Dr. Omar Alquati is a physician working at the Lodi Local Health Authority in Italy. He works in intensive care units but is currently a COVID-19 patient at the San Matteo Polyclinic in Pavia. He shared his thoughts and experience since becoming infected.
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You can find the original version of this article (in Italian) here.
Dr. Omar Alquati is a 43-year-old physician specialized in Anesthesiology & Resuscitation, employed by the Lodi Local Health Authority (in Italian: “Azienda Socio Sanitaria Territoriale di Lodi” or ASST) in Italy. He works in the intensive care units of the Lodi and Codogno hospitals, where he was on duty until last Saturday, February 22nd. At the moment he is in the hospital, but this time as a patient, in the Infectious Diseases Department of the San Matteo Polyclinic in Pavia. Italy. Our editorial colleagues from esanum.it reached him on the phone, to learn more about his experience and opinions about being a COVID-19 patient at the moment.
Dr. Alquati: Right now I'm fine, apart from some bone pain, but nothing much. The fever's already gone, so I'd say it's okay.
Dr. Alquati: I've been here since Sunday (February 23rd, 2020). The day before, I was at work in Codogno. During my shift, I started having symptoms very similar to those of a flu syndrome: joint pain, fever, sore throat, cough. I was tested with a pharyngeal swab and, in the meantime, I was put in isolation, together with other colleagues. The test was positive, so yesterday afternoon I was transferred by ambulance here in Pavia to the infectious diseases unit. I'm quite well, they're just monitoring me. I don't have any major respiratory symptoms, they haven't prescribed any treatment. A colleague of mine, an infectologist, has let it slip that, according to him, hospitalization for cases like mine seems an excessive measure, but this is the procedure to follow at the moment. The ward is full of patients in the same condition as me. Fortunately, this syndrome only causes serious respiratory problems in a small number of cases, for which intensive care may also be required. Almost always, so far, symptoms similar to those of the classic flu have occurred. Ten days ago, if the same thing had happened to me, I would have been home for a couple of days and then gone back to work.
Dr. Alquati: Right now there's three of us. We cover shifts in ICUs in (the towns of) Lodi and Codogno. None of us have serious symptoms. I know that other colleagues who work in the medical clinic have also fallen ill, but I don't know exactly how many. None, to my knowledge, have a severe form of the illness.
Dr. Alquati: I believe I was infected by a colleague, with whom I was on duty last week. We were both at work in Codogno on the very days when the first case that triggered the alarm was diagnosed. With the patients, I always used all the protection. So I don't think I was infected by a patient, it's very likely that I was infected by my colleague when I didn't have protection. The incubation period is commonly about five days according to the WHO, which makes sense. If it had not been so, then I was infected outside of the hospital, as were many others.
Dr. Alquati: I won't hide the fact that there were several critical moments in this first phase. In my opinion, many things could have been handled better. We will have to make a precise analysis of some procedures that took place, but this is not the time to talk about it. Certainly, the precautionary measures that have been taken in these hours are what should have been taken. They are measures that have also been taken in China. The contagion must be contained, so it is right to limit the activities that involve the gathering of people. If you want to slow down the spread of the virus, you cannot imagine doing anything different. Potential exposure to the virus must be limited. Limiting it is the keyword here because preventing it is a term that no longer makes sense. It would be like closing the barn after the cows have left. The cows have escaped, now you have to do damage control. The first case we had in Codogno was probably infected several days earlier. And like him, so many others, who in turn have been infected by and will infect, many others.
Dr. Alquati: According to the infectologists I spoke to, the virus has almost certainly spread to other parts of Italy. The numbers are growing rapidly in Lombardy and Veneto because the virus is being more scrutinized here, and I do not know if other regions are looking for it. Probably many coronavirus cases have been mistaken for flu cases. If we can slow the spread of the virus, I do not expect to work in apocalyptic scenarios.
Dr. Alquati: No, not at all. Based on the data we have, almost all infected people will develop mild symptoms. Most of those infected won't even develop the disease. Certainly, a small portion of those infected will suffer complications and may end up in intensive care. Seasonal flu also leads to some cases in intensive care. Mortality is high among older patients, true, but this is not surprising. For older patients, who are often the most debilitated and have different comorbidities, it is indeed very difficult to get through intensive care, whatever the reason why they have to go into an ICU. I was talking about this just a moment ago with some colleagues who work in a resuscitation unit in Bergamo.
Dr. Alquati: There is quite a lot of scaremongering, true, especially in the headlines. I remember that years ago the same thing happened with HIV/AIDS. We used to talk about it in terrorism terms even, then we even went so far as not to talk about it anymore, today it almost seems as if the disease has disappeared from reality. Probably, the same thing will happen with COVID-19. Today we are talking about it as if it were Ebola, in some time the tone will change and it will be better understood for what it is: that coronavirus infection is not a death sentence. Unfortunately, there is little information, and the one that is available is not definitive and this does not help. This coronavirus is certainly aggressive and the fact that we do not have a vaccine ready makes the situation serious. We must prevent the whole population from becoming infected and ill at once, as this would collapse the health care system and lead to an economic disaster.
Alarmism is not only in the newspapers but it was occurring also in the health sector, which at first reacted very strongly and now - after a few days - is turning back a little. Last Thursday, colleagues who had been in contact with infected patients were quarantined; today, those same colleagues are back at work, with some safeguards, but they are in contact with the patients. I am sick, in hospital, but nobody comes near me wearing a protective suit and or helmet.
Dr. Alquati: Even in the case of a severe syndrome, the physicians will know what to do. This new coronavirus doesn't cause anything a resuscitation specialist with a minimum of experience hasn't seen in his career. Acute respiratory distress syndrome (ARDS) is a situation that all intensive care therapies can handle. These are clinical conditions that we who work in intensive care often see. The coronavirus, from this point of view, does not change anything in our clinical practice. A critical patient can then become irreversibly complicated, but it is really unlikely that these situations will constitute the majority of cases. If we keep focusing on containing the spread of the virus, there´s no need for panic.