The Daily - ‘It’s Like a War’

Episode Date: March 17, 2020

Italy has become the epicenter of the pandemic’s European migration, with nearly 30,000 infections and more than 2,000 deaths in just a few weeks. These numbers are soaring by the day, even after the government took extreme measures to lock down much of the country. Now, the U.S. surgeon general is warning that America is on a strikingly similar path. Today, we speak to one Italian doctor triaging patients north of Milan about the road that may lie ahead. Guest: Dr. Fabiano Di Marco, a professor at the University of Milan who is also the head of the respiratory unit of the Hospital Papa Giovanni XXIII in Bergamo, a nearby town. For more information on today’s episode, visit nytimes.com/thedaily. Background reading: In less than three weeks, the virus has overloaded hospitals in northern Italy, leaving doctors to decide who lives and who dies. Now, with the country on lockdown, families are having to delay the burial of their loved ones.President Trump released suggested guidelines to control the virus, stopping short of the mandatory lockdown now in place in Italy. Here are the latest updates on the crisis.We hope you are well, wherever you are. Here are a few tips on staying safe and coping in this moment.

Can you see me? No, I think. I cannot see you, but I can hear you. And I think I can hear you. Oh, now I can see you. Okay. Sorry for my English. I don't know if my English will be adequate for a podcast, but then you will decide, okay?

It's exceptional. And I'm really grateful that you're making time for us. Thank you. Thank you. So where are you right now? Now I'm at home after three weeks. Today in the afternoon, I am at home because I have a big family with three children. And I decided to come back at home one day. So you have not been home in three weeks? I come back at home one day.

So you have not been home in three weeks? Three weeks, yes. I've been in my hospital every day since the start of the crisis. Friday, the 21st of February. And since then, it was a total mess. It's like a war. a war. From the New York Times, I'm Michael Barbaro. This is The Daily. This is how Italy's cases have grown over the last month, slowly at first, but now more rapidly. It's a textbook epidemic curve. Italy has quickly become the new epicenter of the pandemic, with nearly 30,000

infections and more than 2,000 deaths, numbers that are soaring by the day, even after the government there took extreme measures to lock down much of the country. We are at a critical inflection point in this country. On Monday, the U.S. Surgeon General warned that the United States is now on a strikingly similar path. People, we are where Italy was two weeks ago in terms of our numbers. And we have a choice to make as a nation.

Do we want to go the direction of South Korea and really be aggressive and lower our mortality rates? Or do we want to go the direction of South Korea and really be aggressive and lower our mortality rates? Or do we want to go the direction of Italy? Today, a conversation with a doctor in Bergamo, north of Milan, one of Italy's hardest hit areas. It's Tuesday, March 17. Could I just ask you to just say your full name for me? Okay, my name is Fabiano Di Marco. I'm a professor of the University of Milan and the head of the respiratory unit of the hospital Papa Giovanni Ventitresimo of Bergamo, which is a town

close to Milan. Can you give me a sense and maybe paint the picture of what it's like in the hospital right now, what you're dealing with. I have now, my world has been totally transformed. Nothing is as before. I've been in my hospital every single day and for 14 hours or 15 hours a day to try to deal with the outbreak of coronavirus infection. What has been the story of what has happened in your hospital these past few weeks? Because I think people in the United States are desperate to understand what you have seen and what people have said to you and what it has looked like. You described it as a war. So we want to understand what you mean. Okay. Every day we receive on average between 50 to 70 patients with severe respiratory failure due to coronavirus infection.

Every single day. Every single day. And to describe my reality, my hospital is, at least in Europe, a huge hospital with 1,000 beds. But to receive every day between 50 and 70 patients with severe pneumonia due to coronavirus, it's impossible. You have to change your organization day by day. And tell me what you mean. How do you have to change your organization to deal with people who are in such severe respiratory condition? So we changed the normal ward, mainly surgery wards, because the activity of surgery has been reduced of at least 80%. And we transformed so far five wards of surgery for patients with coronavirus.

Now we have between the five wards and the emergency room, at least 350 patients with respiratory failure due to coronavirus infection. Today is the first day in which we have more than 50% of the hospital dedicated to coronavirus patients. patients. To organize this, we had to teach cardiologists, dermatologists, rheumatologists, specialists of something very different from respiratory failure, how to treat this patient. You try to find a solution, but day by day, it's no longer enough. So I can tell you that my colleagues, both physicians and nurses, they cry every day. Wow.

I'm 47. I'm not so, so old to be the head of a ward, at least in Italy. But I have with me 20 colleagues who are respiratory physicians with many fellows. They are 27, 30. So for me, it's a huge responsibility. And I was scared they could be sick, okay? But we cry every day.

And now we have today 460 nurses at home because they are sick. And I think we have, yes, it's a very huge number. You have 460 nurses who are in a hospital in the middle of this crisis who are home because they're sick. Yeah, today. This is the outcome of today. And is that because they are sick with the coronavirus? There are some who are sick, some with a total burnout for the situation, and others who are contact of patients, so they stay in quarantine at home. Doctor, you said you are upset that you maybe even cry every day. And I wonder if there is an experience, maybe one story or one patient that made you upset. and for us is normal, there is not so emotional, luckily,

because we are used to treat other people. But this is difficult when the patient is your colleague. And we have now admitted tens of colleagues or nurse people who you will meet every day in your life. Your colleagues are now your patients because they have contracted the virus. Absolutely. For example, yesterday, the chief of my department came to the emergency room to be with a low level of oxygenation. He has a bilateral pneumonia due to coronavirus. Wow, I'm sorry.

bilateral pneumonia due to coronavirus. Wow, I'm sorry. Not very severe, but he was the one who tried to organize the hospital to deal with this infection three days ago. And we went to have a dinner with my wife and his wife one week ago. Wow. One week ago. Wow. I don't know.

We are scared because on Friday, only in my hospital, we had 20 deaths. 20 deaths. Yeah. For coronavirus. In one day. That's extraordinary. Yeah. So another important thing. we have not the opportunity to allow the relative to come to the hospital for two reasons.

First, it's a danger for them and for other people, evidently, because in 80% of the cases, they are infected. The second reason, which is not easy to understand if you are not in this situation, is that we do not have enough personal protective equipment. The mask in case of infection, something to cover the shoes and the gown. It's impossible to find these now in Europe, not only in Italy. So you're running out of those

and you can't get them anywhere in the region or anywhere in Europe. You just can't get them. Yeah, impossible to find. Wow. If I allow one or two relatives to come to the hospital, I have to give them these, but we do not have these for us.

Right, you need them for doctors. Yeah. They cannot receive the relative in hospital. So the patients are alone. And they die alone. This is difficult for us. We try to call every day the relative. But I have to tell you that sometimes in the confusion of this new organization with dermatologists who is trying to treat a patient with severe respiratory

failure and probably the doctors cry and no one remembers to call the relative. So it's happened that the relative called the hospital. And the person's already dead. Yeah. We'll be right back. Doctor, you've mentioned a lot of the choices that you and your staff have to make now that this is such a terrible situation. that you and your staff have to make now that this is such a terrible situation. And I wonder how you make decisions about who gets which treatment and who has the best chance to survive. How do you make those decisions?

This is, for us, a crucial point because we have hundreds of very sick patients, but we have tens of ICU beds. The problem is that you can find many scores of gravity, but these scores of gravity have been thought for another reason. And when you say score of gravity, you mean basically kind of a calculation of who is in greatest need. Absolutely. So, for instance, if you are 80, you have a severe respiratory failure. And I don't know, you have also renal failure. I have to admit you in the ICU because you are very severe and you have a probability to die very high.

Okay, I have to admit you in the ICU. But now we need another score, which is a score which helps us to understand your probability to benefit of the ICU bed. And we do not have this score. Because it has not been created. Absolutely. We are trying to do this now because, for example,

the age, for all this stage of severity, higher is the age, higher is the score. But when you have few bets for many people, the age is absolutely the opposite. If you are 85,

I give the bed to another one who is 45. Because 45-year-old is more likely to benefit from the ICU bed than the 80-year-old. So you're saying all the normal rules have to be thrown out the window. Absolutely. We need a new tool. We do not have, because so far, the difference between the number of patients, number of beds, is something totally new for us. Okay?

And not only for us. All the country will have to deal with this. But it's difficult to tell people that if you are 80, you will never have the ICU bed. Of course. But so far, if you have not the opportunity to build a new hospital with 1,000 beds, such as in China, we need this terrible tool. Because this is a tool of selection. Right. Of who lives and who dies. Yeah. And this is why it's important.

If you do not reduce the number of patients who are sick, it's impossible to deal with this disease. Impossible. You have to reduce the rate of infection. You have to reduce the rate of infection. And the only way to reduce the rate of infection is to change totally the life of people. Now, in Italy, everyone is at home. This is a tragedy for economy. No one is working.

No one is working. But it's the only way. There is not something in between. It sounds like you're saying that once you are in a hospital as a doctor looking at a room full of people with this virus overwhelmed, it's too late. That the role of countries who are not yet at the place Italy is in is to make sure they don't ever get to that place, don't ever get to the point that your hospital is at, and to do whatever it takes to not get there. Absolutely. You have two choices. You decide to not close all the activities, close the people in their home, and you will accept thousands of that, or you have to close all the activity.

There is not a choice in between. I know this is difficult to have this approach, because also in Italy, if you speak with my colleague in another town, it's quite difficult to understand this because many people, including many physicians, have not the perception of this. Because in your reality, all is normal. It's difficult to be scared for something you have not the perception, so I can understand that in other countries is the same but trust us or such as in Bergamo each family will have a relative or a friend who dies this is a situation in Bergamo. This is not a disease you can discuss on TV. You will have the perception of this in your family, in your relative, in your town.

It's something very aggressive, very aggressive. Very aggressive. I wonder, as a doctor, what advice you would give to doctors in the United States who may have to do what you have to do and make the kind of difficult decisions that you have to make now. I think that the best is to speak with us, to analyze the situation of Italy. Could be something important. Because you have to be prepared for this this is the only the only thing i would just do my colleague because also in italy i have some colleagues in the other part of italy who are not prepared and i i speak with them they are doing the same thing we did three weeks ago. This is incredible. This new reality we are living

started the 23rd of February, not three years ago, okay? Three weeks ago. After three weeks, we are living in another dimension. For me, it's difficult to think to my life before this. No one can be prepared for this.

Impossible. I wonder, just a final question here. At the beginning of our conversation, you said you were finally home after three weeks. And I wonder what it was like to come home to your family. What are you telling them and how are you feeling? My children are at home now for three weeks. The schools are closed. Luckily, there are three so they can stay together.

But we try to create a normal situation at home. but we try to create a normal situation at home. For me, it's difficult because, evidently, I have a risk of infection which is higher than compared to other people. So I had to decide what to do at home. If stay with a mask, sorry, I decided to stay normal without the mask.

Sounds like this was a tough decision. Yeah, because I have to find a solution to protect the best my wife and do not scare my children, okay? The only good news is that children and young boys or girls are not affected. This is the only consolation for us. And I decided that I changed my approach to my children, okay? I pay attention to my hands. I pay attention to my hands.

I pay attention to my towel. Okay. But I decided to not wear a mask because it would be difficult for them to see the father who is a respiratory physician in Bergamo with a dozen of cases, hundreds of deaths. in Bergamo with a dozen of cases, hundreds of deaths. So also for this, it's really difficult to decide what is the best. And I spoke with my wife and we decided to do this. It sounds like on top of all the difficult decisions

you've had to make, you had to go home and make one more difficult decision, which was this mask. Yeah, absolutely. Doctor, I really want to thank you so much for giving us your time. And I want to wish you the best of luck, you and all your colleagues, doctors and nurses at the hospital. We're going to be thinking about you a lot in the coming days. Thank you. Thank you. It has been a privilege. I hope indeed to be useful for some of my colleagues and for you.

We'll be right back. Here's what else you need to know today. This afternoon, we're announcing new guidelines for every American to follow over the next 15 days. We're announcing new guidelines for every American to follow over the next 15 days as we combat the virus. Each and every one of us has a critical role to play. On Monday, President Trump issued sweeping new health guidelines for Americans, encouraging them to work from home, avoid restaurants, bars and food courts, endary travel. And limit gatherings to 10 people or fewer. If everyone makes this change or these critical changes and sacrifices now, we will rally together as one nation and we will defeat the virus

and we're going to have a big celebration all together. But the guidelines are not mandatory, and the president stopped short of explicitly ordering Americans to stay home, as several countries in Europe and a handful of U.S. counties are now doing. On Monday, health officials in the Bay Area of California instructed nearly 7 million people to remain in their homes, with few exceptions, to slow the virus's spread. These new orders direct all individuals to shelter at their place of residence and maintain social distancing of at least six feet from any other person when outside their residence. We know we need to do this, and we know we need a regional approach.

American health officials now predict that the U.S. outbreak is likely to last for months. That's it for The Daily. I'm Michael Bavaro. See you tomorrow.