FOCUS-Death at home: the invisible trace of the coronavirus in Italy

By Emilio Parodi and Silvia Aloisi

MILAN, Apr 5 (Reuters) – It took up to eleven days of insistent phone calls for Silvia Bertuletti to convince a doctor to visit her 78-year-old father Alessandro, sick with fever and short of breath.

When a doctor on call approached his home near Bergamo on the afternoon of March 18, the epicenter of the coronavirus outbreak in northern Italy, it was too late.

Alessandro Bertuletti was pronounced dead at 1:10 a.m. on March 19, 10 minutes before an ambulance that had been called hours earlier arrived. The only medication that had been prescribed over the phone was a minor pain reliever and a broad-spectrum antibiotic.

“My father was abandoned to die alone, at home, without help,” said Bertuletti, 48. “They just abandoned us. No one deserves an ending like this.”

A series of interviews with families, doctors and nurses in the Lombardy region of northern Italy, hit hard by the coronavirus outbreak, indicate that Bertuletti’s experience is not uncommon, that many patients die at home when Symptoms are not controlled and telephone consultations are not always sufficient.

In the province of Bergamo alone, according to a recent study of death records, the actual number of deaths from the outbreak could more than double the official figure of 2,060, which only records deaths from hospitals.

With global life-saving efforts focused on increasing the supply of respirators, some physicians claim that lack of primary care is proving just as costly because health workers are unable or unwilling to make home visits, consistent with the global strategy to move to the provision of remote medical advice.

“What has led to this situation is that many family doctors have not visited their patients for weeks,” said Dr. Riccardo Munda, who works for two in Selvino and Nembro, two cities near Bergamo, after a colleague contracted the virus.

“And I can’t blame them, because that’s how they saved their own skin.”

Munda said many deaths could be prevented if those with the disease at home received immediate medical attention. But the doctors, with overflowing hospitals and without enough face masks and protective suits against infection, were dissuaded from making house calls except in extreme need.

“Doctors prescribe a treatment for people who stay home. But if that treatment doesn’t work, if there is no doctor to review and change or adjust the medications, the patient dies.”

While hospital workers were given priority access to the masks, some family doctors say they have run out of them, making them feel unable to visit patients safely.

A spokeswoman for the state health agency ATS in Bergamo said authorities in the Lombardy region, considered among the world’s most efficient in health services, asked family doctors to “treat patients by telephone in the as much as possible, “limiting home visits” to reduce contagion and waste of protective equipment. “

The spokeswoman said 142 doctors in the Bergamo area are ill or in quarantine, although all of them have been replaced.

Authorities are now mobilizing to strengthen primary care in accordance with the recommendations of the World Health Organization, which says that providing this service safely should be a priority for governments just behind intensive care. .

In the province of Bergamo, six special medical units began operating on March 19, each adequately equipped to visit the sick in their homes. In nearby Milan, where deaths in homes and in nursing homes doubled in the second half of March, similar units have started operating only since March 31.

HIDDEN NUMBER OF DEATHS

The official number of deaths in Italy reached 15,362 on Saturday, almost a third of the world figure, but there is increasing evidence that this estimate is far from reflecting the true magnitude of the impact of the virus since many people are dying in their houses.

A study by the local newspaper L’Eco di Bergamo and the InTwig consultancy using data provided by local municipalities, estimates that 5,400 people died in the province of Bergamo during the month of March, six times more than a year ago.

Of these, the study estimates that up to 4,500 people succumbed to the coronavirus, more than double the official number. To perform the calculation, 600 people died in residences were taken into account, as well as the evidence provided by the medical services, according to their authors.

ATS did not respond to a request for comment on the study findings.

Pietro Zucchelli, director of the Zucchelli funeral home that serves several municipalities in Val Seriana, near Bergamo, said that in the past two weeks more than 50 percent of his work has been removing bodies from homes.

Before, the majority of deaths occurred in hospitals and nursing homes.

Munda, the doctor who treats Selvino and Nembro, said he has been visiting patients at their homes since the end of February, administering antibiotics for bacterial pneumonia and oxygen therapy when necessary.

Although antibiotics are not a cure for the virus, he said, they can serve to treat some of the complications from the infection and help patients recover without needing to be hospitalized.

To protect himself, he spent 600 euros on facial masks that he sterilizes at home with steam every night.

More than 11,000 health workers have contracted the virus in Italy and 80 of them have died, many of them family doctors.

The Calvary of the Bertuletti family shows how primary care, the first line of defense of the health system, has sometimes failed in its duty in the fight against the coronavirus outbreak.

In several European countries, such as the United States, physicians are encouraged to make telephone consultations whenever possible instead of attending patients in person.

With his own GP hospitalized, Bertuletti says he repeatedly called his surrogate, who initially advised him to give his father a painkiller with paracetamol used to reduce fever.

As his father got worse, Bertuletti reiterated the calls. “He said: ‘I am not obliged to make home visits, be patient,'” said the daughter of the deceased.

Contacted by Reuters, the doctor who treated Bertuletti, who declined to be identified, said tearfully that doctors are being forced to make terrible decisions.

The doctor said that he has been receiving between 300 and 500 phone calls a day and that he is covering the sick leave of a classmate.

“I had to make a selection, I couldn’t visit those who had a cough and fever, I could only go see the most serious cases.”

The association of family doctors in the province of Bergamo estimates that 70,000 people in the area may be infected.

“Despite our best efforts, it is not possible to get everyone to the hospital and sometimes families prefer to keep the sick at home for fear of not having another chance to say goodbye,” said the mayor of Bergamo, Giorgio Gori.

Like him, mayors across Lombardy are crying out for help.

“We have sick citizens in their homes who feel abandoned, I could give hundreds of examples,” Giovanna Gargioni, mayor of Borghetto Lodigiano, wrote in a March 27 letter to regional health authorities on behalf of a group of local councilors.

Even in Milan, the main city of Lombardy and the financial capital of Italy, doctors say that promises by regional authorities to provide medical personnel with protective equipment such as face masks and swabs have not yet materialized in some cases.

“We are working without protection and no one has tested us,” said Roberto Scarano, a surgeon and family doctor in the city.

“Meanwhile, the virus is spreading through homes, entire families are becoming infected and no one is taking care of them.”

Ambulances, which used to arrive within a few minutes of the emergency services receiving a call, can now take hours, according to doctors. Oxygen bottles are so scarce that nurses rush to claim them from still-bereaved families as soon as their loved ones die.

“We are used to seeing people die, but normally you feel like you are accompanying them at the end of their paths,” said Maura Zucchelli, a nurse at Itineris, a private company that provides home health care in the Bergamo area.

“Now you go to people’s houses and in 48 or 72 hours the patient is dead. It is exhausting. This is like war.”

(Edited by Mark Bendeich and Mike Collett-White; translated by Darío Fernández in the Gdansk newsroom)