https://www.bostonglobe.com/2020/03/13/opinion/coronavirus-cautionary-tale-italy-dont-do-what-we-did/?outputType=amp&__twitter_impression=trueA coronavirus cautionary tale from Italy: Don’t do what we did
Many of us were too selfish to follow suggestions to change our behavior. Now we’re in lockdown and people are needlessly dying.
ROME – “As in any war, we have to choose who to treat and who not.”
That was a headline on March 9 in Il Corriere della Sera, a leading newspaper in Italy, that informed us that hospitals in Italy’s north, the epicenter of the coronavirus outbreak in our country, were being stretched thin and the health care system was on the brink of collapse.
An anesthesiologist at a hospital in Bergamo, one of the cities with the most cases of Covid-19, the illness caused by the new coronavirus, told the paper that the intensive care unit was already at capacity, and doctors were being forced to start making difficult triage decisions, admitting people who desperately need mechanical ventilation based on age, life expectancy, and other factors. Just like in wartime. The article was inexplicably placed on page 15, while the main headline on the newspaper’s front page relayed the political quarrels over the measures to curb the contagion.
The hospital in Bergamo was not the only hospital in the area dealing with a lack of capacity and rationing of care. The same day, I heard from a manager in the Lombardy health care system, among the most advanced and well-funded in Europe, that he saw anesthesiologists weeping in the hospital hallways because of the choices they are going to have to make.
In the days since, overwhelmed hospitals have set up tents as makeshift hospital wards, and cargo containers have been placed at the entrances of medical centers to sort out patients coming at an increasing pace. Some of the people who can’t get medical care are dying in their homes.
As more medical professionals started to describe similar situations on social media and in interviews, the Italian society of anesthesiologists published extraordinary new guidelines to help doctors facing ethical dilemmas, making clear that the “first come, first served” criterion that had been used among patients with the same illnesses and level of risk in ordinary times was not appropriate in dealing with the current emergency.
Until last week, the Italian public health care system had the capacity to care for everyone. Our country has universal health care, so patients aren’t turned away from hospitals here. But in a matter of days, the system was being felled by a virus that I, and many other Italians, had failed to take seriously.
The inability of the medical system to deal with the flow of patients in critical condition is not one of the problems of this complex medical emergency. It is the problem. I shouldn’t have been surprised. As a journalist, I had read, heard, and spoken to several experts explaining that the most immediate threat of Covid-19 was the hospital system becoming overwhelmed, and therefore the most pressing need was to avoid too many people getting sick at the same time, as resources are limited. (It’s what’s called “flattening the curve.”)
But that information was somehow stored in some remote interstice of my mind, covered by an incessant flow of bits and charts on the mortality rate of the elderly, political mismanagement, quarrels over under-testing and over-testing, market collapses, projections on the economic impact of the epidemic, and so on. All of this is, of course, extremely relevant — but at the same time feels totally irrelevant when lives are being lost in a situation that was preventable. As of Friday night, 1,266 people have died in Italy due to the outbreak.
So here’s my warning for the United States: It didn’t have to come to this.
We of course couldn’t stop the emergence of a previously unknown and deadly virus. But we could have mitigated the situation we are now in, in which people who could have been saved are dying. I, and too many others, could have taken a simple yet morally loaded action: We could have stayed home.
What has happened in Italy shows that less-than-urgent appeals to the public by the government to slightly change habits regarding social interactions aren’t enough when the terrible outcomes they are designed to prevent are not yet apparent; when they become evident, it’s generally too late to act. I and many other Italians just didn’t see the need to change our routines for a threat we could not see.
Italy has now been in lockdown since March 9; it took weeks after the virus first appeared here to realize that severe measures were absolutely necessary.
According to several data scientists, Italy is about 10 days ahead of Spain, Germany, and France in the epidemic progression, and 13 to 16 days ahead of the United Kingdom and the United States. That means those countries have the opportunity to take measures that today may look excessive and disproportionate, yet from the future, where I am now, are perfectly rational in order to avoid a health care system collapse. The United States has some 45,000 ICU beds, and even in a moderate outbreak scenario, some 200,000 Americans will need intensive care.
