professor Caselli what is the situation
in number D today well the situation is
critical because we have a huge number
of patients currently being treated in
the ICU and you know our hospitals I
know the situation of the ICUs very well
since I am coordinating the network of
kovat 19 ICUs
we now have around 600 patients being
treated in the ICU in about 5055
dedicated ICUs and we have treated a
total of more than 700 patients from the
beginning of the epidemics so if you
think that in Lombardy the total number
of ICU beds was about 800 850 something
like that before the crisis you can you
can understand that it's an incredible
stress for the system what is the age
range that you are dealing with the the
median age of the patients admitted to
the ICU is 65 years
this means that half of the patients are
older than 65 and half are younger than
65 in the last five days seven days we
have we are seeing an increase in in
young people so for example we had a
patient 20 year old boy who was
intubated two days ago
what about Joseph of all children we
have three or four neonates I think who
tested positive and who have not so
severe disease and children as in China
are basically spared at least from the
symptoms I'm not sure that they are not
infected but apparently they don't get
sick now given how incredibly pressure
do you are do you have to in a sense
choose between different patients as to
who you can treat in other words do in
the end have to say long and I'm sorry
if you're over 80 we really can't do
anything no what we are doing what we
exactly every day in our life as
intensivist so independent from the
corona virus outbreak when an
intensivist is called to evaluate a
critical patient he always has to make a
decision about is this patient going to
benefit from intensive care and this is
a complex decision that takes into
account several factors not only age of
course but also I would say biological
age so comorbidities other illnesses
past illnesses current condition health
status frailty and so on so this is
something that we do every day okay
clearly in this situation of incredible
mismatch between the resources we have
and the number of patients who we should
allocate we have to be more strict in
this I will not call it selection I
would say triage of the patients but the
what we what is driving us always is the
consideration that we what we have to do
is trying to grant to every patient who
can benefit from ICU and I see you met
and clearly not all the patients will
benefit from an ICU bed because if a
patient wait I don't know very old or
with a lot of past illnesses or with a
very fragile condition at the beginning
guess bed pneumonia and it's a tube and
a mechanical ventilator that his chest
chances of surviving and of returning to
an acceptable quality of life are very
low right well this is a consideration
that we do every day yeah clearly now
it's more urgent because we have a huge
amount of people in a very limited
period of time but at least now we have
been able to grant ICU admission and
intensive treatments to every patient
who has been judged the candidate as
candidate to to those treatments we have
377 patients and six dead now do you see
what we are doing as adequate or do you
look across and say you should be doing
what we're doing
no I don't think that we can compare the
novice because
as we've seen also in China you know in
the Wuhan region they had a huge number
of patients and the higher mortality
then in the other regions outside Wuhan
work they had smaller epidemic smaller
epidemic episodes so I think that what
happened in Lombardy is just like a bomb
that explode that exploded you know so
it's the region has a very high density
of population all those people come and
go from Iran every day they are
connected to every part of Europe and so
the that's where the epidemic started
and then I think that at least for now
surrounding countries are seeing how can
I call the metastasis of this but not
the center of the disease that's even
even in the surrounding regions in Italy
the number of patients and the number of
critical patients are smaller than in
Lombardy and in Lombardy we have I'm
sure you know all um but is one of the
richest region in in Europe so we have a
very good health system very modern very
efficient so I don't think that we the
problem is that it exploded there and
and and before you can realize what's
happening you are like overwhelmed by
the mass of patients so hopefully in
other countries it's not it's not
behaving like this but what is very very
very important for every country and
that's why I'm at the rear is why I'm
doing this is that everyone must
understand that if you don't if you are
not very careful in controlling the
spread of the disease this disease will
overwhelm your system no matter how
efficient good modern it is so the most
important thing besides you know
creating new ICU beds besides buying new
ventilators which is ok for people who
are already sick but the most important
thing is to avoid a lot of people
becoming sick so you have to teach the
population that they have to behave in
some way in order to avoid the spread of
the disease I don't know where we are
you are now putting in place
of severe measurements of containment
and that's the only way that we can try
to to deal with this incredible number
of patients who are coming to our
hospitals and and then the original
differences are different difficult to
explain I don't know I'm not an
epidemiologist I observed the numbers
and the facts and I see that in other
countries they have smaller numbers
lower mortality
I have no basically have no explanation
for that we Italy the the average age is
very is quite high so most of the people
who die there are patients above 80
years old so patients who really cannot
reasonably survive to a severe acute
respiratory failure like this actually
yourself your explanation to us of the
bomb that was in Lombardi the the
ingredients were such that you got hit
very very badly and those ingredients
don't exactly exist necessarily anywhere
else that's one explanation and and and
also I mean the bomb is it's worse than
a bomb because you know a bomb is at one
event limited in time and in space this
is an event that you know keeps
increasing and it's contagious so so and
indeed indeed everything happens very
quickly if one had told me that in two
weeks we would have created 500 ICU new
ICU beds or completely reorganized our
hospital system I would have said okay
you're crazy and it's happening now one
more question professor casselli
are your own doctors and nurses being
infected we had a certain number of
health care workers infected at the
beginning when you know everything was
starting to happen so now I think that
they are using properly the personal
protective equipment and at least
amalgamates anesthesiology is the number
in fact in doctors is decreasing but
again that's another big problem because
a certain number of health care workers
are affected in those diseases it like
SARS or those coronavirus diseases so
another important message for the
population is that and for the other
health care system who are going to face
this is to train your health care
workers on the use of proper on the
proper use of PPE because that's one of
the most important thing at this point
in the development of this pandemic is
it possible do you think for Britain to
suffer a bomb as you put it in other
words a sudden explosion of a real
intensity of this outbreak possible it's
possible I I think that you have the
advantage of being late compared to us
so you're now realizing that this can
happen and it can happen in again in a
rich and modern and well-organized
region okay so it and I think that
everyone you know I mean I'm being
contacted by several people and several
from all over the world who are asking
us what are you doing how did you do it
and the and this is a great advantage
for you so I hope that in other
countries this is not not going to
happen because they know that it can
happen and they have to be to get ready
to be prepared
professor Griselda thank you very very
much for talking to us and good luck and
our thoughts are with you okay thank you
thank you Thanks
you