[D66] Italy emerging as the new epicenter for the Covid-19 pandemic

[A.OUT]

wsws.org:

Italy emerging as the new epicenter for the Covid-19 pandemic
By Benjamin Mateus
11 March 2020

Prime Minister Giuseppe Conte of Italy extended the emergency measures 
against the coronavirus pandemic to the entire country on Monday in the 
hopes of limiting the spread of the infection to the South, and diverted 
resources to the heavily impacted Lombardy region.

In his TV address to the nation, he stated, “There is no more time.” The 
pandemic has found a new epicenter with more than 10,000 cases reported. 
In just 24 hours, 977 new cases were confirmed with 168 new fatalities, 
while 877 remain in critical condition. The total death toll in Italy 
from Covid-19 now stands at 631. The country’s health care 
infrastructure has become exhausted.

In a recent post that has gone viral by Dr. Daniele Macchini, an 
intensive care unit physician in Bergamo, a city near Milan, he gives an 
unsettling personal account of the devastation being wrought by the 
pandemic.

“I will try … to convey to people far from our reality what we are 
living in Bergamo in these days of Covid-19 pandemic. I understand the 
need not to create panic, but when the message of the dangerousness of 
what is happening does not reach people, I shudder …

“The war has literally exploded, and battles are uninterrupted day, and 
night … cases are multiplying, we arrive at a rate of 15–20 admissions 
per day all for the same reason. The results of the swabs now come one 
after the other: positive, positive, positive. Suddenly the ER is 
collapsing.

“The staff is living at the hospital. Surgical cases are being canceled, 
and operating rooms are converted to treatment rooms where every 
available ventilator being used is considered ‘gold.’ Exhaustion has set 
in as endless shifts proceed without an end in sight. The staff is 
compelled to push beyond the limits of human endurance. They are unable 
to go home out of fear of infecting their families. Some are working 
while their families affected at home are struggling for their lives. 
They watch hopelessly, knowing that the fate of some of the patients 
they are caring for awaits them in just a few hours.”

Similar accounts were shared by Chinese physicians who labored for hours 
as they tried to make sense of the incomprehensible at the outbreak of 
the crisis. Many also became seriously ill and some succumbed to the 
bilateral interstitial pneumonia that took their last breath away.

Concluding, Dr. Macchini wrote, “I finish by saying that I really don’t 
understand this war on panic. The only reason I see is mask shortages, 
but there’s no mask on sale anymore. We don’t have a lot of studies, but 
is panic really worse than neglect and carelessness during an epidemic 
of this sort?”

The data being projected by various sources that are tracking the global 
statistics show that Germany, France, Spain, virtually the entire 
eurozone, as well as the United States, are only one to two weeks behind 
Italy. In the US as of Tuesday officially there were 985 cases reported 
with 29 fatalities, of which 25 occurred in Washington state at a 
nursing facility. There were 169 new cases in the US today, with 
Massachusetts announcing 51 new cases, a 124 percent increase.

New York State, with 173 cases, is just behind Washington with 179 
cases. Most of these cases are in and around New York City. Because of 
the CDC’s utter failure in leading efforts in the detection and 
management of the epidemic, private labs are now being used to test 
people. Public officials are coming to an astounding realization that 
the magnitude of the problem has become critical.

Mayor Bill de Blasio told reporters yesterday, “They’re coming in so 
intensely now that being able to give you a detailed case breakdown, 
we’re not in that position to do that at this moment because there are 
so many coming forward.” There are nearly 2,000 people in the city on 
voluntary isolation, while 30 people have been placed in mandatory 
quarantine.

Governor Andrew M. Cuomo announced that he had placed a one-mile-radius 
containment zone in New Rochelle, New York, centered on a synagogue 
found to be the source of the state’s largest cluster of infection. All 
schools, religious and community centers will be closed for two weeks. 
According to the New York Times, the National Guard is also being 
deployed to “clean schools and to deliver food to quarantined residents, 
including hundreds of students now facing two weeks of being isolated at 
home.”

It is clear these measures are going into effect in preparation for the 
impending tsunami of sickened patients seeking treatment that is around 
the corner, bringing not only panic and chaos but social discontent and 
resentment over the state and government’s utter lack of preparedness or 
concern.

As the number of seriously ill continues to rise, local hospitals will 
find themselves overwhelmed by the sheer volume of patients seeking 
urgent medical attention. The ICU capacities will quickly dwindle as 
community after community is unable to deliver the necessary care. 
Makeshift rooms and beds will be improvised.

The triaging protocol might change from ceasing to assist the sickest 
immediately but to those that have a chance of surviving. There may come 
a situation in which the elderly or those with severe comorbidities will 
not be admitted due to their very high risk of fatality because the 
resources of a region are depleted. Hospitals may have to develop and 
employ scoring systems to make quick assessments as to who will be 
permitted admission.

In a recent study published on the Harvard Library web site, the authors 
report the lessons learned from Chinese cities on demand for inpatient 
and ICU beds for Covid-19. In Wuhan city, for the period from January 24 
to February 29, Covid-19 accounted for 32,486 ICU-days and 176,136 
serious-inpatient days. During the peak of the epidemic, lasting from 
mid to late February, nearly 20,000 people were hospitalized, half of 
whom were considered in “serious” condition and over 2,000 patients 
needed critical care.

The authors note that even if cities comparable to Wuhan, such as New 
York City, Los Angeles or Chicago, were to implement measures as severe 
as the lockdown imposed on Hubei province, “hospitalization and ICU 
needs from Covid-19 patients alone may exceed current capacity.” They 
also note that many US cities have a higher prevalence of vulnerable 
populations, which in turn would need even more resources to manage such 
a volume of patients.

A crucial lesson emphasized in the study’s discussion was that when 
health care resources became inundated in Wuhan, patients would travel 
to other facilities seeking aid. This only contributed to the ongoing 
community transmission they were attempting to control. Additionally, as 
the health care system collapsed under the pressure of such large 
numbers of patients, they were unable to deliver adequate care, which 
translated to worse outcomes.

The case fatality index for Wuhan city was highest, at 4.5 percent, 
while in Hubei province it was less, at 3.2 percent. For the rest of the 
regions that abided by the social distancing and contact quarantine 
measures instituted in the early phase of the epidemic, the study found 
that the fatality index was at an exceptional low of 0.8 percent. These 
regions were able to keep their health care infrastructure operating at 
full capacity.

The US has about 2.8 hospital beds per 1,000 people. By comparison, 
Japan and South Korea have 12 hospital beds per 1,000, or four times the 
capacity. The measures instituted in Japan and South Korea have seen the 
number of new cases drastically curbed. In absolute terms, there are 
about 1 million beds in the US, of which about 70 percent are occupied 
at any given time. Even by the most conservative estimates, at the rate 
that the Covid-19 infection is growing in the US it will reach capacity 
in less than two months.

Additionally, the US stockpile of N95 masks is around 12 million. With 
the outbreak permeating all health care facilities, health providers 
will have to don masks while they work in hospitals and urgent care 
centers. In approximately two to three days, this stock of perishables 
will become exhausted. It is unreasonable to assume that manufacturing 
will have the capacity to keep up with demand.

Dr. Macchini offered these important sobering sentiments to the global 
community, “We at the hospital simply try to make ourselves useful. You 
should do the same: we, doctors, influence the life and death of a few 
dozen people. You, with your actions and choices, decide the fates of 
many more.”