Doctor Daniele Macchini* Alert: “Please listen to us, try to leave the house so much for indispensable things”


In one of the last e-mails that, these days, I received my direction of health with an almost daily rhythm, there was even a paragraph entitled “act responsibly in society”, with some people who can only be supported.

After having thought for a long time, it is possible to write a sentence about what will happen, considering the not serious silence of everyone responsible. I will therefore try to transmit to people “strangers to the profession” and more distant from our reality, or for what we are living in Belgium in these days of the Covid-19 pandemic.

Understanding the need not to create panic, but when a message about the dangers of what is happening does not reach people, there is still no one who is waiting for a loan for how and people who are not on the way to the gym or do vibrant football tournaments.

I also understand the economic loss and I am also concerned about it. After the epidemic or the drama it will be recovered. But, part of the fact that the economic point of view is also being literally devastating for our SNS, allows me to give more emphasis to the importance of the health damage that occurs throughout the country, and it seems to me a little “chilling”, for example, that has not yet managed to establish a red zone, already required by the region, for the communities of Alzano Lombardo and Nembro (I must state that it is a pure personal opinion).

I myself assisted with some attempt to reorganize the entire hospital last week, when our last enemy was still in the shade: like wards on each floor literally “emptied”, like interrupted training actions, the intensive care released to create the greatest possible number of beds available. A containment area that has to be before the emergency room to create diversified routes and avoid possible contagions. All this rapid transformation brings to the hospital corridors an atmosphere of silence and a surreal emptiness that was not yet possible, waiting for a war that has not yet started and that many (including myself) were not very sure that some times it came to us with such ferocity.

(In one example: all of this in silence and without public disclosure, while several newspaper headlines were bold enough to say that private health was doing nothing).

Still recovering my night watch a week ago, after using it without an eye, waiting for a microbiology call (Hospital Luigi) Sacco. I awaited or the result of an analysis of the first suspect patient in our hospital, considering the consequences that will result for us and the clinic. When I think about it again it seems almost ridiculous and injected my agitation in the face of a single possible case, now that I have seen it or it is happening.

Well, now the situation is, so to speak, a little dramatic. No other words came to me.

War, strictly speaking, is already renewed and as battles are uninterrupted, day and night.

One after the other, the poor unfortunate to come to the emergency room. Try something that is quite different from the complications of a complaint. Suffice it to say that it is a very ugly complaint. Aninha has been taught for two years as people from Bergamo do not arrive at the ER for anything. This time, too, they behave well. They followed all the instructions that were given: a week or ten days at home with fever without fever and without other contagious fever, but now they don’t do that anymore. Do not breathe or enough, need oxygen.

Pharmacological therapies for this virus are few. Evolution depends mainly on our organism. We can only support you when you don’t get any better. It is mainly expected that our organism will clear or virus alone, it has to be said. How antiviral therapies for this virus are experimental, and every day we learn something about its behavior. Staying at home until symptoms worsen does not change the prognosis of the disease.

But now it has come to such a need for beds, with all its drama. One after another, like wards that have been emptied, they are filling an impressive pace. Like tables with the names of the patients, which have several nuclei according to the operational unit that is affected, they are now all red; The local surgical procedure, where the diagnosis appears, is always the same damn thing: bilateral interstitial pneumonia.

Now, explain to me what is the flu virus that causes such a drama so fast. Because this is the difference (now tending a little to the technician): in the classic flu, in addition to spreading much less population over more months, cases can become less frequent, only when the VIRUS destroys the protective barriers of our airways and allows BACTERIA normally residing in the upper airways to invade the bronchi and lungs, causing more serious cases. Covid-19 causes banal flu in many young people, but in many elderly people (and not only) it gives rise to an authentic SARS (Severe Acute Respiratory Syndrome) because it directly affects the pulmonary alveoli and infects them, making them those unable to perform their function. The respiratory failure that results from it is often severe, and after a few days of hospitalization, the simple oxygen that can be administered in a ward may not be enough.

Sorry, but I, as a doctor, do not reassure me at all that the most serious cases are mainly of elderly people with other pathologies. The elderly population is the one that is most represented in our country and it is difficult to find someone who, over the age of 65, does not take at least the pill for blood pressure or diabetes. I assure you, therefore, that when you see young people end up in intensive care, intubated, connected to ECMO or worse (Extracorporeal Membrane Oxygenation – a machine for the most serious cases, which draws blood, proceeds with oxygenation and restores it it to the body, in the hope that the organism, it is hoped, heals its own lungs), all that tranquility with your youth passes on to you.

And although there are still people on social media who boast that they are not afraid and ignore the indications, protesting that their normal life habits have been “temporarily” in crisis, the epidemiological disaster is being fulfilled.

And there are no longer any surgeons, urologists, orthopedists, we are just doctors who suddenly become part of a single team, in order to face this tsunami that hit us. The cases multiply, reaching the rate of 15 to 20 daily admissions, all for the same reason. The results of the analyzes now arrive one after the other: positive, positive, positive. Suddenly, the Emergencies are collapsing. Emergency provisions are issued: the Emergency Department must be helped. A quick meeting to learn how the Emergency management software works and a few minutes later I’m down there, beside the warriors who are at the front of the war. On the computer screen the reason for access is always the same: fever and difficulty breathing, fever and cough, respiratory failure, etc … The exams, radiology, always with the same sentence: bilateral interstitial pneumonia, bilateral interstitial pneumonia, bilateral interstitial pneumonia . All to intern. Some are already intubated and go to intensive care. For others it is sometimes too late …

Intensive care is saturated, and where intensive care ends, others are created. Each fan is now worth gold: those in the operating rooms, which have now suspended their non-urgent activity, are transformed into intensive care posts that did not previously exist.

I thought it was incredible, at least I can speak for HUMANITAS Gavazzeni (where I work) how it was possible to implement in such a short time an apparatus and a reorganization of resources so finely engineered to prepare for such a disaster. And the whole reorganization of beds, wards, staff, work shifts and functions is constantly reviewed, day after day, to try to give everything and even more.

The wards that once looked like ghosts are now saturated, ready to try their best for the sick, but exhausted. The staff is exhausted. I saw fatigue in faces that didn’t know what that was, despite the already overwhelming workloads they had. I saw people staying beyond the hours that had already been assigned to them, working overtime that was now customary. I saw a solidarity among all of us, who never stopped going to colleagues in Internal Medicine to ask them “What else can I do for you?” or say, “Don’t worry about that ward that I take care of.” Doctors who change beds and transfer patients, who administer therapies instead of nurses. Nurses with tears in their eyes because they are unable to save everyone and because in the vital parameters of those who are now sicker, a destiny has been established.

There are no more shifts, schedules. For us, social life is suspended.

I broke up a few months ago, and I assure you that I always did my best to constantly see my son, even on days with sleepless nights, without sleeping and postponing sleep for when I am without him, but for almost two weeks I voluntarily see neither my son nor my family members, due to the fear of catching him and of catching an elderly grandmother or relatives who suffer from other health problems around him. I am content, therefore, with some photographs of my son, who I look through tears, and with some video calls.

So be patient, you who cannot go to the theater, museums or gym. Try to have pity on that myriad of elderly people that you can exterminate. It is not your fault, I know, but whoever gets into your head that is exaggerating, and even this testimony may seem like an exaggeration to those who are far from the epidemic, but please listen to us, try to leave the house only for the indispensable things. Do not go shopping in supermarkets: it is the worst, because there are concentrations and the risk of contact with people who are unaware of it becomes higher. You can go there as you normally do. If you have a normal mask (even the ones used to make certain handicrafts) put it on. Do not look for FFP2 or FFP3. These will have to be used by us, and we are starting to get tired of repeating it. We have already had to optimize their use only in certain circumstances, as the WHO recently suggested due to the lack of this material almost everywhere.

And yes, thanks to the scarcity of certain devices, I and many other colleagues are certainly exposed, despite all the means of protection we have. Some of us have already been infected, despite the protocols. Some infected colleagues have infected relatives, and some of their relatives are already struggling between life and death.

We are where your fears would lead you to create distance. Try to create distances. Tell your family members who are elderly or suffering from other illnesses to stay at home. Go and take your shopping, please.

We have no alternative. It is our job. In fact, what I do these days is not exactly the work I am used to, but I still do it and it will please me equally because it will correspond to the same principles: try to improve and cure some patients, or alleviate suffering and pains to whom regrettably cannot be cured.

On the contrary, I do not spend many words in relation to the people who today call us heroes and who, just yesterday, were ready to insult and denounce us. They will again insult and denounce as soon as this is over. People forget everything very quickly.

And we are not even heroes at present. It is our job. We used to risk something bad every day before: when we stick our hands in a belly full of blood from someone we don’t even know if we will have HIV or hepatitis C; when we do this even though we know you have HIV or hepatitis C; when we bite into something that has HIV and walk for a month taking medications that make us vomit from morning until night. When we open with the usual anguish the results of the tests done in several controls after an accidental sting, hoping that we have not been infected. We simply make a living with something that offers us emotions. It doesn’t matter if they are good or bad, just take them home.

In the end, we just try to make ourselves useful to everyone. Now try to do it too, but: we, with our actions, influence the lives and deaths of a few dozen people. You, with yours, of many more.

Please share and share the message. We have to spread the word to prevent what is happening here in Italy from happening.

* Doctor at Humanitas Gavazzeni hospital, Bergamo, Italy

Source: Expresso