Coronavirus in Italy Reports from the Frontlines of COVID-19

What is it like for medical personnel on the front lines of the COVID-19 fight? DER SPIEGEL spoke with some of them about the immense challenges they are facing.
Accounts Recorded by Frank Hornig, Alessandro Puglia und Maria Stöhr
Medical personnel in Rome conducting a simulation ahead of what many fear will be a significant wave of coronavirus infections in the city.

Medical personnel in Rome conducting a simulation ahead of what many fear will be a significant wave of coronavirus infections in the city.

Foto: Andrew Medichini/ AP

Editors Note: These logs were taken down ahead of the publication of the last issue of DER SPIEGEL on Friday, March 13.

"Corona Hit Us Like a Tsunami"

"In the last several weeks, I have hardly slept at all. The other doctors and hospital personnel, all of us have frequently worked 18 hours at a stretch. We set up a sub-intensive care unit within just 24 hours to take pressure off the intensive care unit. We now send cases there that aren't quite as serious.

Corona hit us like a tsunami. The situation at the clinic is extremely difficult to endure. We have almost 200 people in intensive care. We still have enough beds, but nobody knows if the apex of the epidemic might still be ahead of us. Our hospital is just 30 kilometers (18.6 miles) from Codogno, the epicenter of the epidemic. We are right in the middle of the red zone. Many people we treat here need oxygen and ventilators. I don't know how long we will continue to be supplied with important medical supplies.

Personally, I'm not afraid of the virus, but we have to make sure that operations can continue and that our around 20 doctors and 60 nurses don't get infected. We're protecting ourselves with masks as well as we can.

But there is also good news: Some patients have now recovered. Furthermore, it is possible to cure the severest of cases, as can be seen in the example of so-called Patient Zero. He, too, was here in Pavia in the intensive care unit. He is now doing better, he no longer has to be hooked up to a ventilator and he has left the intensive care unit."

Raffaele Bruno, chief physician for infectious diseases at the San Matteo Hospital in Pavia

"We Will Defeat the Virus"

"We are working the whole day with no breaks. We don't know for how long that will continue. It's almost like a warfront. We cannot be afraid of the virus. No, we can't afford that at the moment. Every time a patient dies from the virus, I experience a feeling of loss. Many, many people have already died from the illness here. It hurts a lot. But we cannot allow the negative experiences to block us, otherwise it will rob us of the strength necessary to help other patients and keep going.

And there are always these small, beautiful moments. Recently, a pizza delivery came to our station and brought pizza for everybody. I am sure: Ultimately, we will defeat the virus."

Paolo Viganò, chief physician for infectious diseases at the Legnano Hospital in Milan

"There Is Concern that Our Staff Will Be Decimated"

"Since the beginning of the week, we are no longer performing routine operations. When someone has a heart attack, for example, it might be that they will have to wait a bit longer. The entire clinic is focused on the approaching corona wave. Everything is going full bore, since we know from our colleagues in northern Italy what is coming. The number of ventilators is being increased; the intensive care units are setting up separate areas for corona patients.

The mood in the clinic is extremely emotional, even a bit hysterical. In my station, we had a patient who had been here for a while and whose condition worsened. A test revealed that she had been infected with coronavirus. But hospital management did not conduct tests on the doctors and nurses who had worked with her and none of us were isolated either. We are to keep working until we develop symptoms ourselves. Only then will we be tested for the virus.

There is a significant concern that our staff will be decimated and that nobody will be left. That has led to significant amounts of stress among the colleagues and many stayed home. There is already a shortage of personnel in the Italian health care system. On Monday, I only had a single nurse with me.

Every day there are new regulations. We have received training on how to dress properly and how to disinfect your hands. And then there is the problem with the special masks. When you are in contact with infected patients, you can only wear them for six hours before you need to throw them in the hazardous waste bin. The masks have to be really tight to your face so that there is no contact with the air outside, otherwise they are useless. But they are really laborious.

At our intensive care station, we have more than 40 beds with ventilators. Hopefully that will be enough when the number of infected people climbs further in Rome. We know from colleagues in Milan that they have stopped accepting corona patients who are over 70 years old and have pre-existing conditions. People of that age who have pulmonary or lung disease or have an advanced-stage tumor are no longer being hooked up to ventilators. Under such conditions, we doctors suddenly are forced to make decisions about life or death. It is terrible. Normally, we do all we can to resuscitate people. But now, there is a developing shortage of capacity.

Another hospital wanted to transfer an 89-year-old coronavirus patient to us in the university clinic. But it wasn't accepted.

What is currently happening in northern Italy will repeat itself here in Rome. I believe that we are only seeing the tip of the iceberg."

Nicole Almenräder, anesthesiologist in the cardiac care unit at Policlinico Umberto I. in Rome

"They Are All Alone With Their Fears"

"We have reached our absolute limit. When we call a patient in to treat them, there are already three new ones in front of the door. Some of the faces I am looking into are in a complete panic. The problem is that COVID-positive patients have to be in strict isolation. That means that not even relatives or psychologists are allowed to visit them. They are all alone with their fears.

We are getting to the point where we no longer know how to get the doctors we need. I am extremely worried. We have considered calling in retired doctors. I arrive at the hospital at 7 a.m. at the latest, with the first task force meeting starting at 8 a.m. I am then at the clinic until shortly before midnight. My children hardly see me anymore. I can't think about what might be coming in the next several days. I am completely busy with the here and now."

Elke Maria Erne, head of infectiology at Bolzano Hospital

"Tensions Are High"

"Our service coordinates all responses to COVID-19 in South Tyrol, so we are constantly communicating with the seven hospitals in the region. We manage the ambulances and the bed planning, and we distribute patients among the intensive care units.

We work from 6 a.m. to midnight. We have set up large tents in front of the hospitals, where personnel in protective clothing receive the patients, who are then tested. Public life in South Tyrol has come to a complete standstill. Ski areas have closed down, the hotels have shut their doors. Tensions are high. I find myself unable to decide if everything will turn out OK or if we are sliding into a catastrophe.

At the moment, we have around 70 to 80 infected people in South Tyrol, with six of them in medically induced comas and hooked up to ventilators. We have reserved two entire intensive care units for coronavirus patients. The hospitals are only accepting emergency cases on top of coronavirus patients -- for reasons of capacity but also to avoid infecting personnel.

On top of that come the personnel shortages. Doctors and nurses are working in the newly established emergency care areas of the emergency rooms, in the infection units and intensive care units. Everyone is needed and there are shortages everywhere. We are planning to cancel all vacation time for medical workers. I am also concerned about medical supplies. Already, there is hardly any protective clothing available and almost everything is sold out.

The news from the neighboring provinces is unsettling. Lombardy is in a state of emergency. Medical care there is on the verge of collapse. Many people living in South Tyrol have friends and family in Lombardy and they hear the bad news, which frightens and saddens them."

Marc Kaufmann, medical coordinator for emergency medicine in South Tyrol

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