F or the past month, as Italy progressively became the new epicentre of the coronavirus outbreak, death has been weighing heavily on the shoulders of frontline medical workers.

With the country’s death toll totalling 10,023 – almost double that of anywhere else in the world – and with 92,472 confirmed cases, doctors and nurses work gruelling shifts to manage hospitals overflowing with patients, often at the expense of their own psychological wellbeing.

As an anaesthetist trained in providing pain relief and managing resuscitation, Gregorio Spagnolin is as used to saving lives as much as letting them go. Yet nothing prepared him for what he saw during the Covid-19 outbreak.

“Accepting the death of a metastatic cancer patient is easier than accepting the death of a 30-year-old patient,” he says. “Now, it’s a daily routine.”

In one day, he now witnesses as many deaths as he used to in the span of a month. But the sheer size of the catastrophe hitting Italy goes beyond numbers.

“The hardest thing to process emotionally is how these people die,” Spagnolin tells The Independent. “They are alone.”

Hospitalised Covid-19 patients follow rigorous isolation and infection control protocols that make family visits impossible. At times, the 31-year-old anaesthetist has bent hospital rules, wrapping his own personal phone in plastic to avoid contagion and give patients the chance to say a final goodbye.

“In theory this is not allowed, but it’s the only humane thing to do,” he says. He declined to provide the details of the hospital he works in, which is located in the hard-hit Lombardy region, as he was not authorised to speak in its name.

Medical personnel are working under enormous pressure, including a high risk of infection coupled at times with inadequate protection. More than 5,000 sanitary operators have tested positive to the virus amid a chronic shortages of face masks, swabs and basic supplies.

This can lead to stress, anxiety and depressive symptoms, according to a study published on the scientific journal The Lancet in February that focused on medical personnel in Wuhan, in the Hubei province of China, where the virus was first recorded in December.

Spagnolin says the commitment to his work feels too engrossing to allow for any consideration of the long-term psychological repercussions.

Physical contact has been removed from both their professional work and their private lives, at a time when perhaps all they need is a hug Ivan Giacomel, psychologist

“When you’re at war you do not realise what you feel,” he says. “You just fight.”

But the weight of this responsibility has become too much for some to bear. A 49-year-old nurse working with Covid-19 patients in the province of Venice died by suicide last week, followed by a second 34-year-old nurse, Daniela Trezzi, in Monza, north of Milan.

According to colleagues who spoke to the National Federation of Nurses (FNOPI), Trezzi might have been gripped by guilt for possibly having spread the infection. An inquiry by the hospital was ongoing to ascertain whether she had tested positive to the virus.

Ivan Giacomel, a psychologist providing support to medical personnel in Lombardy and a member of the Italian Society of Emergency Psychologists (SIPEM), says doctors and nurses with no previous experience of dealing with life-threatening conditions are witnessing the deadliest effects of the coronavirus outbreak, with dire repercussions on their psychological wellbeing.

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“A lot depends on how strong the individual is, but many of them are left feeling shuttered and powerless,” Giacomel tells The Independent. “They are thrown into a situation where people are dying all around them, which is unprecedented in our sanitary system.”

Stress is compounded by isolation, as social interaction with family and friends is annulled in fear of contagion. “Physical contact has been removed from both their professional work and their private lives, at a time when perhaps all they need is a hug,” he says.

Giacomel compared the current situation to a war zone and predicted that long-term repercussions will include post-traumatic stress disorder (PTSD), undermining the health of the sanitary system as a whole for the foreseeable future.

There are nurses who have not properly rested in weeks in order to fill the gap in personnel Giancarlo Cicolini, head of National Federation of Nurses

Organisations including SIPEM and the Soleterre NGO are offering free psychological support to medical personnel and volunteers experiencing symptoms that may affect their decision-making ability and have a lasting effect on their overall wellbeing.

Giancarlo Cicolini, head of FNOPI, says this crisis has hit nurses particularly hard because of an underlying shortage in staff. According to statistics provided by the organisation, Italy’s ratio of 5.5 nurses to every 1,000 inhabitants is well below the EU average of 8.9.

“There are nurses who have not properly rested in weeks in order to fill the gap in personnel,” Cicolini says.