In December 2019, a new coronavirus, SARS-CoV-2, emerged in China as the cause of coronavirus disease 2019 (COVID-19), a severe respiratory syndrome.
Since late February, as the first country in Europe and also the first outside Asia, Italy faced a massive outbreak of SARS-CoV-2, whose severity lead the World Health Organization (WHO) to define COVID-19 a pandemic.
In particular, the local epicenter of the Italian outbreak was the city of Bergamo and its province, where mortality increased to nearly five times versus the previous years.
Papa Giovanni XXIII Hospital, where I currently work as chief of the Neuroradiology department, is the only tertiary care hospital in the area and quickly became the main hub for COVID-19 patients.
The rapidly increasing number of patients soon overwhelmed the hospital's capacity, forcing a major reorganization led by the “Crisis Unit.” I was supposed to give a lecture at UCLH in London on the 24th of February but on the 21st all the department chiefs were summoned by the health and administrative management head to be informed of the worrying emergency status.
In that specific moment, I realized what was going on.
At the beginning we were asked to reassign to COVID-19 units 25% of the staff doctors (regardless of their specialty) a number that progressively increased up to 70% during the following weeks.
The infectious disease unit was reconfigured to treat only patients with COVID-19 and other patients were redistributed throughout the hospital or discharged when possible. Dozens of patients were admitted each day, the number of daily admissions continued to increase exponentially. COVID-19 units were formed in both adult and pediatric internal medicine and surgery departments, intensive care units (ICUs), subintensive critical care areas and emergency room, in order to separate patients with COVID-19 infection from other patients. On March 28, patients with COVID-19 occupied a major part of the hospital's beds (498 of 779, 64%). Of these beds, 92 were ICUs and 12 were situated in the subintensive critical care area.
Peer education on COVID-19 management was provided to all hospital personnel: more than 1500 hospital personnel were trained in a week to face this emergency. My staff and I, as well as general radiologists, received a minimal training to give support to physicians in “new-born” COVID wards.
All the ICUs were re-organized to increase the number of beds and to guarantee mechanical ventilation support to patients who needed it.
In the meanwhile, the hospital continued to provide undeferrable outpatient health services.
The whole system was overwhelmed as more patients with severe dyspnea were hospitalized. Some sort of triage was also made in the ER, trying to reduce the burden of patients to the wards, for patients with critical disease and severely reduced life expectancy. Of the first 510 hospitalized patients with confirmed SARS-CoV-2 infection, around 30% died.
As the lockdown flattened the curve, the whole system was more and more disposed towards the hospitalization of the patients and mortality rapidly dropped. At the beginning, there were about 17 deaths per day. In April, during the last phase of the first wave of the epidemic, the average number of deaths was of about 2 per day, which is similar to the average of 2.5 deaths per day recorded before COVID-19.
This was mainly thanks to the incredibly committed work and efforts of all the staff members (doctors, nurses, and other health workers). At that moment we were simply astonished.
On my very first days in the COVID wards, I was shocked by the severity of the disease manifestation and by the exponential increasing number of hospitalized patients. It was the first time in my professional life I questioned myself about my profession, about being a medical doctor and a neuroradiologist. My emotional status was severely challenged and stressed. As chief of neuroradiology department I was asked to reorganize my unit, to ensure dedicated computer tomography (CT) and magnetic resonance imaging (MRI) equipments for COVID patients (“dirty”). Also, rediographer and nurses had been divided in completely separated pathways for “dirty” and “clean” patients. Meanwhile, we continued to perform other types of urgent/emergent exams (both CT and MRI), including oncologic patients.
From the beginning of the pandemic until the end of May, more than 2700 patients have tested positive at our institution, ∼2000 patients have been hospitalized. About 230 patients have been admitted to the ICU and ∼44 have died. Many more called for medical attention for fever or dyspnea but were never tested. In late spring, a population-based study measured a prevalence of nearly 30% seropositivity to SARS-CoV-2 IgG.
Now the virus is spreading again throughout Italy. This second pandemic breakdown is due to the softening of control measures, lack of proper contact tracing, and inaction to the first signs of uncontrolled epidemic in October. Herd immunity will be reached when two-third of the population have been infected or vaccinated. Up to now, Italy has started the vaccination campaign with heath care workers and will prioritize elder and frail people. About 2% of the population has been vaccinated.
Differently from the first wave, we have a more prepared health care system that know how to ramp up the capacity for COVID-19 beds and how to treat COVID-19 patient; also new cases have a different and more diffuse geographical distribution. Bergamo has up to now been less affected in this second wave.
Nevertheless, in our department, we have increased interventional staff so that we can face all possible thrombotic and/or hemorrhagic complications of this infection, and we can rely on our the previous experience about the clinical and therapeutical management of these patients.
Our current aim is to continue diagnosing and treating COVID-19 patients, at the same time to provide adequate health care and diagnostic services to all other patients who may have been underdiagnosed during the first chaotic breakdown.
(Official data numbers are taken from May 5, 2020, at NEJM.org. DOI: 10.1056/NEJMc2011599)