Inside the outbreak: War footing

The intensive care team at Cremona Hospital passed its limit days ago. Nurses and doctors no longer can say how long they’ve been working. When they do go home to sleep, said nurse Carla Maestrini, they wake every hour with nightmares.

Since a COVID-19 outbreak erupted in Italy barely four weeks ago, 107 patients have died out of at least 845 patients treated for the virus at Cremona Hospital. At the eight-story, multi-wing facility in Lombardy, Italy’s wealthiest region and the epicenter of the epidemic, no one with COVID-19 has yet to recover. Surgeries have been postponed so that surgical wards can transform into intensive care units, and a triage tent for incoming patients sits in front of the hospital.

Nothing seems to be working. Patients lie face-down while ventilated, the normal protocol to allow gravity to speed oxygen into the bloodstream. Nurses have begun also switching patients front to back, desperate to see change. “We need something good to happen, so we know we’re doing the right thing,” Maestrini told Britain’s Channel 4. “There have been many deaths, and this is destroying us.”

Italy reported its first COVID-19 cases on Feb. 21, and in less than one month the country has gone from three to more than 31,500 confirmed cases with the world’s highest death toll outside China. At 42.33 deaths per million, Italy has the largest per capita death rate from the virus in the world. Some doctors in northern Italy report working 48-hour shifts, in hospitals where every ward has been transformed for respiratory care, forced to admit 50 or more patients a day with pneumonia brought on by COVID-19.

The number of new cases this week is Italy’s highest yet—topping 3,000 every day since March 14. At the same time, recovery rates are lagging, a worrisome trend considering that the Lombardy region, which has most of the cases, has some of the best medical facilities in Europe. “It has been a fireball,” said Gaetano Sottile, president of Italy for Christ.

Sottile founded the country’s top evangelistic organization 37 years ago and as a leading pastor has helped organize churches and coordinate international efforts to assist in other crisis moments, like recent earthquakes and Italy’s prolonged refugee crisis. In this emergency, he said, “we feel we are trapped with no way out.” As medical shortages mount, and hundreds of medical caregivers themselves have come down with the virus, finding ways for Christian ministries to help in a country on lockdown is a challenge.

This week Sottile helped coordinate one project to bring some good news to Cremona: the arrival of a new hospital. On Tuesday, U.S.-based aid group Samaritan’s Purse flew in a mobile hospital similar to ones it has deployed in war-torn Iraq and to treat hurricane survivors in the Bahamas last year.

The tent facility is a 68-bed respiratory care unit that can also treat ICU patients, according to Samaritan’s Purse vice president Ken Isaacs. The plane carrying it also brought 32 medical staff, he said, with another 30 doctors, nurses, and other personnel (including respiratory therapists and pharmacists) scheduled to arrive later this week.

The U.S. group has a working relationship with the World Health Organization to set up emergency field hospitals in disaster zones. But the coronavirus crisis presents new hurdles: European travel bans plus heightened medical protocols in a country on unprecedented lockdown. Sottile contacted Italian Senator Lucio Malan to help cut through the red tape.

Malan, a fellow Christian and member of the center-right People of Freedom Party, worked with the Ministry of Health, Italy’s Civil Protection agency, and the governor of Lombardy to expedite approval for the facility along with its foreign medical staff—all in under four days.

Sottile called the hospital “a miracle” coming in the midst of a crisis crying out for outside help. Italians are more politically divided than Americans, he said, and tensions between Catholics and Protestants fester. Yet Italians are finding ways to come together across political and religious lines amid a pandemic. Still, he acknowledged, “We have many hard days ahead.”

American policymakers and public health experts are closely watching Italy, believing that the United States may follow its path. The outbreak began in Italy with three cases, including two Chinese tourists, whom health officials quickly isolated in Rome. But for weeks no one detected a case involving a 38-year-old man near Milan who likely transmitted the virus to healthcare workers, family, and friends—forming a cluster that spread the virus across Europe and beyond. Italy had 10,000 cases by March 10; 20,000 cases by March 14; and passed 30,000 on March 16.

Draconian restrictions have yet to slow new cases. Prime Minister Giuseppe Conte this month declared a lockdown in the Lombardy region, and within days extended it over the whole country. Anyone stepping outside his home must carry a self-prepared permit certifying he is going to buy groceries, to essential employment (chiefly, government work or healthcare), or to seek medical attention. Movement without a permit or for other reasons leads to fines of up to $1,000 plus a permanent record. Sporting events and large gatherings are off. Schools, restaurants, and all nonessential retail shops are closed.

“It’s hard on the Italian psyche that loves to gather,” said Michael Schaafsma, founding pastor of Punto Luce Church in San Giuliano, a Milan suburb. Italians find themselves cut off from family and friends, and “the only things open are medical facilities and grocery stores.”

After initial frustrations, residents are adjusting to the lockdown, he said. “We are seeing this spread so quickly, and as a church that loves to gather we are willing to give that up if that’s what it takes to help this rate go down.”

All Catholic Church groups and evangelical organizations have complied with prohibitions on gatherings, according to Alessandro Iovino, editorial director of Real Inside Magazine, an online Christian news outlet based in Naples. Evangelical churches, even small and remote churches, have organized online meetings using Facebook, Skype, or other platforms, he said. The Catholic Church is holding open most of its church buildings for personal prayers, but Pope Francis has directed Italians to “stay home and follow the directives of the government.”

One of the hardest prohibitions is against hospital visitation. “Our people are dying alone,” said Schaafsma. A 72-year-old elder in one nearby church died this month from the virus without family present, and medical workers tell Schaafsma—an American who has worked in church planting in Italy since 1996—that COVID-19 patients, and others, struggle to recover in part because they lack support.

Italy has the world’s oldest population after Japan, a factor many believe has contributed to its high death rate. Church members are stepping in to care for elderly neighbors stranded in the lockdown. Schaafsma grocery shops for a widow on his street, hanging the shopping bag on the fence for her to collect. He is meeting with other church members only via Skype.

Just a week ago, Italy’s confinement orders appeared unprecedented. But as COVID-19 has continued an uncharted course, with European countries accounting for more than a third of all confirmed cases (75,000 as of Wednesday), other countries are following. France began requiring permits for all outdoor movement on March 16, with fines of 135 euros per violation. It also ordered all restaurants, cafés, and retail stores closed.

On Tuesday, the European Union announced an unheard-of ban on nonessential travel into the 27-country bloc for 30 days. Inside the bloc, 19 countries have closed their own borders, including the border between France and Germany. In a speech Monday night, French President Emmanuel Macron said repeatedly, “We are at war.”