It is probably a human weakness to always try to relativize the transferability of cautionary examples to one’s own situation with reference to certain situational differences: This is how China appeared at the beginning of the pandemic enough alien to many and far enough away to feel safe from similar chaos in Germany. And even the dramatic situation in Italy, which is now in direct proximity and undeniably before our eyes, some may want to dismiss it with reference to the differences between the Italian and German health care systems. Thirteen doctors from Papa Giovanni XXIII Hospital in Bergamo are now trying to show that this stance is naive and dangerous in an insightful article in a special issue of the internationally important medicine magazine “New England Journal of Medicine” (NEJM Catalyst).
“This catastrophe, which is happening in the prosperous Lombardy region, can happen anywhere,” is how her three-sided appeal ends there. Her hospital is a new and ultra-modern facility with 48 intensive care beds, and Lombardy is one of the richest and most densely populated regions in Europe. Your clinic has now reached a point far beyond its actual capacity. A third of the beds were occupied by Covid 19 patients, 70 percent of the intensive care beds were reserved for those critical patients with a reasonable chance of survival. Medical standards that would otherwise apply could no longer be maintained: long waiting times were inevitable, old patients could no longer be resuscitated and would have to die alone. In other clinics in the surrounding area, the situation is even more dramatic:
The doctors take this description of the situation as an opportunity to request new solutions for dealing with Covid-19, which not only affect the hospitals but should be thought of as a whole. The entire health system was developed from the perspective of patient-based care. A pandemic, however, requires a community-based perspective. For example, contaminated hospitals, patient transports, and sick medical staff would contribute to the spread of the epidemic. To prevent this from happening, the doctors suggested that the treatment of sick people at home should be increased by using ventilators, blood oxygen meters and nutrition with telemedicine monitoring so that the clinics can concentrate on the care of critical cases.
At the same time, the doctors emphasize that a lock-up strategy is still paramount: social distance has weakened the spread by 60 percent in China. Social scientists, epidemiologists, logisticians, psychologists, and social workers, all of them should now be asked together to find an answer to the crisis, because “We need a long-term plan for the next pandemic”. The coronavirus is the Ebola fever of the rich, not overly fatal, but very contagious and therefore a danger, especially for medically developed and centralized societies.
If you read the short text, you can hardly avoid reading the descriptions as a wake-up call, doing everything to avoid similar conditions in Germany – and trying to learn as much as possible from the Italian situation. Virologist Christian Drosten classified the paper on Twitter as an “urgent reading recommendation”, “all decision-makers should know this text”.