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CARRARA – The Coronavirus has never disappeared. It has arrived and has changed the lives of everyone, all over the world. It took human lives, upset families, and destroyed certainties. He questioned the hierarchy of human rights, even doubting that the most important, the right to life, must be protected in every way and by any means, even sacrificing all the others. And all this, he did within a few months. Then, with the arrival of summer, he hid behind the scenes. But it never left. And in recent days, intense testing activity across Italy is detecting a further increase in infections. The numbers are increasing and many are scary. Fear of going back to the “end point”. But there are also those who, in all these months, have refused to acknowledge the tragic nature of what happened: skeptics, deniers, conspirators. The community that revolves around the Coronavirus is diverse. Certainly irrefutable, undeniable, however, is what happened in hospitals. Images that only tell one truth: that the virus is not an invention. We talked about all this with the resurrector of the Noa Claudio Falchi. He, like many other colleagues, lived through the tragic months of the health emergency on the front line.
Doctor, tell us what experience it was.
I have been doing this work for almost 35 years and have actually seen them “cooked and raw”, but I can guarantee that, in my experience, I have never witnessed such serious and numerous cases. Never. This can also be confirmed by my colleagues, who like me have seen many. At one point, I remember, we looked at each other and said: “If we continue like this, we will not withstand the impact.”
However, some continue to call it “trivial flu” …
To answer, it is enough to look at the numbers, which are irrefutable: they speak and describe a really serious situation. Then there is experience, which tells us that something abnormal has happened. Why pneumonia of this type, situations of respiratory failure so severe at the time of CT, are seen perhaps 10 or 15 times in the space of a year. And they are caused not only by infections, but also by trauma, drowning, poisoning. Instead, the Covid made it reach 20 to 25 per day. During the peak period, we almost reached the saturation limit of the machine. In this sense, I want to thank the marble manufacturers, who have given us lung ultrasounds and very expensive machines, and the general public for supplying various materials, including masks and overalls.
How did you care for these patients?
We have to make a distinction. Severe cases requiring respiratory assistance but not yet extremely aggressive treatment were led to subintensive care, while truly critical cases requiring intubation were led to intensive care. In the subintensive, where I work, we have implemented all the treatment methods, therefore ventilation with masks and by machines, but without intubation. The problem is that the patient often suffers from panic attacks. Think of diving suits, which give the impression of being inside an aquarium with a deafening noise. But all this has allowed many not to reach the intubation stage, where the patient is sedated but absolutely dependent on machines.
It has practically all the cutting edge techniques in place. And the drugs?
These were initially a problem. We did not have drugs to guarantee efficacy, we mainly followed the WHO indications. The use of calciparin, an anticoagulant, was also very effective. In fact, the disease was not a disease of the lung itself, but of the capillaries. In fact, we had cases of limb thrombosis and cerebral thrombosis precisely due to this state of hypercoagulation. At that time we used Calciparin in high doses, and this, although it was not the definitive solution to the problem, helped us a lot.
Is it true that the first autopsies that revealed the true nature of the disease, from which the use of anticoagulants began, were performed late?
I wouldn’t say they were late. The disease had a very strange growth curve. From what I understand, the first cases of “strange” pneumonia reached the various emergency rooms in Italy in December. They were initially classified as flu, but with more severe symptoms than usual. And this was not alarming to the point of leading to autopsies, which were nevertheless necessary at a later time, with the actual outbreak of the disease in late February.
Disease that has caused death after death in Italy. Speaking of which, do you confirm the thesis according to which Covid is fatal only for elderly people with serious previous pathologies?
Based on your experience I can say that yes, at that time the virus mainly affected the elderly and people with other diseases. So much so that the debate on the so-called “Deaths with covid” was born, those deaths whose declared cause was the virus but which were actually produced by other pathologies. This is true, they were mainly sick people, but for whom the virus contributed to further aggravate the clinical picture, anticipating the moment of death.
At one point, in the middle of an emergency, Noa was declared a “Covid Hospital”. What did this conversion entail?
First of all, I want to emphasize, because the local population must be aware of this, that our hospital has performed very well from an organizational point of view. It is a new, modular hospital that can be transformed according to needs and that, due to the emergency we were experiencing, has been closed for all routine activities, except non-postponable emergencies. Our resuscitation was exclusively for Covid patients and a subintensive ward was created on the upper floor. In addition, being a “Covid hospital”, what was not Covid and was not of extreme urgency was taken to other hospitals. All of this has caused a delay, which we are still trying to get rid of, of what has been routine activity. But I repeat, our hospital has proven to be really up to the task from a technical point of view.
Have you ever run into short staff?
That of the staff was undoubtedly a problem, because the Covid patient must be followed 24 hours a day and their assistance requires a huge commitment. We were fortunate to have many nurses, almost all young and recent graduates, who arrived with little or no experience, who, I must say, gave us a wonderful response. They were immediately activated trying to learn new methods and entering a completely new mentality, that of the critically ill. With all the physical and mental fatigue that such a situation entails. Our boys have been commendable, and this is another point in our hospital’s favor.
When did the tipping point arrive, with the decline in intensive care admissions?
Without a doubt with the confinement, the total. A drama from the economic and social point of view, but absolutely necessary. In fact, after 7-10 days, we immediately began to breathe, to experience the decline, noting a decrease in severe cases, until, over the weeks, almost zero.
In Massa-Carrara there were more serious cases and consequently more deaths than the Tuscan average. How do you explain it?
Lunigiana gave us a big hit, where the first outbreak broke out. There a musician, a few days after returning from Codogno, began to have a cough and fever and went to the emergency room in Pontremoli, where initially no one knew the story. When the swab tested positive, they even had to close the hospital to proceed with the sanitation. So at the beginning a large part of the patients came from the different municipalities of Lunigiana, and most of them were older people.
What is the situation in our province now?
Numerical data has its own meaning and tells us that the virus exists and has never disappeared. It is true that in summer it may have lost its virulence and become less aggressive. It is possible, because we certainly do not have the serious illness that we had in the spring. But what will happen when the cold returns, no one can know. In the last period we have started to have some critical cases that have been sent to the Lucca hospital, which the ASL has called for the moment “Covid hospital”. We have some “not serious” patients in Noa, but fortunately we still talk about some cases.
Is it possible that the virus has mutated in the last few months?
The virus had already mutated before, so much so that we are talking about an Asian strain and a European strain. And it will probably continue to mutate because, like all viruses, it is subject to the RNA mutations that it is made of. That said, we cannot know for sure what will happen. It may also be that during the winter the most virulent component reactivates. At the moment we cannot predict it.
What do you think of the Zangrillo-Crisanti clash? The first with his theory according to which “The coronavirus is clinically dead”, the second that demands extreme caution and intense tests, with 300-400 thousand swabs per day …
We anesthetists take Zangrillo’s statement with irony. His theory has come under fire and the scientific community has rightly not taken it well. I personally think he said it big. You have to be careful what they say, the population needs to realize what is happening. We are experiencing a pandemic: this word has an enormous meaning. Crisanti’s plan? It has its own logic: test everyone for a reliable number of positives. In the last period the number of tests has grown significantly, during the emergency this was not possible. Back then, the detected cases were just the tip of the iceberg: more swabs would reveal something different. Therefore Crisanti is right, the problem is that his plan requires enormous costs. Only Korea has done something similar, while the rest of Europe has yet to do so. In this sense, the government will have to make important decisions.
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