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An Italian Doctor On Lessons Learned From The Coronavirus Outbreak


Italy has by far seen the most deaths from COVID-19. That number now tops 10,000. It's considered the country's worst crisis since World War II. The United States is still weeks behind in terms of the outbreak. What lessons have they learned that they could impart to us? Dr. Giacomo Grasselli coordinates a network of intensive care units in northern Italy, one of the hardest-hit regions. And he joins us now from Milan. Thank you so much for joining us.

GIACOMO GRASSELLI: Thanks. Thank you.

GARCIA-NAVARRO: You coordinate intensive care units throughout Lombardy. And that has been the hardest-hit region of Italy - nearly 6,000 deaths as of yesterday's government count. Did you imagine that hospitals could be hit this hard for this long?

GRASSELLI: Actually not - but we - I didn't imagine it, like, let's say one and a half months ago. But then after the first two, three days since the first case was diagnosed, we immediately realized that this phenomenon would have been overwhelming. And so it is now.

GARCIA-NAVARRO: In March, you had around 800 ICU beds for all of the Lombardy region. How much capacity were you able to add? And has it been enough?

GRASSELLI: Yeah. We started from 800 - 750 actually. During the last five weeks, we have treated in our ICUs 2,400 patients. Of these, around 600 died. And 500 have been discharged. So we have now, in the ICU, 1,500 patients. So we've basically doubled our ICU - but capacity only for COVID-19 patients. Plus, we still have something like 200, 300 COVID-19-negative patients with other diseases in our ICU. So we have more than doubled our ICU bed capacity.

GARCIA-NAVARRO: One of the things that has been a big issue here has been ventilators. How have you been able to deal with the shortage there?

GRASSELLI: Until now, I have to say that using all what we have - all the ventilators we have...

GARCIA-NAVARRO: Has been enough.

GRASSELLI: Yeah. Until now, it has. And we have a certain number of ventilators coming now. Personally, I don't - at least here in Lombardy, I think that we're going to have enough ventilators. So a major problem would raise in case other regions will get to the Lombardy point. But I'm confident that, in Italy, we will see something similar to what happened in China, meaning that Lombardy's Wuhan, and the rest of Italy is other epidemic (unintelligible), which are - OK - quite large but not overwhelming like it's happened here.

GARCIA-NAVARRO: Dr. Grasselli, why do you think Italy's death toll has been so high? - according to the numbers, you're seeing a 10% mortality rate, which is much higher than in other countries.

GRASSELLI: Well, it's a - that's the absolute mortality. But there's a paper just published in JAMA which compares the case fatality rate in Italy with the case fatality rate in China in the different age classes. And if you look at the paper, you can see that the case fatality rate in Italy is exactly the same as in China until the age of 70. And mortality increases a lot.

GARCIA-NAVARRO: So what you're saying is you're getting older patients.

GRASSELLI: Well, that's for sure. I mean, the Italian population is probably the second - the older population in the world after Japan. I expect that the population of carriers - of asymptomatic carriers or patients with little symptoms - it's much, much larger. I mean, what I'm saying - that we see that the tip of the iceberg, OK? And there's a huge part behind that we don't see...


GRASSELLI: ...Because they're not testing them.

GARCIA-NAVARRO: As you know, the United States has now surpassed Italy and China with the most confirmed cases worldwide. What is your view on that? What can Americans expect in the coming weeks? Because there's been limited testing and limited contact tracing, if any.

GRASSELLI: What I think is that they will probably now try to do some aggressive testing and contact tracing. Otherwise, what you can expect - it's like a tsunami of patients that, sooner or later, will infest your hospitals because this disease is probably not so lethal as appears - OK? - because, again, if you could track every single positive patient, you would see that the percentage of patients who have serious disease and go to the ICU and who die is probably not so high. But a small percentage of an enormous number makes a very, very big number. And if you let the disease spread freely, the number of patients who will require ICU sooner or later will overcome the number of ICU beds. At that point, you will need to put in place your emergency plans for wise allocation of ventilators.

GARCIA-NAVARRO: Italy has some of the most draconian social distancing rules in place. People can't go outside for any reason that isn't urgent. Do you think that needs to happen here in the United States?

GRASSELLI: Yes, definitely. That's the only way to avoid a catastrophe. I mean, we're talking about the number of deaths, which is comparable to that of the Second World War. That's why this is not the flu.

GARCIA-NAVARRO: Dr. Giacomo Grasselli is coordinating intensive care units in Lombardy, Italy. Thank you very much. I appreciate your time.

GRASSELLI: You're welcome. Bye. Transcript provided by NPR, Copyright NPR.

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