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Updated: Mar 21, 2020 11:27 IST

At some Spanish hospitals, doctors and nurses resort to taping garbage sacks to their arms to shield themselves while they work to save an avalanche of patients fighting for breath. They’ve run out of disposable coats.

The plastic glasses they wear are of such poor quality that medics can barely see through them, so they find the pulses and veins of coronavirus patients by touch, said Samantha Gonzalez, a 52-year-old nurse who works in the emergency room at the Txagorritxu hospital in the Basque city of Vitoria.

“This is not the first world anymore—it’s a war,” said Gonzalez.

The main hospital in Bergamo, northern Italy, is struggling to keep up with the influx of patients as personnel fall sick themselves. Authorities are seeking to transfer the least serious virus patients to local retirement homes equipped with oxygen apparatus, after moving the elderly into hotels.

“Just in the nephrology department, three out of 13 colleagues have fallen ill, one of them seriously,” said Giuseppe Remuzzi, a former head of the department of medicine at the Papa Giovanni XXIII hospital in Bergamo who has joined efforts to contain the outbreak. “This is a scary, terrible situation.”

With Italy overtaking China as the most deadly center of the pandemic and Spain recording its grimmest day yet for fatalities, health care in the two countries is buckling in a way not seen in peacetime.

How they are trying to cope with the crisis is already a worrying lesson for other European countries as the harried ranks of doctors and nurses become depleted by contagion and efforts to find space and breathing aids for patients look increasingly futile. Finding space for the dead is also tougher. Italy has brought in the army.

Hospitals in Italy and now Spain have been overwhelmed by the scale of admissions but more importantly the speed. Staff have watched the number of known cases multiply five-fold or more in just a couple of weeks and are scrambling to dedicate wards previously used for geriatric care or dermatology to coronavirus sufferers.

Across Europe, from the U.K. down to Greece, hospitals are limiting their intake, cancelling non-urgent procedures and appointments and in some cases keeping first-aid services to only the most serious emergencies. Governments have shut down schools, bars and restaurants in an attempt to keep people apart and halt the rapid contagion to take pressure off the health-care system.

Italian authorities had not expected the speed with which the virus arrived from China, nor the pace at which it spreads, said Giovanni Rezza, head of the infectious diseases department at Rome’s Superior Health Institute, the country’s national health authority. The last influenza pandemic was in 2009, he said.

“Like other European countries, Italy wasn’t completely prepared for the coronavirus,” said Rezza. It’s only in some two weeks that Italy will find out whether the government’s nationwide lockdown and social distancing rules have had an impact, said Rezza.

“The lockdown is only delaying the spread of the epidemic, we expect that there will be new outbreaks in future,” said Rezza. “But in the meantime we have to equip hospitals with more intensive care beds, even in Lombardy which is one of the best-equipped regions in Europe.”

The province of Bergamo, which saw its first virus case in late February, now has more than 3,000 cases, making it the most heavily-hit province in Lombardy, the most affected Italian region. Some patients are being transferred to other Italian regions and new treatment centers for virus cases are being set up in cities including Milan and Rome.

“We’ve used up all the intensive care beds we’d stored for natural disasters, now we’ve reached the limit,” said Remuzzi, director of the Mario Negri research institute. “Patients come in after a stroke or a hemorrhage, and it’s only afterwards we find out they are positive for the virus.”

That’s one of the biggest challenges facing hospital staff. Doctors say they are scared of becoming contaminated because patients who come into hospital for other illnesses are only later discovered to be infected. In Italy, 8% of Covid-19 cases are medical staff.

With infected medics confined to their homes for four weeks, the Bergamo hospital has trained 1,500 people in seven days to give respiratory assistance, including oculists and dermatologists. Personnel are being given daily updated instructions on how to clothe themselves in protective gear, including masks which have to be replaced every four hours and splash guard goggles.

The problem first is finding enough ventilators for them to deploy, said Lorenzo Leogrande, who heads the Italian society of clinical engineers.

“Even if you create a giant new structure for patients now, the problem is that there could be a month-long wait for ventilators that have been ordered to arrive,” said Leogrande, who is in charge of technological equipment at Rome’s Policlinico Agostino Gemelli hospital. The ventilators come from Germany, China, Japan, the Netherlands and the U.S. and there’s no guarantee those countries won’t need them, he said.

In Spain, authorities have gone in a matter of days from recommending people to wash their hands often to declaring a state of emergency and forbidding citizens from leaving their homes unless they really need to.

The country’s main public hospitals are increasingly looking like field hospitals, fully focused on treating coronavirus patients. At Hospital Clinic in Barcelona, a new department is converted to treat coronavirus every day. At Txagorritxu Hospital in Vitoria, dormitories have become rooms for patients and staff are sleeping in management offices.

“This thing blew up on us,” said Pelayo Pedrero, a doctor and the head of labor risk prevention at doctors’ union AMYTS in Madrid. “No one was ready for this. They didn’t buy the supplies, they didn’t prepare the hospitals to receive and treat all these patients. Not just in Madrid or Spain, but all over Europe.”

Less than a month ago, the emergency room at Txagorritxu was receiving an average of about 15 people with severe pneumonia every night.

At that time, the protocol was that only patients who had been abroad to countries such as Italy and China should be tested. So those infected with coronavirus were initially hospitalized together with other patients. The disease spread among workers too, to the point that Txagorritxu became one of Spain’s first focus of contagion.

“When we started to wear marks outside we were told to stop to because people would be scared,” said Gonzalez, the emergency-room nurse. “Now that doesn’t matter because everyone is scared anyway.”

In Catalonia, which has the second-largest amount of cases, 14% of the 2,702 people sick with coronavirus were healthcare workers, regional authorities said on Thursday. The same day, the first death of a medical worker infected with coronavirus in Spain was recorded, a 52-year-old nurse who had been hospitalized in the Basque city of Bilbao.

“Many who have come in close contact with the disease are not going into isolation until they have symptoms,” said Pedrero. “They’re wearing masks and working to the point of exhaustion.”

Like other hospitals in Spain, Hospital Clinic in Barcelona is making lists of retired medical personnel aged 65 to 69 and medical and nursing students in their final year. They will start calling them when they run short of personnel.

While shortage of medical workers might still be a few days away, the shortage of supplies is already there. At the Barcelona hospital, doctors and nurses put two surgical masks on top of each other because of a dearth of the higher protection ones.

Things at Txagorritxu change fast. Gonzalez, who has almost three decades’ experience as a nurse, has seen veteran intensive care doctors and nurses break down into tears when they come back to the hospital after a two-day break.

The state of emergency has given medical services some respite. Fewer people in the street also means fewer accidents, and those with mild symptoms of other illnesses are more likely to stay home. But workers in Spain scrutinize the news for the latest developments in Italy.

“We have a false feeling that we have things under control now, but I’ve seen this before in past days,” said Gonzalez. “This is like a tsunami. By the time you realize a wave is coming, it’s already on top of you and all you can do is run and run.”

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