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A doctor in the heart of Italy's outbreak shares what life is like in the hospital now

A doctor in the heart of Italy's outbreak shares what life is like in the hospital now
Photo by JC Gellidon on Unsplash

Those of us living in countries like the U.S., where coronavirus has arrived but not quite exploded exponentially, seem a bit conflicted about what our individual responses should be.


Ideally, we'd simply heed the advice of medical experts at the CDC and WHO instead of politicians who have a vested interest in over-or under-hyping a potential pandemic. But in a heated election season, that appears to be a tall order.

Everyone agrees that we shouldn't panic (no one responsible would ever tell people to panic), but what does that mean exactly? Is stocking up on food and toilet paper a sign of panic, or a smart precaution? What's the sweet spot between alarmism and aloofness?

When numbers are still low where you live, it's easy to say, "Eh, this isn't that big of a deal." But the reality is even if you yourself are not at high risk of dying from the virus, millions of people are. And unlike the flu, there's no vaccine for this. Measures that might seem "extreme" or "panic-driven" are designed to keep spread of the virus to a minimum.

And an ICU physician working in the heart of the outbreak in Italy, Dr. Daniele Macchini, has eloquently explained why limiting the spread is vital.

On February 27, Italy had 650 confirmed cases of COVID-19. Less than two weeks later, they have more than 10,000. The entire country is on lockdown and hospitals are over capacity—a massive contrast to the calm that preceded the storm in the Bergamo hospital where Dr. Macchini works.

Dr. Macchini posted a description on Facebook of what the hospital was like on March 6 vs. what it was like a week before. Below is a condensed translation of his post (which is written in Italian and can be read in its entirety here).

"After much thought about whether and what to write about what is happening to us, I felt that silence was not responsible.

I will therefore try to convey to people far from our reality what we are living in Bergamo in these days of Covid-19 pandemic. I understand the need not to create panic, but when the message of the dangerousness of what is happening does not reach people, I shudder.

I myself watched with some amazement the reorganization of the entire hospital in the past week, when our current enemy was still in the shadows: the wards slowly "emptied", elective activities were interrupted, intensive care were freed up to create as many beds as possible.

All this rapid transformation brought an atmosphere of silence and surreal emptiness to the corridors of the hospital that we did not yet understand, waiting for a war that was yet to begin and that many (including me) were not so sure would ever come with such ferocity.

I still remember my night call a week ago when I was waiting for the results of a swab. When I think about it, my anxiety over one possible case seems almost ridiculous and unjustified, now that I've seen what's happening. Well, the situation now is dramatic to say the least.

The war has literally exploded and battles are uninterrupted day and night. But now that need for beds has arrived in all its drama. One after the other the departments that had been emptied fill up at an impressive pace. The boards with the names of the patients, of different colours depending on the operating unit, are now all red and instead of surgery you see the diagnosis, which is always the damned same: bilateral interstitial pneumonia.

Now, explain to me which flu virus causes such a rapid drama. And while there are still people who boast of not being afraid by ignoring directions, protesting because their normal routine is"temporarily" put in crisis, the epidemiological disaster is taking place.

And there are no more surgeons, urologists, orthopedists, we are only doctors who suddenly become part of a single team to face this tsunami that has overwhelmed us. Cases are multiplying, they arrive at a rate of 15-20 admissions per day all for the same reason. The results of the swabs now come one after the other: positive, positive, positive. Suddenly the E.R. is collapsing.

Reasons for the access always the same: fever and breathing difficulties, fever and cough, respiratory failure. Radiology reports always the same: bilateral interstitial pneumonia, bilateral interstitial pneumonia, bilateral interstitial pneumonia. All to be hospitalized.

Someone already to be intubated and go to intensive care. For others it's too late... Every ventilator becomes like gold: those in operating theatres that have now suspended their non-urgent activity become intensive care places that did not exist before.

The staff is exhausted. I saw the tiredness on faces that didn't know what it was despite the already exhausting workloads they had. I saw a solidarity of all of us, who never failed to go to our internist colleagues to ask "what can I do for you now?"

Doctors who move beds and transfer patients, who administer therapies instead of nurses. Nurses with tears in their eyes because we can't save everyone, and the vital parameters of several patients at the same time reveal an already marked destiny.

There are no more shifts, no more hours. Social life is suspended for us. We no longer see our families for fear of infecting them. Some of us have already become infected despite the protocols.

Some of our colleagues who are infected also have infected relatives and some of their relatives are already struggling between life and death. So be patient, you can't go to the theatre, museums or the gym. Try to have pity on the myriad of old people you could exterminate.

We just try to make ourselves useful. You should do the same: we influence the life and death of a few dozen people. You with yours, many more. Please share this message. We must spread the word to prevent what is happening here from happening all over Italy."

Macchini was speaking to his countrymen, but those of us who live in nations with numbers like Italy had two weeks ago should take note. It's not just a matter of our own personal risk of critical illness; it's also about the capacities of our hospitals and the availability of medical personnel. (I live five hours from Seattle, and a nurse friend here told me yesterday that facilities are offering up to $5000 a week for nurses to go work in Seattle right now to help manage the outbreak there. Things are getting real, real quick.)

Italy had 650 cases less than two weeks ago. As of the writing of this article, the U.S. has 755. If we don't take extreme measures—which many will call mistakenly call "panic"—to keep spread to a minimum, we may soon be facing the same dire straits Dr. Macchini describes in Italy.

Let's all agree to hunker down at home as much as possible, wash our hands religiously, avoid crowded spaces, stop hoarding medical equipment, and ask that our government be proactive with testing and truthful and transparent about the numbers. And let's do all of the above without calling any of it "panic." At this point, it's not panic, but practicality.



Identity

Celebrate International Women's Day with these stunning photos of female leaders changing the world

The portraits, taken by acclaimed photographer Nigel Barker, are part of CARE's "She Leads the World" campaign.

Images provided by CARE

Kadiatu (left), Zainab (right)

True

Women are breaking down barriers every day. They are transforming the world into a more equitable place with every scientific discovery, athletic feat, social justice reform, artistic endeavor, leadership role, and community outreach project.

And while these breakthroughs are happening all the time, International Women’s Day (Mar 8) is when we can all take time to acknowledge the collective progress, and celebrate how “She Leads the World.

This year, CARE, a leading global humanitarian organization dedicated to empowering women and girls, is celebrating International Women’s Day through the power of portraiture. CARE partnered with high-profile photographer Nigel Barker, best known for his work on “America’s Next Top Model,” to capture breathtaking images of seven remarkable women who have prevailed over countless obstacles to become leaders within their communities.

“Mabinty, Isatu, Adama, and Kadiatu represent so many women around the world overcoming incredible obstacles to lead their communities,” said Michelle Nunn, President and CEO of CARE USA.

Barker’s bold portraits, as part of CARE’s “She Leads The World” campaign, not only elevate each woman’s story, but also shine a spotlight on how CARE programs helped them get to where they are today.

About the women:

Mabinty

international womens day, care.org

Mabinty is a businesswoman and a member of a CARE savings circle along with a group of other women. She buys and sells groundnuts, rice, and fuel. She and her husband have created such a successful enterprise that Mabinty volunteers her time as a teacher in the local school. She was the first woman to teach there, prompting a second woman to do so. Her fellow teachers and students look up to Mabinty as the leader and educator she is.

Kadiatu

international womens day, care.org

Kadiatu supports herself through a small business selling food. She also volunteers at a health clinic in the neighboring village where she is a nursing student. She tests for malaria, works with infants, and joins her fellow staff in dancing and singing with the women who visit the clinic. She aspires to become a full-time nurse so she can treat and cure people. Today, she leads by example and with ambition.

Isatu

international womens day, care.org

When Isatu was three months pregnant, her husband left her, seeking his fortune in the gold mines. Now Isatu makes her own way, buying and selling food to support her four children. It is a struggle, but Isatu is determined to be a part of her community and a provider for her kids. A single mother of four is nothing if not a leader.

Zainab

international womens day, care.org

Zainab is the Nurse in Charge at the Maternal Child Health Outpost in her community. She is the only nurse in the surrounding area, and so she is responsible for the pre-natal health of the community’s mothers-to-be and for the safe delivery of their babies. In a country with one of the world’s worst maternal death rates, Zainab has not lost a single mother. The community rallies around Zainab and the work she does. She describes the women who visit the clinic as sisters. That feeling is clearly mutual.

Adama

international womens day, care.org

Adama is something few women are - a kehkeh driver. A kehkeh is a three-wheeled motorcycle taxi, known elsewhere as a tuktuk. Working in the Kissy neighborhood of Freetown, Adama is the primary breadwinner for her family, including her son. She keeps her riders safe in other ways, too, by selling condoms. With HIV threatening to increase its spread, this is a vital service to the community.

Ya Yaebo

international womens day, care.org

“Ya” is a term of respect for older, accomplished women. Ya Yaebo has earned that title as head of her local farmers group. But there is much more than that. She started as a Village Savings and Loan Association member and began putting money into her business. There is the groundnut farm, her team buys and sells rice, and own their own oil processing machine. They even supply seeds to the Ministry of Agriculture. She has used her success to the benefit of people in need in her community and is a vocal advocate for educating girls, not having gone beyond grade seven herself.

On Monday, March 4, CARE will host an exhibition of photography in New York City featuring these portraits, kicking off the multi-day “She Leads the World Campaign.

Learn more, view the portraits, and join CARE’s International Women's Day "She Leads the World" celebration at CARE.org/sheleads.


Health

Over or under? Surprisingly, there actually is a 'correct' way to hang a toilet paper roll.

Let's settle this silly-but-surprisingly-heated debate once and for all.

Elya/Wikimedia Commons

Should you hang the toilet paper roll over or under?



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But their long lifespan isn't the reason people can't get enough of these birds as pets. Just like children, these birds learn to mimic what you say and how you say it, which allows them to engage in endearing moments. In a video compilation uploaded to social media by @themothergothel, you get to see their adorable behavior play out in front of you. A blue ringneck parrot is captured loving on some brand new baby birds and it's the sweetest thing.

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In the clip, we first see Wadsworth’s tween son doing deltoid exercises with dumbbells. Which he apparently got up at 6:30 am to do.

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