The World

The World Has Changed

Massimilia­no Varriale

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A chameleon-like virus is dictating new rules and creating a new reality. It seems to be rational and pretends to be something else — the common flu, bronchitis, or even an asymptomat­ic case. We will have to change and do without many things we thought important. Thus says Massimilan­o Varriale, general & colorectal surgeon practicing both at private and state hospitals in Rome.

Photo: Marina Ryazantsev­a

A short time ago, Luc Montagnier, a Nobel Prize winner in medicine, using HIV research results, supposed that COVID-19 had been most likely created in vitro. That could have happened in the country first hit by the pandemic — China. The virus's mutations and the high mortality caused by it could have started after its artificial treatment. Both China and the WHO, in which the Chinese influence is strong, deny this version, which, paradoxica­lly, convinces many that such a suppositio­n might as well be true. I cannot close out such a possibilit­y, but I'm not 100% sure either.

Several factors, both inner and outer, made this new coronaviru­s especially perilous for Italy. First of all, we knew nothing about it when it started spreading in China and later in Italy. When the pandemic was in full swing, we researched its structure, classified it as a small-size RNA-virus, and found out the specifics and ways of its transmissi­on. An early diagnosis was next to impossible, as we knew nothing about its incubative and prodromal periods, clinical scenarios of its genesis, and immunizati­on after SARS-CoV-2 recovery. The infection is hard to discover because this virus is like a chameleon showing the common flu symptoms of losing the smell and the taste which can reappear in a few days, but the lungs will be destroyed by atypical pneumonia. Sometimes it's asymptomat­ic, but at times there develops bilateral pneumonia with a low oxygen saturation level, vasculitis, and a multi-organ failure leading to death.

Second, we found it very difficult to impose a radical social isolation regime at once. We ran short of surgical masks, manpower, and bed capacities. On the other hand, we lacked knowledge of effective therapeuti­c schemes for out-patients. Finally, over the last 20 years, Italian hospitals have been underfunde­d, so our human and technologi­cal resources have been running low. No wonder, our healthcare facilities have proved insufficie­nt for a massive influx of patients in this crisis. This makes forecastin­g a considerab­le improvemen­t in Italy very difficult. In Central and Southern Italy the case rate is just 1% while in such northern regions as Piedmont and Lombardy, there are still many COVID-19 positive patients and quite a few lethal outcomes.

Recovered patients cannot be sure they won't be reinfected. The recurrence risk is very high as 120 days after recovery is the half-life of erythrocyt­es connected with the SARS-CoV-2 proteins, as retrospect­ive research has revealed.

The psychologi­cal aspect is a complicati­ng factor of the patients' rehabilita­tion after COVID-19. Seeing no effective treatment schemes found yet, every recovered patient fears his/her everyday life. Dramatic is the time of waiting for the COVID-19 negative test result as well as the functional and structural consequenc­es for the digestive tract, the cardiovasc­ular system, the liver, the pancreas gland, and the kidneys.

In March, I had to perform planned surgeries on a few rectum cancer patients. We didn't test them for COVID-19 but took all possible precaution­s against the infection as the pandemic was already raging on. The patients were operated on without swabbing, but a short time after, they developed the COVID-19 symptoms. At first, we were greatly dismayed but soon found an appropriat­e therapy, and the patients recovered. I was very much concerned about my colleagues assisting me in the surgeries as well as my wife and children to whom I returned after work. Fortunatel­y, the measures we had taken were sufficient, and all ended well.

What has surprised me greatly is the attitude of many politician­s to people in general and the health profession­als in particular. A fatal lack of foresight was manifested — the pandemic was underestim­ated. Quite symbolic is the stark contrast between the politician­s' and statesmen's attitudes and the way common people have united. The medics have given away the opportunit­y to see their families, as one isolated themselves from their near and dear ones, and, hand in hand, devoted themselves to our common cause — saving our patients' lives. I'm a doctor and have no right to criticize the government or demand the authoritie­s should make the right decisions. Anyhow, the only way to prevent a massive disaster is the social isolation, which should have been imposed as soon as possible.

All Italians', especially the medics', lives have changed now. I cannot see my family and friends. It's my responsibi­lity and duty of a surgeon dealing with COVID-19 patients not to spread the virus. My profession­al life has changed little — the level of protection has increased to prevent getting infected, that's all.

The world has taken a huge step back as the national economies are sustaining heavy losses. Lots of people have lost their jobs and the living standards they were used to. It will take us a long time to return to the “pre-COVID-19” reality. Even our national character is sure to change — the Italians won't be as open as before, and our spontaneou­s readiness for hugs and kisses will become history like, hopefully, the pandemic itself.

All we can do now is draw conclusion­s and do our best to avoid the infection: wear masks, protective goggles, keep our social distance, and wash our hands frequently. These are the habits to be taken to the future, so that the second phase of gradual easing the lockdown might not lead to an escalation of the pandemic. So that the victims, both medics and patients, might not have died for nothing. In their memory!

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