A doctor at the heart of the coronavirus outbreak in Italy has spoken of the dramatic fight against the disease, saying it is like relentless war and describing how wards are filling up and doctors are working non-stop to save lives.

In a post shared on Facebook, Dr Daniele Macchini likened the disease to a "tsunami that has swept us all".

As Italy battles Europe's worst outbreak, and with the virus spreading fast, doctors are making comparisons to war-time triage medics deciding who lives, who dies and who gets access to the limited number of intensive unit beds.

Dr Macchini spoke candidly of the enormous pressure facing frontline staff in his country - which has reported a total of 463 virus-related deaths and more than 9,000 confirmed cases in just over two weeks.

The message was shared just before the Italian government put the entire country on lockdown. The doctor, from the Humanitas Gavazzeni hospital in Bergamo, northern Italy, works in one of the country's worst affected areas.


Inside Italy's coronavirus hospital

In Bergamo, in Lombardy, there have been - according to local media reports - 1,245 positive cases of COVID-19, the disease caused by coronavirus.

"After thinking for a long time if and what to write about what is happening to us, I felt that the silence was not at all responsible," Dr Macchini said.

He said he understood "the need not to create panic" but felt "the message of the danger of what is happening" was not reaching people.

The doctor said he "shuddered" at the thought of people complaining about not being able to go to the gym or football games.

Dr Macchini spoke of his hospital preparing and reorganising in anticipation of a widespread outbreak.

"All this rapid transformation brought in the corridors of the hospital an atmosphere of surreal silence and emptiness that we still did not 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," he wrote.

The doctor added: "The situation is now nothing short of dramatic. No other words come to mind.

"The war has literally exploded and the battles are uninterrupted day and night," he said.

"Let's stop saying it's a bad flu," he said.

"In these two years I have learned that the people of Bergamo do not come to the emergency room for nothing. They behaved properly this time too. They followed all the indications given: a week or ten days at home with a fever without going out and risking contagion, but now they can't take it anymore."

"They don't breathe enough, they need oxygen."

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Dr Macchini's post, which has been shared more than 29,000 times, is among the most dramatic accounts shared by medical personnel in Italy.

Another doctor from Bergamo, anaesthesiologist Christian Salaroli, told Italian newspaper Corriere della Sera that doctors are now forced to choose who to treat on the basis of the patients' chances of survival.

"We can't attempt miracles. It's the reality," he said.

The Italian society of anaesthesiology and intensive care published 15 ethical recommendations to consider when deciding on ICU admissions during the virus crisis and the ICU shortage. The criteria include the age of the patient and the probability of survival, and not just "first come first served".

Image: Bergamo has reportedly seen 1,245 cases of COVID-19

In his post, Dr Macchini wrote: "One after the other, the departments that had been emptied are filling up at an impressive rate".

"The display boards with the names of the patients, in different colours depending on the operating unit they belong to, are now all red and instead of the surgical operation there is the diagnosis, which is always the same damned one: bilateral interstitial pneumonia."

He also stressed the virus does not just affect old people, warning that younger people "end up intubated in intensive care" or "worse in ECMO (a machine for the worst cases, which extracts the blood, re-oxygenates it and returns it to the body, waiting for the organism, hopefully, heal your lungs).

He bitterly scorned people "on social networks who pride themselves on not being afraid and ignoring the rules, complaining because their normal lifestyle habits are 'temporarily' in crisis - all the while an epidemiological disaster is taking place".

"And there are no more surgeons, urologists, orthopaedists - we are only doctors who suddenly become part of a single team to face this tsunami that has swept us all".

"The cases multiply, we arrive at the rate of 15-20 hospitalisations a day all for the same reason. The results of the swabs now come one after the other: positive, positive, positive.

"Suddenly the emergency room is collapsing."