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But if people don’t understand that the problem exists, as long as we still have gods deniers in this issue, Sara a disaster”.
These are the words of Dr. Claudio De Michelis, director of the Pneumology Service of the Hospital Imperia, on the front line since last March in the fight against Coronavirus
De Michelis told ImperiaPost how he lived, from a medical and personal point of view, the emergency from the first moments of last spring, when the disease surprised the whole world, until today, in the middle of Second wave.
Covid, Imperia: face to face with Claudio De Michelis, head of Pulmonology
Can you tell us, from your point of view, every day on the front line, the emergency of Covid? What is the current situation in the middle of this second epidemic? What are the differences compared to the first wave?
“The situation at the moment has some similarities and some differences with the first wave. The first wave we face a disease that we did not know, with a number of influx very high. To who First aid from Imperia They came dozens of patients a day to help us with our lack of knowledge of the disease, therefore, with great difficulty understanding what to do better. This was our first impact with the disease.
In the first phase we managed to have information from the experience of our Chinese colleagues, in the second half of March, and then we started treat them in a more precise way from a pharmacological point of view. Today we are with him second wave that started here on August 15. The first critical patient after the first spring wave arrived in August, then gradually the numbers have increased. However, we did not have, at the same time, the influx of patients that we had the first time and this, along with the fact that we know how to treat them a little betterand clinical management, medications, mechanical ventilation, allows us to manage better.
What is that different, Today is number of young patients we are seeing. We had a 26-year-old girl as the youngest patient, but overall we have a lot of patientsI am between 40 and 50 years old, in good health, come with severe pneumonia.
In the first wave we had many older people, because we had the most breakoutsor they are found in nursing homes and in our towns in the Valle del Impero. Clearly, dozens of elders were arriving at the same time. Today there are also Old people, because they are patient a risk, however, partly because they are more controlled, partly because we are more careful, a lot of work has been done in the nursing homes for the second wave of summer. We have fewer older people in proportion to the number of young people who have arrived. The lungs when they arrive are as bad as the first wave. We handle them better, as is our capacity, but they are very important pneumonia ”.
How many are hospitalized?
“In this last week we arethe 13 patients hospitalized between ordinary hospitalization and semi-intensive therapy we have between Imperia me San Remo, me 14 patients in intensive therapy, intubati. The number of 130 hospitalizations is stable, because more or less we managed to rule out ea contain growth in numbers.
Important work was done on the territory in the summer, especially with regard to protocols home management of the disease. Still, they are reducing the influx of emergency rooms. This, along with the download speed, allows us to sustain acceptable numbers, so much so that we have also received gods Genoa patients, already discharged and sent home. “
From a personal point of view, what were the most difficult moments to face?
“We have seen so many difficult times, doctors, nurses and physical therapists. We have not seen such a thing in the history of medicine. Modern medicine has never seen such an epidemic, with these numbers and suddenly. What is striking is that searchpatients arrive and are left alone. You imagine people higher, but also Young people, that at some point they are bad and the the family no longer see them. The only contact they have with people is with i sanitary who cures them. You have seen these scenes on television. We are hooked from head to toe, so they only see the eyes of those who are caring for them. Emotionally it is also a very difficult situation.
When we have to intubate a patient, it’s about patients awake, fully. A patient who has a very severe expiatory insufficiency is usually in a coma, so when he is intubated he sleeps. Here instead you come from I wake up patients and tell them ‘look, I have to intubate you because things are going wrong’. Then our companions arrive anesthetists and lose them in charge. But these patients are awake and they know that we are sleeping them, but they don’t know if they will wake up. Humanly it is very complex.
We had to incubate with a 26-year-old girl in her seventh month of pregnancy. I can assure you that It’s not nice. And then when things don’t go well die alone, without family. This is truly a devastating experience.
Then there are things too funny, I could tell one. A young patient, less than 50 years old, had been intubated, had undergone a tracheostomy by our colleagues from the San Remo resuscitation department. A very complex path. He had not seen the family for at least three weeks.. We take it to initiate independence from fans.. The first time the physiotherapist managed to make the call with WhatsApp to the family, I will not tell you the expression, the screams, of the family. of the children, when they heard his voice. One of the children was speechless and all he managed to say was ‘Daddy Daddy, you will have 50 WhatsApp messages to see’!!! ‘. Fortunately, there are also these moments. But the difficult moments were really many ”.
There is talk of a peak of the second wave in 10 days, but also of a risk of collapse of hospitals in two weeks. How do you see the future?
“It is very difficult to give an answer that can be truthful to such a question. There are too many unknowns.
It is clear that the difficulty of these moments is that of being able on the one hand, to reconcile health needs with the needs of the economic system. The two cannot be separated.
The difficulty of those who have to make decisions is precisely this, how much can I pay in good health to save the economy and vice versa, how much do I have to sacrifice economically to save my health.
From a medical point of view, The fewer contacts there are around, the less the infection is transferred from one person to another, the fewer hospitalizations we will have.
Hospitals are starting to have quite a few problems. Here we still manage for the management work that has been done between the territory and the hospital.
We are making a tremendous effort because lack of staff everywhere. For the moment we can.
There are other realities that have been overwhelmed by numbers, such as Lombardy, the Campania. The numbers are the problem, when too many patients come in, the system can’t handle them.
I can’t tell you what the next 15 days will be. If people have a prudent behavior, that everyone respects what the rules are, the mask, hand washing, social distancing, probably the sum of the virtuous behaviors of the individuals can bring results.
But if people don’t understand that the problem exists, as long as we continue to deny this issue, it will be a disaster.
It is very important that the media make it clear thatand nobody here is kidding. Children who get the infection outside and are asymptomatic cannot deny and say that nothing is wrong, Pbecause then they go home, Mom and dad, grandfather and grandmother contract the disease and arrive hospitalized in critical situations.
It is a matter of system responsibility.
How things will go, I don’t know. I hope they can improve, but we are still in a situation too fragile from an epidemiological point of view.
We absolutely must not lower our guard. Let each one do his thing. “
Will it be the decisive vaccine?
“Vaccines in the history of modern medicine have always been crucial. If we no longer see certain diseases, it is thanks to vaccines, such as Polio, the Diphtheria etcc. We could list a large number of diseases. the Smallpox disappeared from the face of the earth.
Vaccines are crucial. The problem is that we should not think that as a vaccine is going to be marketed, two days later we have solved the problem.
First of all you have to understand effectiveness of the vaccine, now I’m in experimentation and they have short-term results.
It will be necessary to see the effectiveness of vaccines over time, that will surely work. Before the world gets vaccinated, what all populations receive the vaccine, it will be a long time.
Meanwhile, the virus will keep running and creating problems. IHowever, the vaccine should be the same for everyone.the. We cannot think of vaccinating only the rich and leaving others behind ”.
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