Jason Van Schoor
From a well respected friend and intensivist/A&E consultant who is currently in northern Italy:
1/ ‘I feel the pressure to give you a quick personal update about what is happening in Italy, and also give some quick direct advice about what you should do.
3:27 PM · Mar 9, 2020·Twitter for iPhone
2/ First, Lumbardy is the most developed region in Italy and it has a extraordinary good healthcare, I have worked in Italy, UK and Aus and don’t make the mistake to think that what is happening is happening in a 3rd world country.
3/ The current situation is difficult to imagine and numbers do not explain things at all. Our hospitals are overwhelmed by Covid-19, they are running 200% capacity
4/ We’ve stopped all routine, all ORs have been converted to ITUs and they are now diverting or not treating all other emergencies like trauma or strokes. There are hundreds of pts with severe resp failure and many of them do not have access to anything above a reservoir mask.
5/ Patients above 65 or younger with comorbidities are not even assessed by ITU, I am not saying not tubed, I’m saying not assessed and no ITU staff attends when they arrest. Staff are working as much as they can but they are starting to get sick and are emotionally overwhelmed.
6/ My friends call me in tears because they see people dying in front of them and they con only offer some oxygen. Ortho and pathologists are being given a leaflet and sent to see patients on NIV. PLEASE STOP, READ THIS AGAIN AND THINK.
7/ We have seen the same pattern in different areas a week apart, and there is no reason that in a few weeks it won’t be the same everywhere, this is the pattern:
8/ 1)A few positive cases, first mild measures, people are told to avoid ED but still hang out in groups, everyone says not to panick
2)Some moderate resp failures and a few severe ones that need tube, but regular access to ED is significantly reduced so everything looks great
9/ 3)Tons of patients with moderate resp failure, that overtime deteriorate to saturate ICUs first, then NIVs, then CPAP hoods, then even O2.
4)Staff gets sick so it gets difficult to cover for shifts, mortality spikes also from all other causes that can’t be treated properly.
10/ Everything about how to treat them is online but the only things that will make a difference are: do not be afraid of massively strict measures to keep people safe,
11/ if governments won’t do this at least keep your family safe, your loved ones with history of cancer or diabetes or any transplant will not be tubed if they need it even if they are young. By safe I mean YOU do not attend them and YOU decide who does and YOU teach them how to.
12/ Another typical attitude is read and listen to people saying things like this and think “that’s bad dude” and then go out for dinner because you think you’ll be safe.
13/ We have seen it, you won’t be if you don’t take it seriously. I really hope it won’t be as bad as here but prepare.
Business idea: Fake IDs for oldsters. “No, really, I’m 59 just like my driver’s license says. Depeche Mode Forever!”
Here’s another thread from Italy, better documented that the one above and less apocalyptic sounding, but still pretty bad:
2/ This is the English translation of a post of another ICU physician in Bergamo, Dr. Daniele Macchini. Read until the end "After much thought about whether and what to write about what is happening to us, I felt that silence was not responsible.
— Silvia Stringhini (@silviast9) March 9, 2020
3/ I will therefore 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.
4/ I myself watched with some amazement the reorganization of the entire hospital in the past week, when our current enemy was still in the shadows: the wards slowly “emptied”, elective activitieswere interrupted, intensive care were freed up to create as many beds as possible.
5/ All this rapid transformation brought an atmosphere of silence and surreal emptiness to the corridors of the hospital that we did not yet understand, waiting for a war that was yet to begin and that many (including me) were not so sure would ever come with such ferocity.
6/ I still remember my night call a week ago when I was waiting for the results of a swab. When I think about it, my anxiety over one possible case seems almost ridiculous and unjustified, now that I’ve seen what’s happening. Well, the situation now is dramatic to say the least.
7/ The war has literally exploded and battles are uninterrupted day and night. But now that need for beds has arrived in all its drama. One after the other the departments that had been emptied fill up at an impressive pace.
8/ The boards with the names of the patients, of different colours depending on the operating unit, are now all red and instead of surgery you see the diagnosis, which is always the damned same: bilateral interstitial pneumonia.
9/ Now, explain to me which flu virus causes such a rapid drama. [post continues comparing covid19 to flu, link below]. And while there are still people who boast of not being afraid by ignoring directions, protesting because their normal routine is”temporarily” put in crisis,
10/ the epidemiological disaster is taking place. And there are no more surgeons, urologists, orthopedists, we are only doctors who suddenly become part of a single team to face this tsunami that has overwhelmed us.
11/ 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 E.R. is collapsing.
12/ Reasons for the access always the same: fever and breathing difficulties, fever and cough, respiratory failure. Radiology reports always the same: bilateral interstitial pneumonia, bilateral interstitial pneumonia, bilateral interstitial pneumonia. All to be hospitalized.
13/ Someone already to be intubated and go to intensive care. For others it’s too late… Every ventilator becomes like gold: those in operating theatres that have now suspended their non-urgent activity become intensive care places that did not exist before.
14/ The staff is exhausted. I saw the tiredness on faces that didn’t know what it was despite the already exhausting workloads they had. I saw a solidarity of all of us, who never failed to go to our internist colleagues to ask “what can I do for you now?”
15/ Doctors who move beds and transfer patients, who administer therapies instead of nurses. Nurses with tears in their eyes because we can’t save everyone, and the vital parameters of several patients at the same time reveal an already marked destiny.
16/ There are no more shifts, no more hours. Social life is suspended for us. We no longer see our families for fear of infecting them. Some of us have already become infected despite the protocols.
17/ Some of our colleagues who are infected also have infected relatives and some of their relatives are already struggling between life and death. So be patient, you can’t go to the theatre, museums or the gym. Try to have pity on the myriad of old people you could exterminate.
18/ We just try to make ourselves useful. You should do the same: we influence the life and death of a few dozen people. You with yours, many more. Please share this message. We must spread the word to prevent what is happening here from happening all over Italy.”
20/ 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 it panic really worse than neglect and carelessness during an epidemic of this sort?
Read it there.