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Having reached, after ten months, the extreme pace of the pandemic, having done, as would be desirable, treasure the experience on the mistakes made so far, where a Covid patient would have the right to die, to be sure that health public has. Everything that was possible and yet not enough to save his life? The reader will agree that the most obvious answer to this question is: in an intensive care unit. But how many people die in the ICU?
Among the babel of partial and contradictory figures that the Civil Protection dispenses every day in its bulletin, this data is not there. However, it can be obtained with a logical exercise. On December 11, 649 people died from Covid. On the same day, the number of hospitalized patients with positive viruses in intensive care decreased from 3,265 to 3,199, with a negative balance of 66 units, despite 195 new admissions. It means that if 195 patients have entered, 195 plus 66 have left: the sum makes 261 patients who have left the beds reserved for resuscitation. This figure includes both the dead and those who have returned to ordinary rooms because their conditions have improved.
To estimate the victims, we can refer to two studies, carried out in Lombardy and Scotland, which identify the mortality of Covid in intensive care, reaching the same conclusions: in a first phase it is very differentiated from one department to another, depending on the quality of the assistance offered, confirming that a ventilator is not enough to perform a good resuscitation. But then, in a settlement phase, mortality fluctuates between 25 and 40 percent. The studies I am talking about date from last summer, today in the most equipped intensive care units the percentage of deaths does not exceed 10 percent. But let’s also consider an average attested to the lower part of the range and suppose that 25 percent, that is, one in four of the patients admitted to intensive care for Covid, cannot be saved. One in four of 261 is around 65. Presumably, many are ill who died on December 11 in intensive care for Covid. And all the others?
The Civil Protection bulletin records 649 deaths. Subtracting the 65 considered here, 584 remain, 90 percent. 90 percent of deaths from Covid do not die intubated in intensive care. It will be said that the death data cannot overlap with that of the revive inputs, because it is temporarily out of date. However, these are stable data, as certified by the balance of ten days, that is, from December 2 to 11: 1,902 new admitted to resuscitation, 417 fewer hospitalized, therefore 2,319 patients who left the ward. 25 percent of this figure, which is the presumed number of deaths from Covid in intensive care, makes 580, just under 9 percent of the total of 6,545 victims registered by Civil Protection in the same period.
As sensational as they are, these data should come as no surprise to those who have studied the pandemic in Italy since its inception. Because the analytical balance of deaths in Lombardy reaches the same conclusions, published on November 24 by the newspaper “La Verità” and ignored by the rest of the national press: that report said that until November 17, deaths in care intensive were only 9.7 percent of the total. More than half, 50.4%, came from ordinary wards, 14.7% from nursing homes and 25.2% from private homes. In Lombardy, one in four people died at home, and this percentage tells all their health tragedy compared to the data from Veneto, where only one in 22 did not have time to get to the hospital and died within their own walls. .
The comparison between this report and our data shows that nothing has changed under the skies of the Italian pandemic. 90 percent of Covid victims in Italy do not die where, in large part at least, they would have a better chance of fighting to the end to save themselves. Not on March 9, the starting date of the first blockade. Not April 3, the date of the peak of admissions (4,068) in intensive care during the first wave. Not on October 12, when we also began to understand that the virus is making a comeback. But on December 11, almost ten months after the outbreak of this tragedy, I would hope I had learned something. And that has changed more than anything in the way he handles it. Only one in ten victims in Italy continues to receive the most effective lifesaving therapies until the very end. Why?
The first reason for the incongruity denounced here is universal. It could be defined as the “tare” of Covid. Many patients die in ordinary wards, such as trauma, gastroenterologist, neurology, cardiology, because they do not have respiratory disorders, despite being positive for the virus. They die from a comorbidity due to diabetes, hypertension, obesity, Parkinson’s, bone fractures and other diseases for which Covid acts at most as a trigger for complications. These are people linked to life by a very fine thread of wool, which breaks by chance, but not always because of the virus. However, the positivity of the swab includes these deaths in the calculation of the pandemic, by express indication of the technical scientific committee.
This choice is not irrelevant. If Covid makes visible and makes visible the social drama of chronic diseases of old age, the health bureaucracy ends up using the infection as a screen to hide them. The effect of an overestimation of Covid is to neglect everything else when it comes to treatment. But also that of perpetrating an emergency that, from health, becomes social and economic, bringing with it poor health as a result of growing poverty. “The science that drives governments treats the coronavirus like a centuries-old plague,” Richard Horton denounced in the Lancet columns. In fact, according to the honorary professor at the London School of Hygiene and Tropical Medicine, we are not at the origin of a plague, not even a pandemic in the classical sense. Rather, Covid is a syndemic, according to the paradigm of the American doctor and anthropologist Merril Singer: that is, a synergy between different pathologies and unequal and disadvantaged health and social conditions.
These conditions are often invoked as extenuating circumstances to justify the sad double history of fatality (number of victims relative to tampons) and mortality (number of victims compared to population) that Italy has in Europe. We are older and have more ailments than others, that is why Covid makes more victims among us: this litany is heard recited in all spaces of public debate by virologists and opinion leaders on demand. But it is just an urban legend, however it is not supported by reliable data. A report from the surveillance group created by the Ministry of Health tells us that the median age of deaths from positive swabs is 82 years, but there are no reliable comparisons with other countries. It is true that Italy boasts, compared to the rest of Europe, both the primacy of aging from below, due to the decline in the young, and from above, due to the increase in the elderly. Since 1980 it has experienced a unique and significant increase in survival and at the same time very low fertility, with the effect of becoming, along with Japan, the oldest country. But if this primacy is due, among other things, to better nutrition, it is not clear how a healthier condition, which makes us live longer, must at the same time be a factor of fragility in the face of the threat of the virus. .
The reality is different: the record of deaths is related to that rate of deaths in intensive care nailed to 10 percent since the start of the pandemic. His film stars a patient hospitalized in an ordinary ward who, in 48 hours, goes from a stable condition to severe respiratory failure. There is a white coat working around his bed, hoping to find a free place in intensive care. Sometimes the patient cannot get there. Or because there is no place or, rather, because there are no staff. If you are hypertensive, obese, diabetic or cardiopathic, the 48 hours become 24, or rather 12. Either you fly or you die.
There is a condition of territorial unrest that in March led the health system to hit its face against the virus, and which remained intact until Christmas. Ventilators have arrived, but three thousand rescuers are missing for the implementation of intensive care to be effective and stable. The bed occupancy rate for Covid patients is slightly below the 40 percent threshold, taken as one of the three-color geographic indicators of the virus. The risk is that the health bureaucracy in charge of the hospitals instinctively raises the severity threshold, necessary to access intensive care, so as not to exceed that 40 percent and retain or win the yellow zone license. The price of this formal adaptation of the system would be a substantial drop in the therapeutic response to the disease. That this has already happened in some part of Italy is currently an inference, which nevertheless deserves verification.
It is true that very elderly patients are not admitted to resuscitation because they are too frail to withstand mechanical ventilation. Hospitalized elderly people die because they are destabilized. The psychic imbalance prevents them from resisting the therapies, the deficit of conscience cancels any capacity of reaction and quickly affects the clinical picture. For this they must be treated at home. As in Germany, Great Britain and most European countries, with a primary care taxi equipped with a ventilator, resuscitator and nurse, who attend to the patient at home and then follow him throughout the course of the disease.
In Italy, primary care was a project that was never born in March, it is a commitment that the government made in May, which failed in December. The special units for continuity of care, which must guarantee the service, have only been present for a few months in some regions, but they have neither the number nor the means to care for the sick in their homes. As for general practitioners, for a minority who bravely launched into the fight against the virus, sometimes losing their skin, there is an overwhelming majority still on the run from patients, even denying themselves over the phone. The refusal to carry out a voluntary swab fully explains this business reluctance. All the more unacceptable if one takes into account that, for this service, the government has offered the white coats 18 euros for each fee. As if it were not a service that is part of the responsibility linked to the exercise of the profession.
Events like this show that in ten months the Italian sanitary machine has not changed one of its shortcomings or its rigidities. The Minister of Health has become the Minister of Confinement, under the illusion that the profession of rigor replaces the ability to manage, waiting for the vaccine to arrive. The side effects of this defensive strategy are largely underestimated. But the delay in the treatment of other diseases and the economic impoverishment of society will soon lead to a system perched in trenches. The vaccine will arrive. And, as is desirable, it will annihilate the virus, but no protection and no balm will lead to public health, brought to its knees by Covid and the fight against Covid alike. The risk is recovering from the plague and dying from everything else.
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