Coronavirus pandemic piles pressure on Italy’s health system

Names marked with an asterisk have been changed to protect identities.

Rome, Italy – As the number of coronavirus cases and deaths surge in Italy, doctors and nurses under increasing pressure are calling out for help while medical supplies run out rapidly.

On Tuesday, Italy’s Department of Civil Protection said the death toll had risen in the past 24 hours by 345 to 2,503, an increase of 16 percent, as cases jumped to 31,506.

Italy, the European epicentre of the infection, is the worst-affected country after China, where the virus originated and where more than 3,200 have died.

“We see new patients arriving daily. Our emergency room had 30 people queueing yesterday, waiting to see if they were positive,” Lucia Mondella*, a 50-year-old nurse, told Al Jazeera. 

Mondella works at a small hospital near Brescia, a city in the northern Italian region of Lombardy where the virus has taken hold strongly.

Since the beginning of the outbreak, she has been doing eight or nine shifts a week.

There are currently almost 900 patients in intensive care in Lombardy, where more than 16,200 have been infected since the start of the outbreak.

“I don’t know how long we can hold up. If we don’t receive some backup, it’ll be hard,” Mondella said.

On March 9, Italy’s health minister ordered a 50 percent expansion of intensive care units nationwide, saying more beds were needed in infectious disease wards.

Lombardy’s capacity has grown by 70 percent – 1,038 beds are now earmarked to treat COVID-19 patients.

“Our hospitals have converted operating theatres [and] coronary units aimed at those who suffered strokes, and put backup ventilators to work,” Giulio Gallera, health and welfare regional minister in Lombardy, told reporters.

The regional government split hospitals into two categories: one group for infected patients, the others to deal with all other emergencies.

President of Lombardy Attilio Fontana has also presented a plan to transform an entire pavilion of Milan’s old Expo 2015 fair into an intensive therapy ward.

If realised, the project would provide 500 more beds.

“I am amazed by how we are still holding up,” Mario Rossi*, a 28-year-old nurse, told Al Jazeera.

Rossi works in the emergency room at one of Milan’s major hospitals, dealing with infected patients who, after a long recovery in intensive care, need a tracheostomy.

“In the last three weeks, I have seen my hospital keeping up by continuously adjusting its wards, but our ventilators are still not enough.”

An emergency decree presented by the government on Monday allocated 3.5 billion euros ($3.9bn) towards the health system – for the expansion of intensive care wards, the acquisition of new mechanical ventilation systems and protective gear, and the recruitment of 5,000 new doctors, 15,000 nurses and medical staff, including those who are still enrolled in medical schools.

Meanwhile, officials in the regions of Lombardy, Veneto, Campania, Puglia and Sicily have issued local calls for health professionals.

As of Monday, 2,200 doctors and nurses applied to newly created positions in Lombardy and so far, about half have been considered. 

“All the specialising doctors at the University of Brescia are enrolling into the local hospitals,” said Gallera. “However, there is a significant [gap] between those who answered and those who really accepted being dispatched.”

On Tuesday, he told local media: “Yesterday, we had almost no free beds in intensive care. I almost started crying after I received news that 30 ventilators were dispatched here.”

To face the shortage of qualified health workers, Lombardy is in the process of recruiting staff from abroad.

Cuba, China and Venezuela have provided lists of doctors who would be available to start working immediately.

Mario Rossi confirmed that his hospital has received a new team of anaesthetists.

“But we were already understaffed at the beginning, and with the influx of the last four days, we still lack both workforces as well as spaces.”

Carlo Palermo, general secretary of the L’Anaao Assomed doctors’ union, said young professionals should be offered long-term work for sustainability in the National Health Service (SSN), which is understaffed even when not dealing with a crisis.

“They are offering mostly freelance, single-use contracts. The regions enroll them in a highly critical situation, and then, when they are not useful, they get dumped,” Palermo told Al Jazeera.

According to the union, by 2025, hospitals will lack 16,700 medical experts.

“We now have roughly 15,000 specialists who are currently working on precarious contracts,” Palermo said, “If I were a young doctor, I would be attracted by [the prospect of] permanent employment.”

But even if there are enough staff, supplies are running out – specifically protective gear and life-support machines.

The Civil Protection Department estimates that amid the coronavirus outbreak, 90 million masks are needed each month.

Italy does not produce masks, and with the pandemic spreading, some of Italy’s closest neighbours have been reluctant to export supplies they may need soon.

“We have closed contracts for over 55 million. As of March 14, we have already distributed five million masks, but we have also realised that we never received 20 million of them,” said Angelo Borrelli, the department’s head, told reporters on Sunday.

“At the moment, there is a complete shutdown from producers in countries such as India, Romania and Russia.”

Lombardy governor Attilio Fontana said: “Since the problem is not only Italian anymore, any producer tends to keep what is needed in their own country.”

Unlike countries in Europe, China and Cuba, however, have stepped in to help Italy in its time of need.

With the lack of resources becoming a critical challenge, a new and sudden outbreak could still tear the health system down. 

“If the whole Milan had a sudden outburst of contagions like the nearby city of Bergamo, we would have already collapsed,” said Rossi, the nurse in Milan.

For now, as they attempt to boost the health service, both doctors and politicians keep on repeating the mantra: “Stay at home as much as you can.”