Coronavirus in Italy | It is a tension never seen before in peacetime: the drama of the Doctors who care for patients with covid-19 in the European country


Every day, hundreds of patients affected by the covid-19 coronavirus flood Italy's hospitals. Hundreds of doctors & professionals face endless hours and resource constraints every day, while exposing themselves to contagion at the main focus of the pandemic in Europe.
The work of doctors in Italy has become increasingly difficult.

Every day, hundreds of patients affected by the covid-19 coronavirus flood Italy's hospitals.

The collapse of the health system in this country has been one of the main problems in dealing with a pandemic that has caused thousands of deaths worldwide.
And the case of Italy has been dramatic: over 35 700 infected until this 18th of March, the total death toll neared 3,000 after living his worst day with 475 deaths.
Italy the country with the highest number of deaths after China, which registered 3,241 as of Wednesday.
Among all this chaos, there are those who have had to lead an especially difficult task: the doctors.
They are the ones who have faced the pressure to save lives every day in a country that has been overcome by the emergency.
How do specialists who are on the front line of fighting the coronavirus in Italy live through this health crisis?
Collapse of health services in Italy
The rapid and exponential growth of infections in Italy exposed the fragility of the European country's health system.
The 5,200 intensive care beds that exist in this country were quickly exceeded, since many of them were already occupied by patients with respiratory problems (which increase in the winter months).

Citizens in various hospitals in Italy have posted messages of appreciation for doctors.

The situation is even worse in the regions most affected by the coronavirus -Lombardy and Veneto-, where they have only 1,800 beds, adding public and private institutions.  Furthermore, the shortage of mechanical ventilators, masks and key clothing to combat the covid-19 has caused Italy to have to request international aid.
Citizens in various hospitals in Italy have posted messages of appreciation for doctors.
The situation is even worse in the regions most affected by the coronavirus -Lombardy and Veneto-, where they have only 1,800 beds, adding public and private institutions.
Furthermore, the shortage of mechanical ventilators, masks and key clothing to combat the covid-19 has caused Italy to have to request international aid.

All of the above has made the work of doctors increasingly difficult, having to make risky decisions under high levels of stress and during long hours of work.
"The situation of doctors in Italy is really dramatic," Filippo Anelli, president of the Italian National Federation of Medical Orders (FNOMCeO), tells BBC.
Anelli explains that this is due, in part, to the lack of individual protection devices (IPD), such as adequate clothing, to treat the sick.
"General practitioners, who work in the hospital for shifts of 12 hours or more, don't have IPD. So, if they get sick, they become superpropagators. That is, they can spread the infection among their patients," he explains.
On the other hand, the president of the FNOMCeO affirms that "the exhaustion of the doctors" is also a problem.
"Let's go to scenarios that are typical of disaster medicine".
"Doctors are stressed by overwork and also by the unexpected loss of colleagues, relatives, friends and patients," he says.
In this way, Anelli recognizes that the covid-19 has triggered one of the greatest crises in the Italian national health service in its history.
"The coronavirus revealed the gaps and critical problems in the management of health systems in recent years," he explains.
"Overwhelmed by a tsunami"
Last week, the testimony of a doctor from the city of Bergamo, named Daniele Macchini, went viral on social media.
Through his Twitter account, the doctor assured that his team from the Intensive Care Unit (ICU) has been "overwhelmed by the tsunami" and that certain elements, such as ventilators, have become extremely valuable: " like gold”.
"The cases are multiplying, [we have] 15-20 admissions per day, all for the same reason (...). Suddenly, the emergency room is collapsing," he wrote.

Medical resources are scarce in Italy in the face of the coronavirus crisis.
several doctors and nurses have assured that they live a tension never seen before in times of peace
Medical resources are scarce in Italy in the face of the coronavirus crisis.
"Some of our colleagues who are infected have also spread it to relatives, and some of their relatives are already between life and death," he added.
Given this, several doctors and nurses have assured that they live "a tension never seen before in times of peace."
Some have even pointed out that it is comparable to what could be experienced in a war.
In this regard, Anelli observes: " We are going to scenarios that are typical of disaster medicine."
And this has begun to be confirmed by the doctors themselves who are in the "red zones" of Italy.

In an interview with the BBC, Dr. Stefano Magnone, who works at a hospital in Lombardy, said: "The situation is getting worse day by day because we are reaching our maximum capacity."
"In our province we have been completely without resources, both human and technological," he added.
"Difficult and painful decisions"
Italy has the second population with the older adults in the world after Japan, according to the United Nations (UN).
This means that there is a significant segment of the population that is particularly at risk of becoming seriously ill if they contract the virus.
Doctors are stressed by overwork and the loss of patients, colleagues, and family members due to the coronavirus.
"Here we have a very old population; many patients need sub-intensive or even intensive therapy. They need devices that help them breathe and there was a shortage in the ICU," Giovanni Rezza, director of the Department of Infectious Diseases of the Italian Ministry of Health.
Rezza also warned that "if there is no decrease in the circulation of the virus, we put the entire system at risk, in attention and treatment."
"We put not only covid-19 patients at risk, but everyone else living with other diseases. This is the biggest problem," he added.
Thus, there are doctors who have stated that they have had to choose which patients to treat and who not.

If a person between 80 and 95 years old has severe respiratory distress, you probably cannot proceed [with treatment], Dr. Christian Salaroli, head of the intensive care unit of a Bergamo hospital, told the newspaper Italian Corriere della Sera.
"These are terrible words, but unfortunately they are true. We are not in a position to try what you call miracles," he added.
The Italian Society of Anesthesia, Analgesia, Reanimation and Intensive Care (SIAARTI), issued a document with 15 "ethical recommendations" for doctors on the admission of people to intensive care in "exceptional cases of imbalance between needs and available resources".
"Doctors and nurses are our heroes, thank you," reads a sign hanging on the Vittorio Emanuele bridge in Turin.
Doctors and nurses are our heroes, thank you, reads a sign hanging on the Vittorio Emanuele bridge in Turin.
Doctors and nurses are our heroes, thank you, reads a sign hanging on the Vittorio Emanuele bridge in Turin.
Thus, SIAARTI speaks of the importance of offering support to professionals who, due to the covid-19 crisis, are forced to make "difficult and painful decisions".

In such a complex situation, each doctor may be forced to make decisions in a short time from an ethical and clinical point of view: which patients undergo intensive treatments when the resources are not sufficient for all the patients who arrive, he says in the document.
In this regard, the association recommends that those with the " longest life expectancy" be privileged. That is, instead of admitting patients on a first-come, first-served basis, they focus on patients with the best chance of recovery after intensive treatment.
It is not SIAARTI that proposes to treat some patients and limit treatment to others. Rather, it is emergency events that compel physicians to focus their attention on the appropriateness of treatment for those who can benefit most where resources they are not enough for all patients, he says.
However, Anelli assures that "under normal conditions, our Constitution and our laws impose a cure on everyone, without any discrimination."
"We are confident that we will not get to the point where we have to make a decision like that."

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