Europe’s largest coronavirus outbreak is putting unprecedented strain on the Italian healthcare system, with hospitals in the worst-affected areas close to breaking point.
Italy went from having a handful of cases to the second-largest death toll after China in less than three weeks, flooding intensive care units with hundreds of patients. If the government’s efforts to contain the spread are unsuccessful — and the lax enforcement of a travel ban bodes ill — experts warn that a new influx would be nearly impossible to manage.
Lombardy, the region around Milan that accounts for more than a fifth of Italy’s economic output, is the worst-affected part of the country. It had 5,469 cases, including 440 in intensive care, by Monday afternoon.
Finding more acute care beds is a “race against time,” Lombardy’s top health official, Giulio Gallera, said in a phone interview. “As of now the region’s health-care system is holding up well, but if the increase in the number of infected people in need of intensive care doesn’t slow down we could have issues.”
Over 80% of the region’s 1,123 acute care beds are dedicated to coronavirus, as many other patients have been moved elsewhere and 223 extra places have been opened to cope with the emergency. About half of those are occupied, Gallera said.
Newspapers and WhatsApp groups are rife with personal accounts from doctors on the front lines of the epidemic. When new patients come in with pneumonia, a symptom of advanced coronavirus infections, doctors have little time to decide whether to assign them intensive-care beds, ventilation machines, or respirators that could make the difference between life and death.
Some doctors have said that they sometimes make the call on who gets treatment based on the age of the patient. In some areas, hospitals are suspending other treatments to focus personnel on the contagion.
A doctor who asked not to be named because of potential repercussions painted a dire picture of the situation in a hospital in Milan. While the coronavirus is best known for causing severe disease in elderly patients, even some young people are affected, the doctor said, and without sufficient beds and ventilators, some can’t be treated.
The hundreds of patients needing treatment for pneumonia have swamped the supply of available specialists, the Milan doctor said. Physicians such as gastroenterologists, who normally focus on the digestive system, have been conscripted to help out with lung patients, and they’re still not enough, the doctor said.
Gallera said about 150 more acute care places will open up in the next week. Whether this will be enough to keep up with the spread of the contagion depends on how effective the government’s containment measures prove to be.
“The best we can do with the quarantines is slow down the number of cases,” said Mike Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “Italy right now from a health-care standpoint has overwhelmed its health-care system.”
The fear is that those who left the north before restrictions were expanded have taken the contagion with them, risking new outbreaks in areas where the health-care system is weaker. An Italian health ministry report from 2017 said the overall level of care in some southern regions — including Campania, where Naples is located, and Calabria — was sub-standard.
“We have a health-care system in southern regions, especially south of Naples, where we actually have very few facilities,” said Prisco Piscitelli, an epidemiologist and vice president of the Italian Society of Environmental Medicine. Their ability to cope may be “even worse with the increased number of occupied beds in hospitals and intensive-care units.” Hospital berths are only part of the answer. Italy is also suffering from a shortage of doctors. As many as 1,500 leave the country every year after finishing their specialisation, according to doctors’ association Fnomceo.
The government last week announced a plan to hire 20,000 new doctors, nurses, and hospital employees. In the meantime, medical authorities are avoiding quarantining doctors who have come in contact with coronavirus patients, telling them to keep working unless they show symptoms of the infection or test positive.
The rest of Europe is watching closely.
- The HSE have developed an information pack on how to protect yourself and others from coronavirus. Read it here
- Anyone with symptoms of coronavirus who has been in close contact with a confirmed case in the last 14 days should isolate themselves from other people - this means going into a different, well-ventilated room alone, with a phone; phone their GP, or emergency department - if this is not possible, phone 112 or 999 and in a medical emergency (if you have severe symptoms) phone 112 or 999