There are two patients left in Niguarda’s “Corona-5” ward. They were positive for Sars-CoV-2, very serious: the hospitalization lasted months. They are 46 and 70 years old. The youngest entered the hospital 87 days ago and has been breathing independently for 72 hours. Before, it was attached to the Ecmo, an extracorporeal circulation machine used in heart or respiratory failure. Every day he improves a little, he no longer risks death but he fought a battle to the death. Roberto Fumagalli, director of the Department of Anesthesia and Resuscitation of the Niguarda Hospital in Milan and professor at the Bicocca University, the patients of Covid saw them, shared the suffering of those who died without being able to embrace relatives, but also the boundless joy of those who are healed.
Professor, how is your department in Niguarda today?
«Almost Covid-free, we haven’t seen people with respiratory problems for three weeks. We have two non-serious positives, and two other patients, now negative, who have entered Covid, who are recovering. “
Tell us what happened in the past few months.
«In March-April 4-5 people with acute respiratory failure from Covid, a potentially lethal condition, arrived every day. At the worst time we had 74 intubated patients. From the 35 places we had in Resuscitation we went to 100, converting every possible space (for example the operating rooms). We were able to welcome all the patients and took some from other hospitals, such as Bergamo and Crema “.
How would you describe the patients you have treated?
«Subjects with severe respiratory insufficiency, that is, with little oxygen in the blood: for deep lesions in the lungs they had damage to all vital organs, such as the kidneys and the heart. Mortality here in Niguarda was 35% among the most critical patients, the others took 2-3 weeks to heal. “
Were there many elderly people?
“In the first phase of the epidemic, yes, then younger patients also came. The average age of our inpatients was 62-63 years, but the vast majority were over 50 years old. And almost all those who had severe forms suffered from other pathologies: diabetes, hypertension, chronic obstructive pulmonary disease “.
How did you cure them?
«With hydroxychloroquine and various antivirals, including remdesivir. In many cases cortisone was critical. And then enoxaparin, an anticoagulant, on which Niguarda started a clinical trial: we used it from the beginning, well before it became standard therapy for Covid. We realized, thanks to an altered blood value (D-dimer), that in many patients the infection was associated with pulmonary embolism and that there was a high risk of deep vein thrombosis “.
You have saved two out of three serious patients: how have you lived these months?
“Only one word comes to mind: fatigue. I still catch her in the eyes of my colleagues, doctors and nurses, along with fear. We saw people die alone, we did everything possible to transmit their messages to relatives and vice versa. The epidemic cost us so much humanly. We feared to get sick, to infect families. I couldn’t hug my grandchildren, it was the thing I missed the most. But there is not only bitterness: I will always remember the deep and almost unbelieving joy of the healed, the gratitude towards us “.
What is the thing you are most satisfied with?
«Teamwork: everyone in the hospital has done his part. In an intensive care unit, beds and fans are not enough. We need good doctors and nurses, auxiliaries who clean everything thoroughly to prevent other infections. It is the combination of these and other factors that can save patients’ lives. “
How do you see the future?
«I think we have to be positive, but also careful and continue to use masks, avoid gatherings, wash hands. Sars-CoV-2 has deceived us several times, all the predictions have turned out to be wrong. But we have not been overwhelmed. “
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