Italian doctors cry foul over protection

Medical staff in the hardest-hit northwestern Italian region of Lombardy have blamed the government for not doing enough to protect them and stem the spread of the virus. Doctors in particular say their role in the fight against the virus has been underestimated, leaving them to work without adequate protection.

Paola Pedrini, a general practitioner in Bergamo and the head of the regional association representing general practitioners, believes that protective equipment arrived in her province too late, when the number of infections was already going through the roof.

Though the shortage of personal protective equipment (PPE) at the national level has been a recurring theme almost since the beginning of the outbreak, Lombardy's doctors say something needed to be done as soon as the first reports of an epidemic started coming out of China.

Last month, Pedrini sent a cease-and-desist letter on behalf of her colleagues to the regional health authorities and the national Health Ministry, accusing them of not putting together a plan of action to bulk-buy protective equipment for physicians when the World Health Organization issued the first warnings of a pandemic. The letter also points out that lax measures around the testing of medical staff caused many practitioners to keep working despite being infected. 

Sick, but still working

Pedrini said that in her home province of Bergamo, doctors with few symptoms were sometimes encouraged by the local health department to continue working. 

"We were thrown into the fray," Pedrini said. "We didn't have protocols or guidelines for us on the ground explaining how to manage patients or modify our own work. This happened despite everything we knew had already been happening in China. They definitely underestimated the issue," she said.

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Another general practitioner in Alzano Lombardo — a little town north of Bergamo where a police investigation is underway to determine whether the failure to sanitize the hospital's emergency room in February may have contributed to the town's cluster of infections — echoes Pedrini's concerns.

The physician, Alessandra Raimondi, said that guidelines on how to behave in the epidemic came to her practice with a five-week delay, and that she had to fight to get tested even though her daughter, whom she lived with, had tested positive. "I firmly requested a swab, but [the health department] wouldn't provide them," Raimondi said. "They would tell us, wear a mask and keep working."

Left to their own devices

Bergamo's health department and Lombardy's regional government later announced that they had bought hundreds of thousands of face masks for medical professionals. But Pedrini, the doctor in Bergamo, said they weren't enough, and that her practice had to buy their own protective equipment to continue seeing patients. 

Bergamo's health department said in an emailed statement that it is considering every issue presented by physicians in order to better understand the moment. It confirmed that there have been issues around the availability of protective gear in the first two to three weeks of the emergency.

Massimo Vajani, another general practitioner and head of the local medical professionals association in Lodi, outside of Milan, said that he shut down his practice at the end of February out of his own initiative, before the Ministry of Health and the local health authority advised doctors to do so. 

"At the beginning we were improvising, unfortunately. Maybe people didn't understand the importance and the gravity of the contagion, and, not having protective gear, maybe someone still saw patients in person and got infected," said Vajani.

In all of Italy, 139 physicians have died since the beginning of the epidemic. Almost half of them were general practitioners. 

Planning ahead

The plight of local doctors emerged in another letter that the federation of Lombardy's medical associations recently sent to the regional health authorities, sparking a heated back-and-forth with the region's Welfare Ministry.  

In their letter, physicians both in primary care and in hospitals lamented lack of coordination on the shutdown of at-risk areas, which eventually resulted in an explosion of cases in Bergamo province, where areas that became clusters weren't reportedly closed off early enough.

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They also highlighted a mismatch between the officially registered number of positive cases and the real one. And as it emerged that there could be thousands of patients that are positive but couldn't access testing, it also became clear that among them there could be doctors.

Lombardy's government publicly responded to the accusations by defending its work and assuring it did all it could to provide medical workers with adequate protection. The government didn't respond to DW's repeated requests for comment. 

Though the tally of new infections has slowed, Lombardy's total number of infected people has surpassed 64,000, accounting for almost a third of the country's total. A recent investigation by the daily Corriere della Sera pointed out that serious shortcomings also happened at the national level, where a lack of clear instructions on how to implement a state of emergency initially left regions in the dark on how to coordinate their response.

Francesco Venneri, clinical risk manager and co-founder of the Italian Network for Safety in Healthcare, thinks that only proactive and preventative measures can save a system from collapse in case of an adverse event.

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"Just as we simulate the evacuation of a hospital in case of fire, we need to consider that we might have an infectious disease emergency," Venneri said. "If we don't even consider that as a possibility, of course we will find ourselves without protective gear. The moment it actually happens, we will never be ready."