Italy’s health system at limit in virus-struck Lombardy

The coronavirus outbreak in northern Italy has so overwhelmed the public health system that officials are taking extraordinary measures to care for the sick, seeking to bring doctors out of retirement and accelerate graduation dates for nursing students.

The region of Lombardy has been the epicenter of Italy’s outbreak, registering the first positive test of the northern cluster and now counting 984 of Italy’s 1,694 cases. Most alarmingly, 10% of Lombardy’s doctors and nurses are out of commission, because they tested positive for the virus and are in quarantine, said the region’s top health official, Giulio Gallera.

With officials saying they expect Italy’s numbers to continue rising for at least another week, until containment measures begin to take effect, the health care emergency in Lombardy has reached a crisis point.

Hospitals in hard-hit Lodi and Cremona were so overwhelmed at times last week, with more sick people arriving than could be accepted, that they closed their emergency rooms and new patients were taken elsewhere.

“Effectively some of the hospitals in Lombardy are under a stress that is much heavier than what this area can support and has trained for for years, to face this type of emergency,” Dr Massimo Galli, head of infectious disease at Milan’s Sacco Hospital, told Sky TG24. “This epidemic is on a scale that is larger than anyone could have thought, imagined or prevented.”

Lombardy’s regional government has asked the central government to reactivate retired doctors and nurses and get them back on the payroll. In addition, nursing students who were due to take their final exams next month are now expected to graduate in the coming days so they can be immediately put to work, Gallera said.

“We’ll take anyone: old, young. We need personnel, especially qualified doctors,” Gallera told reporters.

Private hospitals in Lombardy have offered up beds in intensive care units and more than a dozen doctors from the private sector have agreed to work in public hospitals to ease the crisis, regional president Attilio Fontana said. Regional authorities have asked Lombardy’s hospitals to reduce by 70 percent their planned or elective surgeries, to free up ICU beds for virus patients.

Underscoring the emergency, Fontana himself has been in quarantine for several days after one of his top aides tested positive for the virus. A second member of the regional government tested positive yesterday, forcing the entire regional government to undergo testing. Fontana has been working and sleeping out of his office, appearing at each day’s virus briefing via video.

Lombardy and Veneto have been two of the hardest-hit regions in Italy, registering most of Italy’s 34 deaths, and over the weekend the

United States issued a travel advisory warning American citizens against visiting. While schools remained closed yesterday, at least one sign of life returned to normal, with Milan’s Duomo cathedral reopening to tourists.

The Lombardy cluster was first registered in the tiny town of Codogno on Feb. 19, when the first patient tested positive. Several doctors, nurses and patients at Codogno’s hospital tested positive as well, since no protective measures had been taken when the patient first came to the emergency room a day earlier complaining of flulike symptoms.

The plight of the Codogno medical staff has become emblematic of the challenges facing Lombardy’s health system, which has also been hit by a chronic shortage of protective masks. A visiting World Health Organization mission made a public rebuke of the Italian government last week demanding that the “front-line heroes” of Italy’s virus crisis receive the protective equipment they need.

Civil protection chief Angelo Borrelli has insisted Italy is doing what it can, including centralising the acquisition and distribution of specialized masks, which Italy doesn’t produce domestically.

To confront the strains, the civil protection force has erected 283 triage units in tents outside hospitals and other facilities in the hardhit regions, to provide protected environment for patients to be assessed and treated.

Borrelli has to date rejected suggestions that Italy erect a Wuhanstyle hospital specifically to treat virus cases, saying officials have gamed out such a scenario but to date believe they can handle the outbreak with existing structures and mobile hospital units.