'Every Single Individual Must Stay Home': Italy's Coronavirus Surge Strains Hospitals

Mar 19, 2020
Originally published on March 19, 2020 7:39 pm

Daniela De Rosa, a 43-year-old veterinarian in Italy's southwest Campania region, made a video message over the weekend as she was hospitalized with COVID-19. Her video plea has gathered much attention in Italy, which has just surpassed China in the number of reported deaths from the new coronavirus.

"I've been in isolation in a hospital room for so many days I've lost count," she says. "I have no contact with anyone other than doctors twice a day."

"Very few people understand what's happening. I want people to see I'm suffering," De Rosa continues.

"Every single individual must stay home and not endanger the lives of others," she insists.

Since the video was shared on Facebook last Sunday, it has racked up more than 11 million views.

As of Thursday afternoon, Italy has registered 41,035 diagnoses of the coronavirus and 3,405 deaths. The death toll is now higher than China's known COVID-19 deaths of over 3,200. Earlier this month, Italy became the first Western country to launch a nationwide lockdown to contain the outbreak, but despite strict measures, the number of cases continues to rise.

Italy has a universal health care system. But now, its hospitals and medical staff are overwhelmed, prompting anguished debate.

The Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care has issued guidelines for what it calls a "catastrophe medicine"-like scenario. The college put it starkly: Given the serious shortage of health resources, patients with the "best chance of success and hope of life" should have access to intensive care, the organization says.

"If you have an 99-year-old male or a female patient, that's a patient with a lot of diseases. And you have [a] young kid that need[s] to be intubated and you only have one ventilator, I mean, you're not going to ... toss the coin," says Carlo Vitelli, a surgeon and oncologist in Rome.

He's speaking just a few hours after operating on a perforated appendix of a young man who had been in contact with a person from northern Italy, where the virus has hit the hardest in the country. It was "an emergency operation done on somebody who was in quarantine," Dr. Vitelli says, "don't know if he's going to develop. I don't think so. But, you never know."

Italy is treating the coronavirus pandemic like a wartime emergency. Health officials are scrambling to set up more beds. In Milan, the old fairgrounds is being turned into an emergency COVID-19 hospital with 500 new beds; across the country, hospitals are setting up inflatable tents outdoors for triage.

Other countries can learn important lessons from Italy, says Dr. Giuseppe Remuzzi, co-author of a recent paper in The Lancet about the country's dire situation. The takeaways include how to swiftly convert a general hospital into a coronavirus care unit with specially trained doctors and nurses.

"We had dermatologists, eye doctors, pathologists, learning how to assist a person with a ventilator," Remuzzi says.

Some question why Italy was caught off guard when the virus outbreak was revealed on Feb. 21.

Remuzzi says he is now hearing information about it from general practitioners. "They remember having seen very strange pneumonia, very severe, particularly in old people in December and even November," he says. "This means that the virus was circulating, at least in [the northern region of] Lombardy and before we were aware of this outbreak occurring in China."

He says it was impossible to combat something you didn't know existed.

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AILSA CHANG, HOST:

Italy hit a grim milestone today. More people have died of COVID-19 there than in China. The number of cases continues to rise, and that is despite draconian measures the Italian government imposed this month. As NPR's Sylvia Poggioli reports, the country's national health system is overwhelmed.

(SOUNDBITE OF ARCHIVED RECORDING)

DANIELA DE ROSA: (Speaking Italian).

SYLVIA POGGIOLI, BYLINE: Daniela De Rosa lives in the Campania region, south of Naples. In this video posted on Facebook, she's breathing through the ventilator she calls the friend who saved her life. She's a 43-year-old veterinarian who enjoyed excellent health until she was infected by the coronavirus. Today's the first day she's been able to speak.

(SOUNDBITE OF ARCHIVED RECORDING)

DE ROSA: (Speaking Italian).

POGGIOLI: "I've been in isolation in a hospital room for so many days I've lost count," she says. "I have no contact with anyone other than doctors twice a day." She wants to send a message.

(SOUNDBITE OF ARCHIVED RECORDING)

DE ROSA: (Speaking Italian).

POGGIOLI: "Very few people understand what's happening. I want people to see I'm suffering. Every single individual," De Rosa says firmly, "must stay home and not endanger the lives of others." Over three days, the video was viewed by more than 11 million people.

Italy has a very good health system, and every citizen has access, but now hospitals and medical staff are overwhelmed. This has prompted an anguished debate. The Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care has issued guidelines for what it calls a scenario similar to catastrophe medicine, in which it says starkly, given the serious shortage of health resources, patients with the best chance of success and hope of life should have access to intensive care.

CARLO VITELLI: If you have a 99-year-old male or female patient that's a patient with a lot of diseases and you have a young kid that need to be intubated and you only have one ventilator, I mean, you're not going to toss the coin.

POGGIOLI: Dr. Carlo Vitelli is a surgeon and oncologist in Rome. He was speaking just a few hours after operating on a perforated appendix of a young man who had been in contact with a person from the virus epicenter in Northern Italy.

VITELLI: An emergency operation done on somebody who was in quarantine. Don't know if he's going to develop - I don't think so, but you never know.

POGGIOLI: By Thursday evening, Italy, with a population of 60 million, overtook China, with a population of 1.5 billion, in numbers of deceased from COVID-19. That brings the death toll here to more than 3,400. Italy is treating the epidemic like a wartime emergency.

Dr. Giuseppe Remuzzi is the co-author of a recent article in The Lancet that paints a bleak picture.

GIUSEPPE REMUZZI: We will reach, in four weeks from March 11, when the paper was published, 40,000 patients infected and that we would need 4,000 additional beds in the intensive care unit.

POGGIOLI: Health officials are scrambling to create them. In Milan, the old fairgrounds is being turned into an emergency COVID-19 hospital with 500 new beds. And across the country, hospitals are setting up inflatable tents outdoors for triage. Other countries, Remuzzi says, can learn important lessons from Italy. These include being able to suddenly convert a general hospital into a COVID-19 hospital and specialized training for doctors and nurses.

REMUZZI: And we had dermatologists, eye doctors, pathologists learning how to assist a person with a ventilator.

POGGIOLI: Some question why Italy was caught off guard when the virus outbreak was revealed on February 21. Remuzzi says only now is he hearing new information from general practitioners.

REMUZZI: That they remember having seen very strange pneumonias, very severe, particularly in old people in December and even in November. It means that the virus was circulating at least in Lombardy before we were aware of this outbreak occurring in China.

POGGIOLI: That's why, he says, it was impossible to combat something you didn't know existed.

Sylvia Poggioli, NPR News, Rome. Transcript provided by NPR, Copyright NPR.

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