Pandemic Journal 17/3/2020 — scores of gravity: an interview with Dr. Fabiano Di Marco, Bergamo, Italy

March 17, 2020: I transcribed an outline of this New York Times podcast interview below because it is a powerful and moving prompt for us all to #StayHome. The haunting and terrible story told by this doctor should shock us all into action. And with many government closures of public spaces, more of us should be sheltering inside if you possibly can.

You can listen to the moving interview “It’s Like a War” here.

The globe has shifted on its axis. The COVID-19 pandemic according to Deb Verhoeven is “a brutal rupture of life worlds.” The speed and range of this coronavirus terrifies.

The goal of isolation, quarantine, closure of schools and universities and bars and restaurants and libraries and recreation centres and other public spaces is to slow down the arrival of the virus in order to ensure our healthcare system can support so many lives at risk.

Here in Canada, the federal government is taking a number of measures including providing financial support for businesses and individuals. Tonight, Canada and the US are negotiating how to close the border to all but essential traffic. Today Ontario declared a state of emergency. And so did Alberta. West Jet Airlines closed for business save for reconnaissance flights ferrying Canadians home. Canadian snowbirds in Florida are heading north early. Tonight the Canadian-owned department store Simon’s closed its doors across the country “for the foreseeable future.” This is just a sign of what is to come. So many unemployed workers. The economic perils that await so many.

Lack of leadership in the US impeded testing and preparation. People are concerned the burden on hospitals will be overwhelming as the number of cases mount in a trajectory comparable to Italy. This graphic illustration of possible British deaths calculated with and without mitigating measures is a gruesome prognostication. And certainly the implications are frighteningly relevant for all of us.

While some authorities continue to speak about the virus as though visible symptoms are the key infection indicator, studies in Germany and in the US indicate otherwise. ”Stealth Transmission’ Facilitates Rapid Geographic Spread of SARS-CoV-2 Coronavirus” outlines the contagion:

“The explosion of COVID-19 cases in China was largely driven by individuals with mild, limited, or no symptoms who went undetected. …Depending on their contagiousness and numbers, undetected cases can expose a far greater portion of the population to virus than would otherwise occur.”

Much of the discussion by our provincial authorities is about visible symptoms. The fact that contagion occurs before symptoms appear, leaves us all vulnerable to each other. Unless we distance ourselves and even self-isolate. #StayHome

There will be much suffering to match what has come in the months since this virus first appeared late last year.

March 17, 2020

You can keep up with the escalating COVID-19 virus on this map built by Professor Lauren Gardner, a civil and systems engineering professor at Johns Hopkins University, and her graduate student, Ensheng Dong. It is maintained at the Center for Systems Science and Engineering at the Whiting School of Engineering, with technical support from ESRI and the Johns Hopkins University Applied Physics Laboratory.

I am sequestered at home. With my poodle. I find it difficult to write about this without weeping. We all must weep.

“It’s Like a War”

March 17, 2020, New York Times podcast:

NYTimes: “Italy has become the epicentre of the pandemic’s European migration, with nearly 30,000 infections and more than 2,000 deaths in just a few weeks. These numbers are soaring by the day, even after the government took extreme measures to lock down much of the country. Now, the U.S. surgeon general is warning that America is on a strikingly similar path. Today, we speak to one Italian doctor triaging patients north of Milan about the road that may lie ahead. Guest: Dr. Fabiano Di Marco, a professor at the University of Milan who is also the head of the respiratory unit of the Hospital Papa Giovanni XXIII in Bergamo, a nearby town. For more information on today’s episode, visit 

NYTimes: Background reading: In less than three weeks, the virus has overloaded hospitals in northern Italy, leaving doctors to decide who lives and who dies. Now, with the country on lockdown, families are having to delay the burial of their loved ones.President Trump released suggested guidelines to control the virus, stopping short of the mandatory lockdown now in place in Italy. Here are the latest updates on the crisis.We hope you are well, wherever you are. Here are a few tips on staying safe and coping in this moment.

The interview begins (an outline):

This doctor has not been at home for 3 weeks.

Italy epidemic curve. nearly 30.000 infections and 2000 deaths even after govt locked down the country.

On Monday March 16  the US Surgeon General announced that the US is where Italy was two weeks ago. 

Bergamo is one of the hardest hit areas.

Fabiano Di Marco Prof of U of Milan is head of a hospital in a town close to Milan —
My ward is transformed now. I am in the hospital 14-15 hours a day. 

Every day I  receive 50-70 patients with severe respiratory distress. We have a huge hospital with 1000 beds. 

You have to change the hospital day by day.

350 patients in a ward are in respiratory crisis.

Today more than 50% of the hospital is devoted to this. 

They had to teach dermatologists, rheumatologists how to treat patients.

Every day my colleagues cry.

I am 47… Colleagues. We cry every day. 

Today we have 460 nurses at home. Some are sick. Some are at home in quarantine so as not to contaminate other patients.

We have admitted to intensive care tens of colleagues. Nurses …

Yesterday the chief of my department  was admitted with bilateral pneumonia. He tried to organize the hospital three days ago. Our wives and both of us had dinner a week ago. We are frightened.

Yesterday we had 20 deaths in our hospital.

Relatives cannot come to the hospital. They could get infected. Second reason. We do not have enough personal protective equipment. Impossible to find in Europe. We would need the protective equipment for the relatives.

Patients are alone and they die alone. This is difficult for us. We try to call every day the relatives but sometimes in the confusion no one remembers to call the relative. It has happened that the relative calls the hospital…and the person is already dead.

…How do you make decisions about who survives.

We need a new tool we do not have. This is a crucial point. 

You can find many scores of gravity. For instance, if you are 80 with respiratory and renal failure. I admit you. But we have another score. The probability to benefit from an ICU bed. We do not have these. For us the usual stage of severity is: the higher the age, the higher the score. But if we have no beds, the score is the opposite. I give the bed to the 45-year-old. We need a new tool we do not have. The difference between the number of patients and the number of beds is new for us. It is difficult for us to tell someone that if they are 80, they will never have a bed. This is a terrible tool. Because it is a tool of selection. If you do not have this tool, it is impossible to reduce the deaths. 

If you do not reduce the number of patients are sick, it is impossible.

You have to reduce the rate of infection.

The only way to reduce threat of infection is to change the life of people. 

Everyone is home. It is a tragedy for people. No one is working. 

There is not something in between. 

You have two choices. You decide not to close activities and keep people at home. And you will add thousands of beds or you will close the activities.

Or you close people’s activities. 

Many people including physicians don’t have a perception of this. 

Trust us. Or such as in Bergamo. Each family will have a relative or a friend who dies. This is the situation in Bergamo. It is not a discussion on tv. You will have the perception in your family, relative, town. It is something very agressive.

….Advice to doctors: 

Best to speak with us to analyze the situation of Italy. Because you have to be prepared.

I have colleagues in other parts of Italy who are not prepared. I speak with them and they are doing the same things we were three weeks ago. 

This new reality we are living started 23 of February, three weeks or three  years ago.  After three weeks, we are living in another dimension. 

No one can be prepared for this. It is impossible.

…On coming home to the family.

My children are coming home. We try to create a normal situation at home. I have a risk of infection higher than others. It is difficult. I had to decide to stay at home with a mask or without it. I decided to stay without a mask. I have to find a solution to protect the best my wife and to not scare my children. The only good news is that children and young girls and boys are not affected. This is the only consolation for us. I changed my approach to my children. I pay attention to my hands. I pay attention to my towel. 

For this it is very difficult to decide what is the best. I spoke with my wife and we decided to do this. 

…Thank you I hope to be useful for some of my colleagues and for you.

Photo credit:
“A woman on a stretcher is carried out of an ambulance into a tent set up by the Italian Civil Protection next to the emergency ward of the Piacenza hospital, northern Italy.” Photograph: Claudio Furlan/AP (The Guardian)

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