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«My daughter repeats to me” father, the confinement was a disaster, we could not bear it again. ” I answer that the disaster could be to see the row of coffins in the streets as it happened in Lombardy ».
At the desk of his clinic, on the ground floor of the ninth ward, once again transformed into a Covid room and already almost full, Spartaco Sani, head of Infectious Diseases at Spedali Riuniti, draws a ghostly image of what the future (also) of Livorno. : “If the confinement is not imposed, we will end up like Bergamo,” he said.
What worries you the most, doctor?
“I will answer you with some information: on March 2 there was the first positive patient in Livorno, on March 10 our ward was already full of patients, on March 9 the confinement had begun, on March 24 was the peak of the influx In the emergency room and from there the decline began.Here, today we are witnessing a similar, if not greater, turnout at the hospital, but we do not have the same perspective as then, because a total closure is not expected.
Is it a problem of hospital stiffness?
“The health system is under great pressure. The operators have returned to a vortex of great difficulty, they are highly rehearsed and the staff is not complete because it was almost impossible to find additional operators, especially doctors.
So if the numbers continue to rise, isn’t the quality of care guaranteed?
“The problem is precisely this: if there is an influx of many patients together, the quality of care worsens and mortality increases. You see, in the second week of August we began to see patients, even young people, with severe pneumonia again: the first cases reviewed in intensive care were Albanians who had returned from their country, or tourists who were returning from Madrid. One arrived a week and they handled themselves in the best way. But if we had 10 or 20 together, how would we have managed them with the same resources? The initial, terrible mortality also derived from the fact that in certain cities the hospitals were overwhelmed by so many cases in total.
You speak of closure, but the new decree has provided for a series of limitations and some Regions have already decided on a night curfew. Don’t you think that is enough?
“I believe that the measures that have been taken – which are very successful – have a high possibility of being insufficient and that soon the confinement will have to be done the same and in worse conditions, when the hospitals will no longer be able to withstand the ‘pothole’.
But a total shutdown like the one in March would create disastrous effects on the economy, in thousands of companies, without considering the psychological consequences for the population.
“I am aware of the enormous difficulties and problems, but I am convinced that, perhaps by safeguarding school and work activities, we must intervene drastically.”
The new decree also gave mayors the power to intervene: what should they do?
«Leaving the decision to the mayors leaves me perplexed: the problem is everywhere, it is national. In any case, the nightlife must be removed, you must put a curfew, but not at 11 at night, so it is useless, you have to do it much earlier. You have to avoid all the things that are not essential: you go to work and you go home. Otherwise, in a few weeks there will be a closure similar to that of March with uncontrollable figures and the damage will be worse than it would be now.
However, the differences with the first wave are considerable, starting with the number of deaths which is much lower.
“The death toll is increasing. However, it is true that there is less.
Why?
“We are also seeing relatively young people, around 50 years old, with severe pneumonia who need respiratory assistance: so far there has not been a single death among them, probably because we have improved the treatments and because of their age. It is a healthier population and reacts better to treatment.
Is mortality the same for people at risk?
“The diabetic, hypertensive or cardiopathic patient over seventy years of age who falls ill and ends up in intensive care is very likely not to succeed.”
How is the situation in the hospital now?
We have 56 hospitalized, of which 17 here in Infectious Diseases, the others in the 2nd ward and 6 in Intensive Care ”.
Under what conditions?
“Three are intubated and another three are on non-invasive ventilation but they are compromised, very serious situations.”
The influx seems greater for Covid departments than for Resuscitation: is it true?
“Many patients who are not seriously ill are being intercepted: they are people who have to stay in the Covid zone. More than for intensive care, the problem is for places of ordinary hospitalization.
So many prisoners are not so bad?
“There are also patients who could be at home, but those who feel unwell, who have even modest pneumonia and cannot be managed in the area, however, represent a serious problem that requires hospitalization.”
Is there a problem with territorial medicine?
“Let’s say that despite the commitment of the Usca (the special units of doctors dedicated to Covid, ed), the cases are so many that patient management at home and follow-up are now out of control, in Livorno, most of Tuscany and Italy.
How long is an average hospital stay?
“Every day we discharge someone, but it is difficult: those who have a Covid disease and need hospitalization stay here for at least three weeks.”
The result is that the number of beds decreases day by day, eliminating space for other sanitary activities.
“Covid is a tragedy for those who take it and also for those who do not suffer from it but have other diseases. For example, we have closed the infectious disease clinic. The truth is that Covid destroys hospitals.
We are also moving towards a halt to scheduled surgeries …
“In March, people got scared and stopped going to the emergency room, so the additional burden of Covid was significantly reduced and this allowed the conversion of resources from other departments to Covid areas. Now, this is not happening, in part because it is correct that people are treated, but by not having a load reduction, at this stage the load is not redistributed to the staff of all departments. Therefore, there is an additional management difficulty. And in the end, if the influx continues, there will be a need to reduce services: the Region does not want to do it, nobody wants to do it, but if we continue like this, I no longer see any other solution than to reduce part of the activities because we are capable of managing them. “
Where did you transfer infectious disease patients?
“The work of the ward actually ends here, our patients, who were not contagious, are now in Nephrology. From now on we will manage only the essentials.
The risk of hospital infections remains one of the most feared.
“I want to give a clear message: you must not come to the hospital. We should not come to visit relatives: I understand that it is dramatic, but if a positive person attacks a patient for Covid, pandemonium occurs. Hospital epidemics are born outside these walls, not inside, but once the virus turns around there is no going back ».
Why have some of your colleagues, even those of national fame, often spoken of an exaggerated alarm about Covid?
«I think that Crisanti and Galli express the situation in the most correct and intelligent way. Then there is the group of Bassettis and Zangrillos who have always had an attitude that has favored the ignorance of the problem. Someone should apologize: a message of reassurance has been launched, what people wanted to hear. It is not clear why. Among other things, arguing refutable things in the data, from when they assured that the virus died: it is not true, the virus is the same, and if at a certain moment the cases were reduced, it was precisely then that we had to insist. . As in China, zero contagion was to be expected. And instead everything went wrong, reopening cities and borders … ».
Does the announced arrival of the vaccine reassure you?
“Look, this virus wins in the territory from the epidemiological point of view, blocking and eliminating its transmission. It’s the only thing we can do, the only serious weapon we have. Even when the vaccine comes, if it works, we will have to block transmission. We are on a very dangerous hill, perhaps it is too late. I repeat: total blocking would be ideal. I do not want to scare, but the situation is dramatic. –
