‘Ticking time bomb’: Hospitals in Italy at breaking point as doctors overwhelmed by coronavirus crisis

Doctor Angelo Pan is at work today – for the 24th day in a row.

He has been on his feet frantically helping patients for 12 to 15 hours a day, before then spending two hours dealing with emails and admin when he gets home at night.

He is the director of the Infectious Diseases department at the hospital in Cremona, some 17 miles to the east of the cordoned “red zone”— the coronavirus outbreak area in Northern Italy.

The Cremona hospital is one of the worst-hit in Italy, and is facing what Angelo describes as a “tsunami” of pressure and workload.

Coronavirus often leads to pneumonia, and the hospital has seen 180 cases in the last 15 days – compared to 250 pneumonia cases per year.

Its intensive care units (ICUs) used to treat up to eight patients at a time, but they currently have 15.

“We are tired,” Angelo tells the Independent, “It’s a very remarkable workload.”

He’s not the only one working around the clock: in late February, a doctor in nearby Pavia reported doing an 80-hour shift.

With the virus spreading – Italy has over 3,000 contagions including 80 dead – medical staff in the country’s north have stepped up their response to the emergency, but face increasing levels of fatigue, stress and pressure – a key risk factor to contain the Coronavirus epidemic.

Research in the Lancet has also raised concerns about an increased mortality rate if health services are overwhelmed.

But while it’s still too early to say whether Italy’s measures to contain the outbreak have worked, some are now sounding the alarm about the pressure facing hospitals because of the epidemic.

“If the spread keeps extending, hospitals will go into a grave crisis,” Lombardy authorities said in a statement on 28 February.

They explained that the coronavirus appears to be easily curable for 90 per cent of cases, but 10 per cent of patients require time in intensive care units. “The available places are limited,” the region said. A few days after the note, on 4 March, the Lombardy regional government went into self-imposed quarantine after an assessor was infected.

Earlier in the week, Lombardy scrambled to free intensive care beds. The region set up a dedicated hospital in Milan, suspended non-urgent surgeries, asked private clinics to provide beds for ordinary patients, and requested that hospital maximise space for ICUs.

But the additional beds filled quickly, says Cristina Mascheroni, Lombardy president of AAROI-EMAC, the association of Italian anaesthesiologists and intensive care doctors.

As of yesterday, she says, there were only about 20 ICU beds available in Lombardy, a region that has seen more than 1,500 contagions and has a population of 10 million.

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The Italian government is expected to announce a new plan to free more ICU beds and employ medical personnel from less-affected regions in the coming days.

The crisis has also hit staff in A&E, Intensive Care and Pneumology.

“We have been skipping rest days, suspending holidays and doing double shifts,” Mascheroni says. “I have to thank all of my colleagues, nobody protested.

“But we are at the limit, I don’t know how long we’ll be able to carry on.”

Mascheroni says the workload is so intense that it was “impossible” to reach her colleagues on the phone. She created a group chat on Whatsapp to speak to association members working in hospitals across the region and keep track of developments.

Several medical professionals have been infected, but many continue to work using protections, although they face even more stress because they must eat alone, change alone and minimise social contacts.

Other doctors have been working overtime for days.

Stefano Bianchi*, a doctor working in intensive care in the hospital of Bergamo, which has also been strained and forced to re-organise quickly due to the epidemic, says that on top of their regular hours he and his colleagues have been working an additional 20-to-25 hours a week.

“Coronavirus patients in ICUs need a very high amount of intensive care,” he explained to the Independent.

“So, while working, we never go out, we never eat, we never drink – we just think of the patients and work to provide the best care we can.”

He added that the personal protective equipment medical staff wear adds to the pressure as it’s very warm and only lets in a very small amount of air. The facial protections leave pressure sores because of how tightly they must be sealed.

“In our team, we are holding on well,” he says. “But if you ask me whether we’ll be able to sustain this pressure for two or three weeks… It doesn’t look good.”

Critics say the Lombardy staffing crisis has been self-inflicted, with consecutive governments slashing health budgets for years.

“Governments have underfunded the health service for 15 years, hitting professionals the most,” says Mirko Claus, President of FederSpecializzandi, the association of Italian junior doctors.

“These policies have created a lack of specialists that has become apparent in the last year and a half,” he says.

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As evidence that Italy could have trained more specialists but chose not to, Claus says that over 17,000 medicine graduates took a national test to specialise in 2019 – but there were only 8,000 on offer.

Regional authorities have allowed hospitals to temporarily recall doctors and nurses from retirement.

Angelo’s hospital in Cremona is among the ones that have called doctors, including retired specialists, to apply to work during the crisis.

“What I fear is how long we’ll be able to work in these emergency circumstances, how long we’ll be able to hang in,” Angelo says.

He says that what his hospital has faced in the last few days is “like a bomb”. “It’s unlike anything I have ever seen in my professional life,” Angelo says.

He was on the frontline of the fight against the AIDS epidemic in the 1980s and 1990s, but says that epidemic doesn’t compare to the pressure the Coronavirus is putting on hospitals and medical professionals.

“I don’t know how long this epidemic will last,” he says. “But if it lasts, we’ll need more doctors.

“And I don’t know if they exist.”

*Names have been changed to protect their identity