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Liguria. We are in the second wave of Covid-19 and while the number of infected is decreasing, the dead show no signs of decline, rather they are increasing. Controversy over access to treatment has erupted in some Milanese hospitals and a group of doctors and nurses have complained of having reached the point of having to choose who to treat. We posed these and other questions to Matteo Bassetti, director of the Infectious Diseases Clinic of the San Martino Hospital in Genoa. A comprehensive interview on the current Covid situation and the lessons to be learned from this epidemic.
Italy has a sad world record: it ranks first in number of daily deaths. How do you explain it?
“It is linked to two orders of factors. On the one hand, probably because we are an old country: there are many people who, also thanks to health care that works well, go very far over the years and when an infection hits the elderly so hard it is clear that there are more deaths. The second reason is that we carry a rather important original sin in our stomach: in March and April all those who had a positive tampon and who perhaps had not been killed directly by the covid, but perhaps by something else, were classified as dead. COVID-19. It is evident that there is a difference in the classification of deaths at the European level, if we have a lethality that is almost three times higher. Either we or they count wrong. I do not think that our health service – which in my opinion works well – can say that it has three times the mortality rate compared to other countries that have health systems similar to ours. So one thing is lethality, which is the total number of deaths compared to the number of infected, another is mortality. In March and April it is evident that there was, especially in some areas of Italy, but we will have to wait until the end of the year and see what the Italian mortality will be in 2020, comparing it at the national level with that of the previous five years, and see what the excess mortality will have been at the end of the year. Once we have these data, we can say what the reasons for mortality are. On the one hand, it is certainly for Covid, but are we sure that we have not had a mortality because for three months we have completely forgotten about all the other diseases that we no longer deal with?
At the San Carlo and San Paolo hospitals in Milan, doctors recently reported that they were in such an emergency that they had to choose access to treatment and who to save. What is the current situation in San Martino? Have you ever had to choose who to treat first?
“This has never happened to me. I Not for a moment have I had the problem of saying who to save or who not to save because in Liguria we have had beds for everyone. It is evident that when we swear before Hippocrates we also swear not to do these things. Then there is the therapeutic persistence: it is clear that a ninety-year-old man has a tube down his throat, I will not put it on him, otherwise he dies after an hour. It is part of our being doctors, some things are done in some patients, others are not done in others. But it is not that they are not done because there is no place for the sick ”.
There is much talk of food supplements, lactoferrin and vitamin D that would boost the immune system, advising them as prevention of covid. What you think?
“Lactoferrin is a food supplement and to date we do not have enough data to be able to say whether it works or not, we cannot say with certainty that it works or that it does not work. We are in the anecdotal. There are no randomized studies ”.
It has an optimistic approach, intended not to scare and reassure Italians.
“I have an approach that is not optimistic but realistic, it is a different thing. A realist looks at the numbers, sees how things are going, and communicates them. In May and June I said some things because I saw that my patients died less, they were better, they went home faster. In October I was not ashamed to say that my predictions were wrong and that we had a second wave. I’m not a fortune teller, I’m a doctor. In Italy, however, they like to conspire in only one way. I I’ve only seen conspiracy studies on what Bassetti said, but not on the nonsense my colleagues said.. Those who said there would be 151,000 admissions to the ICU, those who said it would be the second round like the Spanish with 50 million deaths, those who said we should not have voted. These things, however, are immediately forgotten, what Bassetti says is set in stone. But it’s part of the game I know that I’m uncomfortable, I have not aligned with the mainstream, it is normal for them to attack me, it no longer warms me or cools me ”.
Following the example of the title of your book “A lesson not to be forgotten”, what lesson that you will not forget has Covid taught you?
“That of not being surprised and that of communicating more between different health systems. It can no longer happen that the infection is born in a country that lies to us about numbers and about what and when it happened. I will not forget the effort that we have made and that united us, I speak as a doctor: working in a group has united us a lot, even with the other specialties, we have united and that is why there are some lessons and teachings that we will not forget. Covid has not left us only bad things: unfortunately we will surely remember the coffins of Bergamo, the elderly who suffer locked in a RSA for eight months, but we must also remember the good, the reaction capacity of our country, at the service of the workers Of the health. We work uninterruptedly for three months without night or rest on Saturdays and Sundays. Another lesson that we should have learned is that in 2020 we cannot not have a pandemic plan, which we did not have, we cannot not have a health and territorial organization and be without protocols. The lessons of the first wave are all in the book that I wrote with Martina, a book that we finished at the end of July and by reading it you can see that everything that happened is written and the things that happened are written in the book. Letter sings! “
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