[ad_1]
As Italy prepares to emerge from the West’s first and most extensive coronavirus blockade, it is increasingly clear that something went terribly wrong in Lombardy, the worst hit region in Europe’s worst hit country.
Italy was unlucky enough to be the first western nation to be hit by the outbreak, and its official total of 26,600 deaths lags behind only the US. USA In the global death toll. Italy’s first homegrown case was recorded on February 21, at a time when the World Health Organization still insisted that the virus was “contagious” and not as infectious as the flu.
But there is also evidence that demographic and healthcare deficiencies collided with political and commercial interests to expose the 10 million people in Lombardy’s northern Italy region to COVID-19 in ways not seen anywhere else. , particularly the most vulnerable in nursing homes.
Virologists and epidemiologists say what went wrong will be studied for years, as the outbreak overwhelms a medical system long considered one of the best in Europe, while in the neighboring Veneto region, the impact was significantly more controlled.
Prosecutors, meanwhile, are deciding whether to charge the hundreds of deaths in nursing homes, many of which do not even figure in the official death toll of 13,325, half of Italy’s total in Lombardy.
By contrast, Lombardy’s frontline doctors and nurses are hailed as heroes for risking their lives to treat the sick under extraordinary levels of stress, exhaustion, isolation and fear. A WHO official said it was a “miracle” that they saved as many as they did.
Here’s a look at the perfect storm of what went wrong in Lombardy, based on interviews and reports with doctors, union representatives, mayors and virologists, as well as reports from the Italian Higher Institute of Health, the national statistics agency ISTAT and the Organization for Economic Cooperation. and Development, which advises developed economies on policies.
Caught without preparation
Italy was the first European country to stop all air traffic with China on January 31, and even put scanners at airports to verify the arrival of fever. But by January 31, it was too late. Epidemiologists now say the virus had been circulating widely in Lombardy since early January, if not earlier.
Full coverage: virus outbreak
Doctors treating pneumonia in January and February did not know what the coronavirus was, as the symptoms were very similar and the virus was still believed to be largely confined to China. Even after Italy recorded their case on February 21, doctors did not understand the unusual way COVID-19 could present itself, and some patients experienced a rapid decrease in their ability to breathe.
“After a stabilization phase, many quickly deteriorated. This was clinical information that we did not have, “said Dr. Maurizio Marvisi, a pulmonologist at a private clinic in Cremona.” There was virtually nothing in the medical literature. “
Because Lombardy intensive care units were already filling up just days after the first cases in Italy, many primary care physicians attempted to treat and monitor patients at home. Some put them in supplemental oxygen, commonly used for home cases in Italy.
That strategy proved deadly, and many died at home or soon after hospitalization, after waiting too long to call an ambulance.
Dependence on home care “will probably be the determining factor why we have such a high death rate in Italy,” said Marivi.
Italy was forced to use home care in part because of its low ICU capacity: after years of budget cuts, Italy entered the crisis with 8.6 ICU beds per 100,000 people, well below the median OECD of 15.9 and a fraction of Germany’s 33.9, the group said.
As a result, primary care physicians became the frontline filter for virus patients, an army of mostly self-employed professionals working within the public health system but outside of Italy’s regional hospital network.
Since only those with strong symptoms were being evaluated because the Lombardy laboratories could not process any more, these family doctors did not know if they themselves were infected, let alone their patients.
With so little clinical information available, doctors also had no guidelines on when to admit patients or refer them to specialists. And being outside the hospital system, they did not have the same access to masks and protective equipment.
“The region was far behind in providing us with protective equipment and was inadequate, because the first time, they gave us 10 masks and surgical gloves,” said Dr. Laura Turetta in the city of Varese. “Obviously, because of our close contact with patients, it was not the right way to protect ourselves.”
The Lombardy medical association issued a blistering letter on April 7 to regional authorities listing seven “mistakes” in handling the crisis, including the lack of evidence for medical personnel, the lack of protective equipment and the lack of data on contagion. .
The regional government rejected the criticism and defended its efforts. But the civil protection agency also recognized that Italy relied on imports and donations of protective equipment and simply did not have enough for everyone.
Some 20,000 Italian doctors have been infected and 150 doctors have died.
LOST WEEKS
Two days after registering the first case in Italy in the province of Lodi in Lombardy, which caused a quarantine in 10 cities, another positive case was registered more than an hour by car in Alzano, in the province of Bergamo. While the emergency room at the Lodi area hospital was closed, the Alzano emergency room reopened after a few hours of cleaning, becoming a major source of contagion.
Internal documents cited by Italian newspapers indicate that the handful of severe cases of pneumonia that the Alzano hospital saw on February 12 were likely COVID-19. At that time, the Italian Ministry of Health recommended tests only for patients who had been in China or had been in contact with a suspected or confirmed positive case.
By March 2, the Higher Institute of Health recommended that Alzano and Nembro be closed as the cities of Lodi had been. But political authorities never implemented the quarantine recommendation there, allowing the infection to spread for a second week until the entire Lombardy region was blocked on March 7.
“The army was there, prepared to do a total closure, and if it had been done immediately, perhaps they could have stopped the contagion in the rest of Lombardy,” said Dr. Guido Marinoni, head of the association of doctors in the Bergamo province. “This was not done, and they took softer measures across Lombardy, and this allowed the spread.”
When asked why Bergamo did not close earlier, Prime Minister Giuseppe Conte argued that the regional government could have done it alone. Lombardy Governor Attilio Fontana replied that any mistake “was made by both of them. I don’t think there is any fault in this situation.”
Lombardy has a sixth of Italy’s 60 million inhabitants and is the most densely populated region, home to the commercial capital of Milan and the industrial heart of the country. Lombardy also has more people over the age of 65 than any other Italian region, as well as 20% of Italy’s nursing homes, a population demographic pump for COVID-19 infections.
“Clearly, with the benefit of hindsight, we should have made a complete closure in Lombardy, everyone at home and no one is moving,” said Andrea Crisanti, a microbiologist and virologist who advises the Veneto regional government. But he acknowledged how difficult it was, given Lombardy’s outsized role in the Italian economy, that even before the pandemic it was heading for a recession.
“Probably for political reasons, it was not done,” he told reporters.
INDUSTRIAL LOBBY
Unions and mayors in some of Lombardy’s most affected cities now say the country’s main industrial lobby group Confindustria exerted enormous pressure to resist blockades and production stops because the economic cost would be too great in one region. responsible for 21% of Italy’s GDP.
On February 28, a week after the outbreak and long after more than 100 cases were reported in Bergamo, the Confindustria province branch launched an English social media campaign, #Bergamoisrunning, to reassure customers. He insisted that the outbreak was no worse than elsewhere, that the “misleading feeling” of its large number of infections was due to aggressive testing, and that production in mills and other industries was unaffected.
Confindustria launched its own campaign in Lombardy’s largest region, echoing that message, #Yeswework. The Mayor of Milan proclaimed that “Milan does not stop”.
At the time, the head of Confindustria Lombardia, Marco Bonometti, acknowledged the necessary “drastic measures” in Lodi, but tried to reduce the feeling of alarm.
“We have to let people know that they can return to life as they were, while safeguarding their health,” he said.
Even after the Rome-based national government closed all of Lombardy on March 7, it allowed the factories to remain open, sparking strikes by workers worried that their health would be sacrificed to keep Italy’s industrial engine running.
“It was a big mistake. They should have taken the example where the first group was found, “said Giambattista Morali of the metalworkers union in the city of Dalmine in Bergamo.” Keeping the factories open did not help the situation; obviously made it worse. “
Finally, production, except the essential one, was closed throughout the country on March 26. The national president of Confindustria, Carlo Bonomi, has urged that the industry be reopened, but safely.
“The paradigm has changed,” Bonomi told RAI state television. “We cannot assure the Italians if we do not reopen factories.” But how do we make factories safe to protect Italians?
It is a difficult sale, as Lombardy continues to add an average of 950 infections a day, while other regions total between a few dozen and 500 each, with the majority of new cases registered in nursing homes. Italy will begin a gradual reopening on May 4, leading with regions further south where the outbreak is more under control.
Lombardy will likely be the last to fully open, with its 73,000 confirmed cases, 70% of Italy’s total, and estimates that the actual number could be 10 times higher.
AN EXPENSIVE FIELD HOSPITAL
Perhaps no initiative better illustrates Italy’s confusing coronavirus response than the 200-bed field hospital built in less than two weeks on the grounds of the Milan convention center.
The hospital was presented with great fanfare on March 31, the result of a € 21 million ($ 23 million) fundraising campaign led by the Lombardy governor, a member of the right-wing League party, to try to relieve pressure on regional ICUs, which at that time was close to capacity in 1,324 patients.
The national civil protection agency opposed the plan, arguing that it could never equip it with fans or staff in time. Instead, the agency, which reports to the rival government of 5-star Democrats in Rome, preferred smaller field units established outside of hospitals and a program to move critically ill patients elsewhere.
In the end, the Milan field hospital was barely used, treating only a few dozen patients. Since its opening, Lombardy has seen the pressure on its ICUs drop considerably, with just 700 people needing intensive care today.
Fontana, the governor, defended the decision and said he would do it again, and told Radio 24: “We had to … prepare a dam in case the epidemic beat the embankment.”
NURSING HOME “MASACRE”
While the regional government focused on building the field hospital and finding ICU beds, its testing capacity was delayed and Lombardy nursing homes had to fend for themselves in many ways.
Hundreds of elderly people have died in Lombardy and across Italy in what a WHO official has called a “massacre” of those most vulnerable to the virus. Prosecutors are investigating dozens of nursing homes, as well as steps taken by local health authorities and regional governments that may have made the problem worse.
Lombardy has more nursing homes than any other region, is home to at least 24,000 older people, and also recorded more deaths in those facilities than in others. Of the 3,045 deaths from February 1 to April 15 in the region, 1,625 tested positive for the virus or showed its symptoms, according to preliminary results of a survey conducted by the Superior Institute of Health.
Of particular attention to prosecutors was the March 8 regional government’s decision to allow recovered COVID-19 patients to be admitted to nursing homes to free hospital beds. The region says it required houses to guarantee that patients would be isolated, but it’s unclear who was responsible for ensuring that or if anyone did.
Even before that, staff at some homes said management prevented them from wearing masks for fear of scaring residents.
A regional decree of March 30, again intended to ease the pressure on Lombardy ICUs, told nursing home managers not to hospitalize sick residents over the age of 75 if they had other health problems. The decree said it was “timely to treat them in the same facility to avoid increased risks of decreased transportation or while waiting in the emergency room.”
For the elderly in a nursing home in Nembro, one of the most affected cities in the province of Bergamo, the decree amounted to a death sentence. But it was not the first or the only one that gave the managers of the house the feeling that they were being abandoned.
When the administration proactively banned visitors on February 24 to try to protect residents and staff from infection, local health authorities responded by threatening sanctions and a loss of accreditation for cutting off family visits, the new director said. of the installation, Valerio Poloni.
In the end, 37 of the 87 residents died in February and March. His doctor, as well as Poloni’s predecessor as director, also tested positive, were hospitalized, and died. A nursing home resident was unable to enter the hospital in late February because the emergency room was too full.
The center’s health director, Barbara Codalli, said she was told to use her existing resources to treat the sick. “The patient returned a few hours later, and a few days later he died,” La7 told television.
To date, none of the surviving residents has been evaluated. Poloni said tests are expected to begin in a few days. Two other residents have died so far in April, but the situation appears to be under control.
“We are calm,” he said.
