Lessons from Northern Italy: Why even great Health Systems collapse under COVID-19 case load

By Elie Lehmann, HGHI | March 10, 2020

Here is something many people in high-income nations take for granted: The capacity of their excellent health systems to take care of patients suffering from COVID-19.

The dramatic scenes currently unfolding in Italy show a different reality. As the novel coronavirus spreads through an immunologicaly naive population at rapid speed, even one of the best health care systems in the world is quickly reaching its limits.

Take this number from Antonio Pesenti, head of the crisis team for intensive care in Lombardy, the region at the epicenter of the outbreak in Italy: By March 9, the 50 hospitals in the region were at ICU capacity as they were handling around 600 COVID-19 patients needing intensive care. (Source)

A viral Facebook post by Daniele Macchini, a physician in the region, described the disease as a “tsunami that has swept us all” and urged against portraying the virus as “a bad flu.”

Translation from Twitter of Dr. Daniele Macchini’s Facebook Post

Facebook and Twitter haves become real-time windows into how the epidemic is unfolding: An intensivist in northern Italy reports of overwhelmed hospitals running at 200% capacity.

All routine procedures have been stopped. Operating rooms have been transformed to intensive care units and other emergencies like trauma and stroke are being diverted or not treated at all. There are hundreds of people with severe respiratory failure who have no access to any form of treatment. People above the age of 65 are not even being assessed, and when they arrest, no ICU staff responds. 

Translation of Twitter Thread from Intensivist in Northern Italy

On Feb. 25, Italy had about 350 confirmed coronavirus cases and only 11 deaths. Two weeks later, by March 10, the numbers have risen to 10,149 known cases and 631 deaths. Crisis manager Pesenti observed that the infection rate in Lombardy has doubled every 2.5 days and estimates that by March 26th, there will be 18,000 positive cases with 2,700 – 3,200 requiring intensive care. 

How did Italy get to this state of disaster so quickly? Just two weeks ago people were being advised to avoid large gatherings and now, medical staff is falling ill, ERs are collapsing and patients are dying in the ICU. Lombardy is known to have one of the best healthcare systems in all of Europe and the country has tested over 42,000 people as of March 7th compared to only a few thousands tested in the U.S.(the exact number is unclear at the moment as the CDC only reports tests performed, note people tested, and sometimes people are tested more than once.)

Italy got to this point because any nation may get to this point. The U.S. is only 11.5 days behind Italy and currently on the same trajectory for exponential growth of the rate of infections. As Ashish Jha, faculty director at the Harvard Global Health Institute put it on Twitter: This can happen here.

Further reading:

Italy’s coronavirus crisis could be America’s

Vox | Julia Belluz | March 10, 2020

WHAT DOES THE CORONAVIRUS MEAN FOR THE U.S. HEALTH CARE SYSTEM? SOME SIMPLE MATH OFFERS ALARMING ANSWERS

Stat News | Liz Specht | March 10, 2020