Perfect Storm: Lombardy’s Viral Disaster is a World Lesson

Rome-
So Italy Preparing to emerge from the first and most widespread west Coronavirus As a result of the lockdown, it is increasingly apparent that something went terribly wrong in Lombardy, one of the most damaged countries in Europe.

Italy has the misfortune of being the first Western nation to be blamed for the outbreak, with its official total of 26,000 deaths lagging behind the United States alone in global death toll. ItalyThe first domestic case of was recorded on February 21. At this time, the World Health Organization claimed that the virus was “containable” and not as infectious as the flu.

However, the lack of demographics and health care clashed with political and business concerns to make Lombardy’s 10 million people unseen elsewhere, especially in the most vulnerable way in nursing homes COVID-19. There is also evidence of exposure to

Virologists and epidemiologists say they will be investigating what went wrong there for years, given that the outbreak overwhelmed the medical system long considered to be one of the best in Europe.

The prosecution, meanwhile, has decided whether to criminalize hundreds of deaths in hundreds of nursing homes, many of which are half of Italy’s total, even the official Lombardy death of 13,269. .

In contrast, Lombardy’s frontline doctors and nurses say that heroes are endangering or risking life to treat illness under abnormal levels of stress, fatigue, isolation, and fear. You are welcome to An official at the WHO said it was a “miracle” that saved as many people as they had saved.

Here we discuss a complete storm of problems in Lombardy, based on interviews with doctors, trade union representatives, mayors, and virologists, as well as from the Institute of Health, National Bureau of Statistics ISTAT, and the Organization for Economic Co-operation and Development. Based on the report. Advises developed countries on policy.

Not ready

Italy was the first European country to stop all air transport to and from China on January 31, and even installed a scanner at the airport to check for arrivals for fever. But it was too late by January 31st. Epidemiologists now say that the virus has been widespread in Lombardy since early January, if not before.

Doctors who treated pneumonia in January and February did not know that it was a coronavirus because the symptoms were very similar and it was believed that the virus was still largely confined to China. did. Even after Italy registered its first domestic case on February 21, doctors didn’t understand the unusual way COVID-19 could show themselves, so some patients were unable to breathe. Fell sharply.

“Many things deteriorated rapidly after the stabilization phase, which was clinical information we didn’t have,” said Dr Maurizio Malvisi, a blockbuster lung clinic at a private clinic in Cremona. Told. “There was virtually nothing in the medical literature.”

Lombardy’s intensive care unit was already full within a few days of the first case in Italy, so many primary care physicians tried to treat and monitor patients at home. Some oxygen supplements are commonly used in Italian homes.

The strategy turned out to be fatal, and many died at home or shortly after being hospitalized, waiting too long to call an ambulance.

“Depending on home care will probably be a decisive factor in why this high mortality rate occurs in Italy,” Maribi said.

Italy’s low capacity forced Italy to use home care: after years of budget cuts, Italy ran into a crisis with 8.6 ICU beds per 100,000 people, with an OECD average of 15.9 and Germany. Well below the 33.9 part. The above.

As a result, primary care physicians have become the frontline filters for viral patients. This is an army of mostly self-employed practitioners who work outside the Italian regional hospital system.

These family doctors didn’t know if they were infected, as only those with strong symptoms were tested because the Lombardy lab couldn’t handle it any more.

With so little clinical information, doctors also had no guidelines on when to accept patients or refer them to a specialist. Also, because they were outside the hospital system, they could not have the same access to protective masks and equipment.

“The area was very late in providing us with protective equipment, which was inadequate because, for the first time, they provided us with 10 surgical masks and gloves,” Varese City. Said Dr. Laura Turetta. “Obviously, it wasn’t the right way to protect ourselves because of the close contact with the patient.”

On 7 April, the Lombardy Medical Association issued a blister letter to local authorities listing seven “errors” in responding to the crisis. Important among them are lack of medical personnel testing, lack of protective equipment, and lack of data on infections. .

Local governments and civil protection agencies advocated the effort, but admitted that Italy relied on imports and donations of protective equipment, which was simply not enough to go around.

About 20,000 Italian health workers were infected and 150 doctors died.

Lost week

Two days after the first case was registered in the province of Lodi, Italy, 10 towns were quarantined and another positive case was registered in Alzano, Province of Bergamo, more than an hour’s drive away. While the emergency room at the Lodi District Hospital was closed, Alzano ER reopened after several hours of cleaning and became the main source of infection.

An internal document cited by an Italian newspaper shows some severe cases of pneumonia that the Arzano Hospital saw as early as COVID-19 on 12 February. At that time, the Italian Ministry of Health recommended testing only to those who had been to China or had contact with suspected or confirmed positive cases.

By March 2, the Superior Institute of Health recommended that Arsano and nearby Nembro be blocked, as was the town of Lodi. However, political authorities did not implement quarantine advisories there, so the infection spread for two weeks until March 7, when all the Lombardy areas were blocked.

Dr. Guido Marinoni, Chairman of Bergamo’s Doctor, said: “This was not done, and they took gentler steps in all Lombardy, and this allowed the spread.”

Asked why he didn’t block Bergamo early, Prime Minister Giuseppe Conte argued that the local government could have blocked it on its own. Lombardy Governor Atyrio Fontana argued that the mistake was caused by both. I don’t think I was responsible for this situation. “

Lombardy is a densely populated region, accounting for one-sixth of Italy’s 60 million population and is home to Milan’s business center and national industrial . Lombardy has more than 65 years of age than any other Italian region. Also, 20% of Italian nursing homes are demographic time bombs for COVID-19 infections.

“Obviously, thanks to hindsight, we should have had a complete closure in Lombardy. No one was at home and no one moved,” said microbiologist and virologist Andrea Crissanti Veneto. Advised the local government. But even before the pandemic was heading into a recession, he admitted how difficult it was, given the oversized role of Lombardy in the Italian economy.

“Probably for political reasons, it didn’t happen,” he told reporters.

Industrial lobbying

Unions and mayors of some of Lombardy’s most devastated cities say that the country’s main industrial lobby group, Confindustria, is too costly in regions that make up 21% of Italy’s GDP. Says he put a lot of pressure on him to resist lockdowns and production outages.

On February 28, one week after the outbreak, after more than 100 cases were registered in Bergamo, a branch in the province of Confindustria launched an English social media campaign #Bergamoisrunning to reassure its clients. Claims that the “misleading sensation”, even with a high number of infections, was due to positive testing and was not worse than elsewhere, as it did not affect production in the steel mill or other industries. Did.

Cofindustria has launched its own campaign in the larger province of Lombardy, reflecting its message #Yeswework. The mayor of Milan declared that “Milan will not stop”.

At that time, Marco Bonometti, Chief of the Confindustria Lombardi, admitted the “radical measures” necessary for Roddy, but tried to reduce his alertness.

“We have to let people know that they can return to normal while protecting their health,” he said.

Even after Rome blocked the entire Lombardy on March 7, the plant remained open and strikes from workers worried that health had been sacrificed to keep Italy’s industrial engines running. Was done.

“It was a big error. They should have taken the example of the first cluster found,” said Giambattista Morali, a metalworkers’ union in Dalmine, the town of Bergamo. “Continuing to open the factory didn’t improve the situation and it obviously got worse,” he said.

Finally, all but the essential production were closed on March 26th. Carlo Bonomi, the state president of Confindustria, calls for the industry to resume, but in a safe way.

“The paradigm has changed,” Bonomi said on RAI television. “You can’t make the Italians safe without restarting the factory, but how can you make the factory safe and the Italians safe?”

Lombardy has an average of 950 infectious diseases every day, while dozens to 500 are added in other areas, and most new infections are registered in nursing homes. Is a difficult sell. Italy is scheduled to reopen gradually on May 4, advancing into the more controlled regions of the South.

It is estimated that Lombardy is probably completely open to the end, with 72,000 confirmed cases, 70% of the total in Italy, and a real number 10 times that number.

Expensive hospital

Perhaps the initiative is more representative of Italy’s confused coronavirus response than a 200-bed field hospital built in less than two weeks on the grounds of the convention center in Milan.

The hospital was announced in Fanfare on March 31 and seeks to relieve pressure on the ICU in the region as a result of a € 21 million ($ 23 million) fundraising campaign led by the right-wing league governor, Lombardy. did. The day was almost full with 1,324 patients.

The National Security Agency opposed the plan, arguing that it could never equip ventilation or personnel in time. Instead, the agency reporting to Rome’s rival five-star democratic government prioritized smaller field units located outside the hospital and programs to move critical patients to another location.

After all, the field hospital in Milan was barely used, treating only dozens of patients. Lombardy has experienced a significant reduction in ICU pressure since its inception, with more than 700 people now requiring intensive care.

Governor Fontana defended the decision, saying he would do it again, and told Radio 24: “We had to prepare the dam in case the epidemic overcame the embankment.”

Nursing home “MASSACRE”

Local governments focused on field hospitals and scrambles to find ICU beds, but their test capabilities were lagging, and Lombardy’s nursing homes were in many ways unable to cope on their own.

Hundreds of older people have died in Lombardy and throughout Italy, and one WHO official calls it a “genocide” of the most vulnerable to the virus. The prosecution is investigating dozens of nursing homes and actions taken by local governments and local governments that may have exacerbated the problem.

Lombardy has more nursing homes than any other region and is home to at least 24,000 seniors. Of the 3,045 deaths from February 1 to April 15 in the area, 1,625 were virus-positive or symptomatic, according to preliminary results from a study by the Superior Institute of Health.

Of particular interest to the prosecutor was the decision on March 8 to allow local governments to put COVID-19 patients’ recovery into care facilities and release hospital beds. The community required that the house ensure that the patient was quarantined, but it is not clear who secured it, or whether someone checked.

Earlier, some home staff said managers banned wearing masks for fear of scaring residents.

The March 30 decree again aims to relieve pressure on ICU in Lombardy and instructed the Nursing Home Director not to hospitalize sick people over the age of 75 in the event of other health problems. The law said, “it would be convenient to treat them in the same facility to avoid reduced transport and the additional risk of waiting in the emergency room.”

For senior citizens in a nursing home in Nembro, one of the most devastated towns in Bergamo, the act was a death sentence. But it was not the first or only one that gave homeowners the feeling that they were abandoned.

On February 24, when managers banned visitors to protect residents and staff from infections, local health authorities responded, threatening sanctions and loss of accreditation to prevent family visits. Said Valerio Poloni, the new director of the facility.

Eventually, 37 of the 87 residents died in February and March. The doctor and Poloni’s predecessor, the director, also tested positive and died in hospital. Residents of a nursing home could not be admitted to the hospital in late February due to the crowded ER.

Barbara Codalli, health director of a nursing home for the elderly, said he was told to use existing resources. “The patient returned a few hours later and died a few days later,” she told La7 TV.

To date, none of the surviving residents have been tested. According to Poloni, the test is expected to begin in a few days. Two people have so far died in April, but the situation seems to be under control.

“We are quiet,” he said.

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Contributed by Colleen Barry of Soave, Italy.

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