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- Jolanda Sabatino, MD, PhD∗ ()
- ↵∗Address for correspondence:
Dr. Jolanda Sabatino, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro 88100, Italy.
Treating coronavirus disease 2019 (COVID-19) infections is a big challenge, not only technically, but also emotionally. Because COVID-19 has quickly spread worldwide (1), our lives have changed quite abruptly.
On February 21, 2020, I was coming back to my hospital in south Italy from London after a few days stop in northern Italy to attend an echocardiography course. In Italy, that day, everything began: a swell of infected patients was observed from day to day in northern Italy, and new restrictions on common activities were set up to stop the virus spread. On Monday February 24, 2020, I was quarantined because of my trip in northern Italy, and all of my appointments from my outpatient pediatric cardiology clinic were cancelled indefinitely.
At first, I was making jokes about the new reality, but soon, it felt quite strange and surreal, with incoming phone calls from confused and agitated patients. Clearly, I did not understand what was going to happen. It is commonly believed human minds start with denial, needing time to accept and get accustomed to new circumstances, including loss or other tragedies.
Everyone knows what came next: on March 10, 2020, Italy became the first Western country since World War II to impose a nationwide lockdown. Streets were empty and hospitals were crowded. People were having mixed feelings: sadness, despair, fear of the “unknown” threat, and, from a doctor’s perspective, the strength and the courage to pull through.
My hospital has now been turned into a COVID-19 hub. COVID-19 has been absorbing the cardiology department, together with the whole team and resources. And, here we are: health care professionals working at the forefront of this pandemic, often without a safety net.
Clearly, the COVID-19 storm suddenly involved our patients with cardiovascular disease, sowing questions, fear, and uncertainty. Although they are terrified of the coronavirus, they are also afraid of not being able to proceed with their usual treatments, or that any potential modification of the initial treatment plan might impair their outcome. Our patients wish to stay safe and away from the virus, asking themselves if going to the hospital might be dangerous. At the same time, they desperately wish to speak to their doctors, receive necessary drugs, and discuss future plans.
In the regions of northern Italy, where the pandemic arrived earlier, a disproportionate amount of health care workers were infected. They were put at risk not only by the nature of their work, but also by a shortage of individual protection devices and by government procrastination on testing programs. Widespread testing was delayed for weeks, while the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) managed to spread around the country and across hospitals undetected.
Because testing was slow to ramp up, health care workers often had no way to identify whether patients coming to their attention with respiratory symptoms had the seasonal flu or COVID-19. Even when precautions were taken, SARS-CoV-2 found its way into health care facilities.
This is how the pandemic has affected me as a doctor, causing stress, fatigue, new uncertainties, and the need to reorganize my whole work and life priorities. People call us heroes, but because of the lack of evidence-proven treatments, we doubt the effectiveness of our work and we do not feel like heroes. Meanwhile, we need and wish to stay safe while keeping the hospital SARS-CoV-2 free. Rather than heroes, we look like prey in heroes’ capes. That kind of bravery, that work integrity, is not boundless. No one is so fearless or short-sighted as to discount all risks.
When I try to figure out how I feel in this moment, the Italian motto “andrà tutto bene” (“everything will be alright”) that has been viral since the onset of the COVID-19 outbreak in my country comes to mind. But, I am still worried whether everything is going well or, more likely, in the worst possible way.
This is our darkest hour. Too many among us are mourning their loved ones, those who have left their families abruptly and often without the chance of a last encounter. Funerals are banned and too many deceased are now front page news, fodder for Twitter or Facebook pages: they are our grandparents, our fathers, our teachers, our cardiology professors.
It is now time to grieve our collective losses. In Bergamo, the deceased are placed in blue bags for isolation; one after another. Even in the morgue, there is no space. Every morning our thoughts are with them and their families, as the road to the hospital presents us with paradoxical landscapes. The deafening silence of a deserted city has become our new normal. Public transport still continues to circulate, but nobody gets on, nobody gets off.
Should you ask me about my fears, I have plenty of them. But, more frequently, I wonder if everything will return to normal. The time when we gathered together, shared things, and embraced friends now seems to me like such a remote era.
Some years ago, when I graduated as a cardiologist, we arranged a big party. My colleagues and I danced all night long, laughing and screaming. Two weeks ago, I graduated as a PhD in a videoconference, while I was self-isolated at home. I have not seen my parents and friends since February 21, 2020; they are still waiting for me to celebrate.
The pandemic is shaking the whole world, shuttering cities, disrupting trade, and battering financial markets. From the human tragedy to the economic impact, it reminds me most closely of a fantasy movie. We do not know what will come next. However, no matter how difficult and harsh the circumstances may be, sooner or later we will get over it. I pray we will shortly return to taste the incomparable flavor of a true normality, but hopefully without forgetting the touching lessons we are learning now.
The author has reported that she has no relationships relevant to the contents of this paper to disclose.
The author attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, or patient consent where appropriate. For more information, visit the JACC: Case Reports author instructions page.