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29 Mar 2020 15:52
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  •   Home > News > International

    I'm a doctor at Italy's hardest-hit hospital. I had to decide who got a ventilator and who didn't

    Guglielmo Gianotti has fought on the medical frontline of Italy's coronavirus crisis. He saw the wave of patients overwhelm his hospital, then he caught the virus himself. He has a warning for other countries like Australia.


    I am the executive director of surgery at the Cremona hospital, which has probably been the hardest hit by the coronavirus outbreak in northern Italy.

    It's where the first patient died in this country.

    Like every hospital in the region of Lombardy, we are working at the extreme limit of our capabilities.

    All the beds in the hospital have been taken up by patients with COVID, so there isn't much scope for activity beyond this disease.

    It's a very, very bad situation.

    Catching the virus on the medical frontline

    I got infected a week ago.

    Over the two weeks prior, we faced the admission of thousands of patients who came from around Codogno, a tiny town close to Lodi.

    In the middle of the night, we were suddenly having to transfer all the patients who weren't COVID-related to other hospitals.

    My ward, like all the other wards, was transformed into a COVID treatment centre.

    It was a strange situation. We were surgeons having to manage patients who were nothing like our regular patients.

    That's because the infectious diseases doctors, respiratory experts and general physicians had all been removed from the hospital.

    They were all infected. The only ones left to care for these people were us.

    We made ourselves available to help them .

    Hundreds of people were arriving with flu-like symptoms and we admitted everyone. Some people were waiting up to 35 hours just to get a swab test.

    We didn't have enough protective equipment like masks and gloves to confront this infection, so in those early days I was not well protected.

    After two weeks I found myself fatigued and feverish but I didn't have the classic COVID symptoms. My fever wasn't extremely elevated.

    One day, I just couldn't continue. I took a CAT scan of my chest and found a lateral respiratory COVID infection.

    They put me into isolation. I took anti-retroviral drugs, which are normally used to treat HIV, but they gave me diarrhoea so I had to suspend that therapy.

    The only other drugs we were using in the ward were anti-malaria treatments together with HIV drugs, but there weren't any indications that they were working.

    On the contrary, patients adopting those treatments were seeing significant side effects. We worried they were doing more harm than good.

    The only drug that we've seen that is showing the slightest bit of benefit to patients is the immunosuppressive drug Tocilizumab, which is mainly used for the treatment of rheumatoid arthritis.

    It's being trialled at the Pascale Cancer Institute in Naples with very encouraging results.

    But I have to say, you feel a sense of despair to learn you've been providing therapies to sick people that have been entirely ineffective.

    Who lives and who dies

    My body appears to be recovering well and the virus seems to be under control. My fever is stable and I'm bouncing back.

    I'm 62 years old and suffer bronchial asthma, so I'm not what you would call the ideal candidate for a COVID infection.

    In my department, three other colleagues have become infected with the virus. One is 38, one is 40 and the other is 50.

    As you can see, it can touch anyone.

    The 38-year-old doctor is someone who runs marathons and jogs every day, but evidently the possibility of catching this virus is high even among young people.

    What we're seeing is that those who aren't surviving this are those who have many co-morbidities. They're elderly patients who suffer from other illnesses and other problems.

    But don't get me wrong. The young are infected at just the same rate as old people, and we're seeing many young people end up in intensive care.

    They might be more likely to recover but the chances of your condition deteriorating after infection are just as likely if you're young. We're seeing evidence of that every day.

    My specialty is in emergency surgery. I have always been taught that in times of war, we must decide which patients will live and which are probably going to die.

    That's the situation we're currently living through in Italy.

    It's a massive responsibility having to decide to give a ventilator to one patient and not to another.

    Perhaps worst of all, we're not able to care for other patients who aren't COVID-infected. Many cancer patients won't make it through.

    When it comes to who gets the ventilator, it's a choice. There aren't any specific protocols. Suffice to say those decisions are based largely on good judgement.

    You might have a patient who is 80 years old and has a ton of other problems – he's had a stroke, or Alzheimer's, or other pathologies. And then there's a younger patient. In that case, it's an easy choice.

    Then you've got patients who might be 80 or 90 years old but they're in fine health. That choice becomes much harder.

    You don't know how you should react in that circumstance. It's not just the age that makes a difference.

    A warning from Italy's medical frontline

    I hope the Italian experience will serve to help other countries understand this is not a joke. You can't take it too seriously.

    Everything needs to close and stay closed. Even if the economy collapses, the stock market collapses, it doesn't matter. There's always time to rebuild.

    The important thing is "portare a casa la pelle " – to come home safely each day, as we say in Italy.

    Other countries should now be getting prepared for the impact. Understand what will be necessary: better hospitals and better facilities tailored specifically for this situation.

    Because when the virus arrives you will no longer have the ability to do anything else. Everything will be paralysed.

    You don't have any time to think even of what to do. You arrive at work hoping to help but you don't even know if what you're doing is right or wrong.

    There are no proven therapies yet, so you don't actually know how to help these patients. That's the real problem.

    What worries me the most about the new coronavirus

    I'm at home recovering for now. I would prefer to be on the front line lending a hand but I would be too much of a risk to others.

    The situation at my hospital is quite chaotic, it's changing from hour to hour. It was like that even when I was there, and it has been like that since then.

    In the hospital, the day passes swiftly, especially given the mental torment of decision making.

    The fact that you are caring for COVID patients means you can't ever let your guard down because you could become infected at any moment.

    Stress and fatigue become big issues.

    I am a little worried about going back to work because we don't know the likelihood of a relapse with this illness once you've had it.

    Worse still, I don't know how it could affect me if I did get the virus again. If I get it a second time it could be worse than the first.

    There is currently no reliable test to determine whether having the virus transmits any immunity to the person at all.

    That is the most worrying aspect of all this, because this virus could have another mutation and attack people who've already had it.

    This is an edited transcript of Dr Guglielmo Gianotti's interviews with Foreign Correspondent reporter Emma Alberici.


    ABC




    © 2020 ABC Australian Broadcasting Corporation. All rights reserved


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