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Diagnosing the first COVID-19 patient in Italy – Codogno, Italy


I diagnosed the first COVID-19 patient in Italy, which triggered the national emergency. He was a 38-year-old healthy athlete with no comorbidities. He arrived at the emergency room in Codogno on Saturday 18 February with fever, cough, and shortness of breath. He was given antibiotics but refused to stay at the hospital. He returned that evening because he couldn’t breathe and had a very high fever. He was admitted to internal medicine and given antibiotics and an oxygen mask.

On 20 February, they called me because he couldn’t breathe. He was having a CT scan: his lungs looked terrible and he had an atypical pneumonia. I decided to take him to my intensive care ward and intubate him. There I talked with his wife – it was about 11:30 am – who said that two weeks ago he had attended a dinner with a colleague who, two weeks prior to the dinner, had returned from China. I suspected a coronavirus infection and immediately called my chief to request a nasopharyngeal swab. The patient did not meet the national criteria for coronavirus testing but because of his severe situation, we decided to do it anyway. At noon we sent the test to Milan.

Even before we received the test result, my decision was to quarantine the patient because the risk of not doing so was too high. I stayed in quarantine with the patient, together with the nurses, and we used PPE straight away; this quick reaction is why we were not infected.

The positive result came back at 9:00 pm. I called the chief of the hospital who declared it a crisis situation. The chief in Lombardy was contacted as were the politicians, and a national emergency was announced. Codogno hospital was put in lockdown and emergencies were sent to Lodi Hospital, which is 30 km away.

Annalisa-Malara-4.jpgI worked in quarantine for 36 hours because I did not want other doctors to be exposed. After that I went home, self-isolated and waited for my test results. I had no symptoms and the results came back negative. So, after three days at home, I returned to the hospital and have been working every day since then.

I have never experienced anything like this before. We have a very high volume of patients, many of whom are young and healthy. The work is relentless and long: up to 14 hours per day with no time to eat or drink. There is no time to lose so we don’t want to stop. But maybe once or twice a day we go for a drink of water, once a day to the bathroom. It means removing all the PPE, leaving the ward, then reversing the process when you get back. We also work with the danger of being infected.

This is psychologically very difficult, not just physically difficult. We are all very stressed. But if we don’t do it, nobody will, so we have to continue. When you go home you continue to think about what you saw in the hospital. You are afraid that this situation will never end. You worry about everyone’s safety: your patients, friends, relatives and your own. There is no break from it; you can’t relax.

When it came to testing, we started with the patient’s family and everyone who had been in contact with him. In the hospital, we tested patients who had been near him in the emergency room and the ward. After four days, we then tested all the doctors and nurses. Now we only test people with symptoms because the numbers are too high to check everyone. Mass testing slows down results for people who really need them, and the swab gives a lot of false negatives – possibly around 20%. A serum test with immunoglobulin is more sensitive overall but it does not detect the infection in the first few days. Another possibility is lower respiratory tract aspiration but it’s invasive and cannot be performed in patients who are not intubated. So, the swab is the best we have. Even without test results, if a patient has a fever, cough, shortness of breath, and an X-ray showing lung infiltrates, they should be considered positive.

We reorganised our hospital and tripled our intensive care beds. The striking thing about this disease is the huge numbers of patients. We have too many patients to hospitalise them all, so we treat the milder cases at home using telemedicine.

We are dealing with a severe emergency. A lot of people are very sick and some of them do not overcome their serious respiratory crisis. Families can’t come to the hospital to be with loved ones, so patients endure this experience alone. This is very sad. We are with patients throughout, even at the end, but we are strangers. It’s not the same.

After this, we will all be different.


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