Italians must follow rules and stay home to stop coronavirus 'disaster,' says doctor
'The only way to control this is to stop the spread of the disease,' says Dr. Giacomo Grasselli
As coronavirus cases climb in Italy, the doctor co-ordinating the intensive care response at the epicentre of the outbreak says the health-care system is struggling to keep up.
The number of recorded cases in Italy has risen to 9,172 over the last two weeks, with 463 deaths. The outbreak is largely centred in the northern region of Lombardy.
On Monday evening, the government extended its "red zone" in the Lombardy area to cover the entire country, restricting travel nationwide, shutting down schools, movie theatres, museums and sports events. The government has also told shops and restaurants to keep patrons at least one metre apart.
Dr. Giacomo Grasselli, an anesthesiologist from the University of Milan, is co-ordinating the intensive care response in northern Italy. The following is an excerpt from his conversation with As It Happens host Carol Off, which took place on Monday afternoon before the lockdown was extended nationwide.
Just how stressed is the hospital system where you are right now?
The hospital system here in Lombardy, which is the region around Milan — which is, by the way, a very rich and, I would say, modern and organized region — is very stressed.
We have ... around 900 ICU [intensive care unit] beds in the region. And since the first case came out on Feb. 21, we have admitted to ICU more than 600 patients.
So we have increased our ICU beds capacity by about 30 per cent, and we are planning to increase further by 50 per cent. But, again, we admit to the ICU around 40 to 50 patients per day.
And this the ICU we're talking about. These are not just people showing up with symptoms or who are not feeling well. These are critically ill people.
In our experience now, about 40 to 50 per cent of the people who test positive to the swab require hospital admission for pneumonia and some form of respiratory failure.
And around 10 to 20 per cent of the positive people require ICU admission, and they are all seriously ill.
That is considerably different than what we've heard from China or Iran, where it's a smaller percentage. Do you think it's because, as some have said, that you have an older population in Italy, more people have underlying health problems. Is that contributing?
I don't know. That's a possible explanation. The median age of the people admitted to ICU is 65 years old, compared to around 50 in China.
In the last, let's say, seven to 10 days, we've seen an increase in the number of younger people admitted to ICU.
I'm not sure that the denominator is the same. Because when you're talking about positive people, you know, it depends on who you test. Because some countries test asymptomatic contacts, while here in Italy, we test only symptomatic people.
There is now just an extraordinary lockdown ... is that going to help?
The only way to control this is to stop the spread of the disease. Not increasing the number of ICU beds, of course, because the more patients you have, sooner or later the number of ICU beds will be insufficient.
The only way is to make people understand that they have to stay at home. They have to avoid crowded places. They have to wash their hands, and all the simple rules that you know very well.
But why do you think that Italy is in so much worse shape? I mean, compared to other parts of Europe even.
It's a very contagious and very insidious disease. Here in Lombardy ... we have a quite good, I would say, health system. So we did everything that was possible to check all the contacts of the first patients. But people move a lot around here, and the density of population is very high.
There may be also a time lag. So I hope that it won't, but I'm not sure that what's happening here now ... cannot happen in one week or so elsewhere.
'The most important thing is to avoid the spread of the disease through the education of the population, because no matter how good is your health-care system, if the tsunami arrives, sooner or later, you will be submerged.- Dr. Giacomo Grasselli, University of Milan
What concerns do you have for your doctors and nurses, for your health practitioners? Because I'm sure they're exhausted and they're exposed.
We are ... struggling lots.
Doctors nurses are heroes here, because it's ... 17 days now that they work night and day, seven days a week without rest, trying to save as much lives as possible.
Here, we have many health-care workers who tested positive, especially in the first days of the epidemic when ... people were not actually realizing what was happening. But now since they started to use the appropriate PPE [personal protective equipment] ... I would say that the number ... is decreasing.
But clearly it's a big stress for the people, for the system.
How long before you see it spreading to the rest of Italy?
I know that the if the containment measures are strong enough, we will be able to control the spread of the disease. Otherwise, it's going be a disaster — here in Lombardy and then in the rest of Italy, and in Europe.
You're on the front line there in Italy. Canada is in the early days of a growing problem. What message do you have for countries like Canada?
The health-care system in Canada is very good, so I'm sure that you'll be able to to deal with this. But the most important thing is to avoid the spread of the disease through the education of the population, because no matter how good is your health-care system, if the tsunami arrives, sooner or later, you will be submerged.
Written by Sheena Goodyear with files from Reuters. Interview produced by Chris Harbord. Q&A has been edited for length and clarity.