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Dr. Martina Vignani is also among the twenty-four thousand who are suspended. “Many of us have made significant sacrifices and sacrifices and now we find ourselves in an absurd situation.” Who remembers them, the young doctors? They had become heroes in a country that then needed heroes. In the long night of March and April, they had filled the gaps in the health system for lack of staff. They had been hired as tracking operators, enrolled in the Continuity Units for Special Newborn Care, established by the decree of March 9, the one that closed Italy, to face the disaster of territorial medicine.
The opposite femur
With the first emergency, the gratitude of those who chose to help out also passed, leaving aside more important experiences for their training course. Then came question number 87, to keep them in limbo as they continue to invoke the need to enlist white coats. A perhaps wrong question in the admission test on September 22, with an X-ray that reproduced a right femur instead of the left, generated a shower of appeals to ART. The new doctors that according to Minister Roberto Speranza they should become the lynchpin of the vaccination campaign, they have been held hostage by the bureaucracy for more than four months, and they will only be released on January 12 when they finally start their activities. It happens almost every year, but this is not a year like any other. “After so many conversations about the need for new forces,” says Martina, 27, a Pisa graduate, “people are being called to leave retirement while young people are being cut off.”
The emergency
Even a little story like this, which was unlocked yesterday, helps to understand. We have faced the emergency, we have not managed the pandemic. To do this, the much-invoked Italian system was needed. Luciano Gattinoni, dean of Resuscitation in Italy, emeritus professor at the University of Milan, for years in Göttingen, Germany, affirms that we have lost one more opportunity. “We should have improved. To really do this, it would be necessary to change the healthcare organization, which does not work. It will take at least twenty years. But there were things that could be done immediately. Framing general practitioners who have just entered the national health service instead of continuing to maintain them as self-employed. Treat general medicine as a university medical specialty thus creating a single army with a general and a way of proceeding. But if you ever start, you never will. And in its tragic nature, this should and could have been the right time.
The differences
The illusion of having gotten out of it did not last long, but it was almost as contagious as Covid. Statistics in hand, the second wave is proving more dire than the first. Starting with the deaths. From February to May 31, the dead were 33,415. Today we surpass them, with 33,731. And sadly, they are increasing steadily. ISPI researcher Matteo Villa, who since its inception has specialized in very precise analysis of the pandemic in Italy, estimates that it will reach about 45,000. The infections are also getting worse. Today we are already at 3.9 million, given that the number of people actually infected is estimated, not only positive swabs, and we could reach 4.5 million. The first time it was 2.3 million. On April 4, we reached the figure of 29,010 ordinary hospitalizations, and it was the so-called peak. On November 23, we reached 34,697 people hospitalized at the same time.
Intensive terapie
Intensive terapie: The peak of April 3, 4,068 was reached on November 25 with 3,848 patients. Since then, we have fared better and better on this critical stat. But after three weeks in the first wave, the drop in ICU admissions was 48%. After three weeks in the second wave, it was only 26%. Still, it is not true that everything turned out in the worst possible way. The numbers also show that at the end of November, in a phase of exponential increase, contagion cases doubled every 7-8 days instead of the 2-3 days of last March. And compared to that period, when 1.2 of every 100 infected died, at the beginning of the second wave this figure was 0.8%.
The alarm not heard
“Italy is in an epidemiological phase of transition with a tendency to progressive deterioration. There is widespread transmission of the virus throughout the national territory, causing outbreaks even of considerable size. It was shortly before August 15. The control room of the Higher Institute of Health and the Ministry of Health wrote that things were going badly. In those days, the public debate went in another direction. Italy was open for holidays, some regional presidents gave the “curse” to those who warned against the risk of a second wave. It is useless to mention names. Most of us have fallen into this mirage. On October 13, the control room begins its report. “We are witnessing an acceleration of the epidemic that has now entered an acute phase, which runs the risk of reaching critical values in the next month“That day, the government’s prudent line prevailed over the” rigorists “by imposing no longer a ban but a” strong recommendation “to avoid group parties in the apartment.
The mistake
In March, Bergamo was the epicenter of our fears. Lombard, Nembro, lift the military trucks that removed the coffins from the cemetery. “Seeing those scenes, I thought that if the wave had reached Lazio, we would be ready. Instead, we find ourselves facing him without a proper training phase. Luciano Antonaci, a family doctor in Rome, recognizes that for him this is the true baptism of the virus. «My first positives in September called me to say: what should I do? He had no specific indications on treatments. We help each other doctors through talks, transforming the experience of some into solidarity for all. Remakes are always worse than the original, not just in the movies. Territorial medicine still lacks an address, a single address, as well as a network, which includes at least one available nurse or secretary. At the moment, they only exist in Veneto and Emilia-Romagna.
The unique protocol
On March 16, the Scientific Technical Committee said there was an “absolute” need for a unique protocol for home care of Covid posts. A first draft was published at the request of the Ministry of Health on November 16, when Italy had entered the second blockade for almost two weeks. But now general practitioners deal with spontaneous documents, drawn up by the most disparate sources. And after the first contact between doctor and patient, the care of the sick by the health authorities continues to jump. Can something be done in the short term? Riccardo Munda learned everything he knows by knocking on the doors of patients, on the long night in Val Seriana, as a temporary substitute for a general practitioner in Nembro. “They should have immediately increased the number of doctors by lowering the loan limit. So yes, we could have made a difference. Instead, the opposite happened. In September they raised the ceiling because the staff is not there.
Admission
In early October, we are the first in Europe to acknowledge that they have lost control of tracing, which means identifying a positive’s close contacts for quarantine. A fundamental step to contain the execution of the virus. In the week between 5 and 11 of that month, in one of every three cases it is not known who infected whom. Thus, the weekly monitoring report: «There is a sharp increase in the number of new cases outside of known transmission chains. This week the Regions reported 9,291 cases where no epidemiological link was found (4,041 the previous week), which includes 33% of all cases reported in the week. In the following days, Emilia-Romagna declares that she can carry out only 40% of epidemiological investigations, an interview with an infected person that allows us to understand who she came into contact with. Liguria, 44%. Lombardy 53%. Experts believe that tracking is possible with approximately 5,000 cases per day throughout Italy, 50 cases per week for every 100,000 inhabitants. In addition, it becomes a lottery. Contact tracing jumps as soon as the contagion curve increases. “Our system has limited capacity,” says Giovanni Di Perri, an infectious disease specialist at Amedeo di Savoia in Turin, a regional referral center for infectious diseases. The only way to preserve a critical defense weapon is to prevent infections from escalating. Here is the real point. “From June to October” concludes Di Perri “we behave like Sweden, which nevertheless has a population density ten times lower than ours. But the virus dictates the rules, not us. An obsessive preventive attitude was necessary. Instead, at a certain moment, with the consent of the institutions, he seized the desire for normality … ».
To delay
We had an advantage and we wasted it. In the end, the differences come down to this. The “stoplight” approach was enough to dramatically reduce infections in the red zones: in Calabria, Lombardy, Piedmont and Valle d’Aosta, new infections have dropped by 74% since the peak. In Lazio, Molise, Sardinia, Trento and Veneto, which have always remained in the yellow zone, new infections have been reduced on average by 24% from the peak. But the Dpcm that divides Italy in color only arrives on November 3 and comes into force on 6, when instead the infection curve is exponential since the beginning of October. Intensive care management also confirms a widespread underestimation. In October, as shown by the data from the Higher School of Economics and Health Systems Management of the Catholic University, there were 6,458 places available, 1,963 less than in April. During the first wave they were upgraded, from 5,179 to 8,421 beds at the time of maximum capacity. This level was not maintained during the summer. It was believed that beds could be instantly reactivated in a pinch. Before going back to last spring’s issue, we wait until December. Only today we have reached 8,651, in line with the increase forecast by the Ministry of Health. It took us more than sixty days to get back to where we were at the end of the first wave. We knew what we were going to run into, all the models and simulations pointed in the same direction. A whole summer to prepare. But the “Italy does not stop” phase lasted much longer.. It was then two weeks, from February 23 to March 9. This time, between the coming and going of the government and the Regions, tactics and pressures of all kinds, it took two months. The lesson from Alzano Lombardo and Nembro did not help.
December 22, 2020 (change December 22, 2020 | 07:36)
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