrowded, nearing collapse,” the doctors write, pointing to a mounting shortage of medication, ventilators, oxygen and personal protection equipment. “Patients lay on floor mattresses. The health care system struggles to deliver regular services — even pregnancy care and child delivery — while cemeteries are overwhelmed, which will create another public health problem.”
The document is not a distress call, but a useful lesson for the whole world. According to the doctors at Papa Giovanni XXIII, “Western healthcare systems have been built around the concept of patient-centered care, but an epidemic requires a change of perspective toward a concept of community-centered care. What we are painfully learning is that we need experts in public health and epidemics, yet this has not been the focus of decision makers at the national, regional, and hospital levels.”
In an epidemic, the relationship between patients and doctors can even be reversed: “For example, we are learning that hospitals might be the main Covid-19 carriers, as they are rapidly populated by infected patients, facilitating transmission to uninfected patients. Patients are transported by our regional system, which also contributes to spreading the disease as its ambulances and personnel rapidly become vectors.” In addition to the sick, doctors must also be protected: “Some [health workers] might die, including young people, which increases the stress of those on the front line.”
The solutions cannot be just for hospitals, but for the entire population. “Home care and mobile clinics avoid unnecessary movements and release pressure from hospitals,” the doctors from Bergamo write. “This approach would limit hospitalization to a focused target of disease severity, thereby decreasing contagion, protecting patients and health care workers, and minimizing consumption of protective equipment. In hospitals, protection of medical personnel should be prioritized.”
Social distancing measures are crucial, but we must also look beyond this particular epidemic wave. The doctors point out that “a further peak will likely occur when restrictive measures are relaxed to avoid major economic impact.” That is a plausible scenario, as scary as it is. “We need a long-term plan for the next pandemic.”
The first signatory of the document is Dr. Mirco Nacoti, who, in his work with the Doctors Without Borders NGO, has experienced the epidemics of the Ivory Coast first-hand. His point of view helps to give us context on this epidemic as well: “Coronavirus is the Ebola of the rich and requires a coordinated transnational effort. It is not particularly lethal, but it is very contagious. The more medicalized and centralized the society, the more widespread the virus. This catastrophe unfolding in wealthy Lombardy could happen anywhere.”
The text is eloquent enough and hardly needs further interviews and explanations to be fully understood. Its aim is “to help other regions and other countries in the world to avoid the humanitarian catastrophe in Bergamo,” Dr. Nacoti explained to il manifesto. “Our task now is to defend the scientific nature of that testimony.”
