"Il Senno di Po", Ruggero Po's audio blog for Start, with the testimony of Claudio Micheletto, director of UOC Pneumology of the Integrated University Hospital of Verona
“Il Senno di Po”, Ruggero Po's audio blog for Start, with the testimony of Claudio Micheletto, director of UOC (Complex operating unit) Pneumology of the Integrated University Hospital of Verona
After eighty days we closed a COVID department, we are trying to return to normal life. We carry many stories, so much effort, but also many satisfactions. It's time to do some peaceful meditation, in this period we have read all kinds of them. This is my decalogue, it does not contain absolute truths, but what I have breathed on the field, day by day.
1) The COVID 2019 virus is a very dangerous infection. Let's look at the numbers: in the United States 16,000 people of influenza die every year (latest publication JAMA 2019); in the last three months the deaths are 107,000;
2) The number of deaths in Italy is real, possibly underestimated because all those who died at home or in RSA are not included in the official estimates. When you close a folder you write the DRG (diagnosis related group). We have been doing this for over 30 years, we know how to do it, people died of COVID, with difficulty breathing and whitewashed lungs, certainly NOT WITH COVID. Don't teach us this practice, we know how to do it;
3) Autopsies have been made all over the world, large numbers were not needed, they are all the same, there is no conspiracy behind it. Alveoli filled with inflammatory material, like all respiratory distress, and changes affecting the microcirculation. Doing many autopsies would not have added anything, since the first day we treated all patients with anti-coagulants, adjusting the dose according to certain blood values. Coagulation increases during inflammation, it is a very ancient notion;
4) The containment measures have made it possible to gradually put an end to the epidemic. Perhaps in some areas they could have been promulgated earlier, in others they could have been discontinued a few weeks earlier, but the substance does not change. In no country has the virus disappeared with alternative measures: the Swedish model has failed, in Brazil the situation is out of control, the United States and England have had to back off;
5) We know how to cure this disease in the best possible way. There are no specific drugs, but if we use competently antivirals, hydroxychloroquine, anticoagulants, cortisone, etc. we can heal almost all patients. We are in trouble with those who have many concomitant diseases. Now we have to analyze the results of our case studies to evaluate which of these interventions is fundamental in the management of COVID. Among the possibilities there is also plasma, which we have collected and used also in the Veneto. There is no conspiracy against plasma, caution comes from the need to evaluate the data. The results of the protocols will arrive shortly and we will discuss them without preclusions.
6) In my personal evaluation, oxygenation and ventilation are fundamental, Veneto has also had good results due to the presence of 16 Pneumologies that have tripled their number of beds, and Resuscitations have done the same. Public Health serves this purpose, to maintain an effective network against frequent diseases such as respiratory diseases, ready to grow in case of need;
7) There is a discipline called risk management. Now would be the time to think about the mistakes. Not to blame someone, but to understand mistakes and not repeat them in the future. Unfortunately, politics has entered this debate: I judge the health interventions according to the card of the Governor or the General Manager. This is not the correct method, I hope that competent people, with a free mind, will be able to objectively analyze the past and propose effective organizational models for the future. One example above all: the reopening of the school and transport;
8) Early detection is useful in all diseases. If I can identify patients with swabs or antibody dosage, I can isolate the patients, or treat them at an early stage, without going to intubation or ventilation;
9) The vaccine is not in antithesis with the rest of the measures, I don't have to choose between vaccine, plasma or treatments. The vaccine is to prevent, we wait for it;
10) The nurses, doctors, physiotherapists have done a great job. But I do not forget the administrators, who worked to hire the technical offices, medical engineering and all these services in a very short time, which have expanded departments and insured the sanitary material.
But we are not heroes. In recent years, in my raids as an omnivorous reader, I have discovered Rocco Schiavone, grumpy vice-commissioner created by Antonio Manzini's pen. In the last book Rocco is hospitalized, and tells us so:
“The hospital seemed to him an airport. With takeoffs and landings. Birth and death, healings and complications, smiles and tears. A painful or healed human mass, full of hopes or illusions. And around them the white coats that he had begun to appreciate more every day. Men and women with tired, brusque faces, always in a hurry, wrinkles and dark circles. He could never have been a doctor. He knew that under the layer of cynicism, as light as the lab coats they wore, there must be a layer of love at the bottom. Otherwise, why dedicate a lifetime to treating human beings? Put them back on track? He hated humans, barring a few exceptions. And he could not stand the complaints and anxieties that others unloaded on him. "
It's just like Rocco. You understand everything, without that annoying rhetoric
This is a machine translation from Italian language of a post published on Start Magazine at the URL https://www.startmag.it/mondo/vi-racconto-80-giorni-in-un-reparto-covid-parla-micheletto-direttore-pneumologia-verona/?utm_source=rss&utm_medium=rss&utm_campaign=vi-racconto-80-giorni-in-un-reparto-covid-parla-micheletto-direttore-pneumologia-verona on Mon, 08 Jun 2020 05:00:29 +0000.