One small advantage America has in tackling the coronavirus outbreak is that it didn’t start here. We have the opportunity to see what worked and what didn’t work in China, Italy, and other places, and we have the chance to anticipate some of the things that they didn’t anticipate. Italy, in particular, can be very instructive for our medical hospitals and responsible government officials.
There are simple things that only seem obvious in retrospect, like dedicating only a couple of ambulances for coronavirus cases and training the staff so that the whole fleet doesn’t become infected. There are things that require a good bit of time, like transforming medical facilities to maximize bed space or building temporary hospitals. There are best practices for triage, including establishing separate locations for non-coronavirus cases. Italy has learned these hard lessons too late, but we can benefit from their experience.
As things stand there, in the area of worst impact in Lombardy, no one is getting needed intubation if they’re over 60 years old. Virtually no one over 70 is being accepted in Intensive Care Units and, in many cases, people over 80 are not being accepted in hospitals at all. Facilities are not set up to prevent the spread of the virus and their emergency phone lines are overwhelmed.
In normal times, the ambulance service at the Papa Giovanni hospital runs like a Swiss clock. Calls to 112, Europe’s equivalent of 911, are answered within 15 to 20 seconds. Ambulances from the hospital’s fleet of more than 200 are dispatched within 60 to 90 seconds. Two helicopters stand by at all times. Patients usually reach an operating room within 30 minutes, said Angelo Giupponi, who runs the emergency response operation: “We are fast, in peacetime.”
Now, people wait an hour on the phone to report heart attacks, Dr. Giupponi said, because all the lines are busy. Each day, his team fields 2,500 calls and brings 1,500 people to the hospital. “That’s not counting those the first responders visit but tell to stay home and call again if their condition worsens,” he said.
This is what our near-future will look like, and we’re running out of time to mitigate the situation.
“Until three weeks ago, we did everything for every patient. Now we have to choose which patients to put in intensive care. This is catastrophic,” said anesthesiologist and intensive-care specialist Mirco Nacoti.
Dr. Nacoti worked for Doctors Without Borders in Haiti, Chad, Kurdistan and Ivory Coast, and he is one of the few medics in Bergamo who has seen epidemics. Yet, those were diseases with vaccines, such as measles and rubella.
He estimated that around 60% or more of the population of Bergamo has the coronavirus. “There is an enormous number of asymptomatic people, as well as unknown dead who die in their home and are not tested, not counted,” he said. “The ICU is the tip of an iceberg.”
Three weeks is an eternity right now. But it will be three weeks before there is another Democratic Party presidential primary. The country will be in a very different place by then, which is something that Bernie Sanders needs to consider:
Sen. Bernie Sanders (I-Vt.) will spend the next few weeks talking to supporters to “assess his campaign,” his campaign manager said Wednesday following decisive victories Tuesday by former vice president Joe Biden in Florida, Illinois and Arizonathat gave him firm control of the Democratic nominating contest.
“The next primary contest is at least three weeks away,” Faiz Shakir, Sanders’s manager said in a statement. “Sen. Sanders is going to be having conversations with supporters to assess his campaign. In the immediate term, however, he is focused on the government response to the coronavirus outbreak and ensuring that we take care of working people and the most vulnerable.”
He can no longer hope to win the nomination through the primary process, but of course, he can still maximize how many delegates he will send to the party’s convention. This would help him have influence over the platform and any rules changes affecting future elections, but the convention probably will take place in strictly virtual space online rather than in a Milwaukee arena as planned. It just seems hard to justify continuing the campaign in these circumstances.
Barring illness, Joe Biden will be the nominee and he should be focused on the campaign against Trump and on assembling a team that can take over in January and get right to work trying to manage one of the worst catastrophes any of us has seen in our lifetimes. If Sanders can be helpful in that effort, that will be great, but he certainly shouldn’t impede Biden by distracting him.
I suspect this will be clear to Sanders soon, and probably long before three weeks have elapsed. But it’d be nice if he made his decision before events force his hand.