Giancarlo Bosio retired last Monday, after working for 40 years at a hospital in Cremona — a city in the region of Lombardy, where Italy’s COVID-19 outbreak began in March.
As a pulmonologist, or lung specialist, the 66-year-old’s final months at work were particularly strenuous: during the first wave of the pandemic he didn’t take a single day off. But before having any time to think about reorganizing his life post-retirement, he got a call to return. The mayors of Cremona and the surrounding cities sent a letter to the director of his hospital, asking for him to be brought back to deal with the second wave. So in a few more days he will come out of retirement. “I couldn’t say no,” he says.
It wasn’t the only offer he received. “Other hospitals and private clinics have also contacted me with generous proposals … Pulmonologists in Italy are now just as valuable as strikers on Serie A soccer league,” he jokes.
Italy, one of the countries worst hit in the original surge of COVID-19, is now buckling under the second wave crashing across Europe. Unlike other countries in Europe, it has not introduced a second national lockdown but has instead assigned each region a different color—red, orange or yellow—with tiered restrictions reflecting the gravity of the situation. Yet the numbers are looking increasingly grim; On Nov. 17, there were 753 deaths attributed to the coronavirus nationwide, among the highest daily rates in the world.
Most of the hospitals in Italy that treat COVID-19 patients are under enormous strain due to lack of medical staff, with doctors and nurses who have already faced the first wave in many cases worn out and disheartened. “The adrenaline we felt from the first wave has been replaced by exhaustion and anger”, says Silvia Giorgis, 49, an anesthesiologist at the Maria Vittoria hospital in Turin. “Over the past months nothing was done to prevent this situation.”
A shortfall in frontline doctors
Italy was the first European country to see a serious COVID-19 outbreak. During that first wave medical workers from all over Italy as well as from other countries, like the United States and Cuba, flowed into the “red zone” in Lombardy. This is no longer possible, since the virus is now such a widespread phenomenon that doctors are needed everywhere. Seven regions in Italy are currently designated as red zones.
In the spring, entire hospitals had been converted to admit COVID-19 patients, with physicians from other specialties working to defeat the virus even if they had no experience with infectious or respiratory diseases. Now they can no longer afford to do so, for fear of denying treatment to people with chronic illnesses who for months have not received adequate care.
There is also a growing shortfall in specialists, as systemic cuts in the Italian health care system over the past twenty years have created a huge gap between the number who are retiring and those who are qualified to enter the workforce. “The gap that is being created is 20,000 jobs”, says Filippo Anelli, head of the National Federation of Italian Professional Orders of Doctors (FNOMCeO). “The result is that physicians are overwhelmed with work. We have estimated that taken all together they work overtime for over 15 million hours every year.” The pandemic has made the situation worse, he says. “Doctors were generous but now many are in burnout,” he explains.
The problem is not a lack of interested candidates, but of investment in training. This year 23,000 graduate students took the exam to get a scholarship for the school of specialization (the equivalent of a residency in the U.S.) but only 14,500 will be awarded one, Anelli says. “In past years the number of those admitted was even lower.”
In some regions the shortage of medical staff has been addressed by expanding programs to recruit young doctors with limited or no experience. In Piedmont, one of the most severely affected regions during this second wave, the medical school of the University of Turin has agreed to provide the local administration with senior and junior residents to help handle the pandemic. Yet Crisis Units and hospitals’ HR offices are also independently recruiting those who earned their degree just a few months ago, without even having begun their residency.
Paola Molino, the director of the ER department and coordinator of the COVID-19 floors in the Rivoli hospital, near Turin, says she is employing dozens of recent graduates in all her COVID-19 wards except the ICU. “During this second wave, specialists in other disciplines are much more reluctant to deal with this virus. Last spring they made themselves available, but now they are more tired, more afraid and they are also angry because they have seen that little has been done to reorganize the system,” she says.
‘We have gone from being heroes to being criminals.’
Among the young doctors Molino recruited, those who gained experience during the first wave are now training and helping others. “After all, we are dealing with only one pathology, with precise symptoms. You don’t need to be omniscient,” she says. She doesn’t leave those young colleagues alone, she adds. “They know they can call me whenever they need to.”
Andrea Prina, 27, is among those who earned his degree last July. “I feel very useful. I am certainly less experienced than my peers who worked during the first wave, but also less tired than many doctors who went through that,” he says. At the moment Prina has no set working hours. “I stay at work as long as I’m needed”, he says during a short break.
Molino has a positive feeling about this temporary solution. “It’s working very well, they are always keen to help,” she says. “For a disease like this – which puts us in such emotionally difficult situations – sometimes it’s easier to work with people with great enthusiasm rather than great experience.”
But the experience of being a doctor now is very different to how it was in the spring. Back then, doctors were receiving all sorts of treats in COVID-19 wards, from trays of pizza to cakes, and Italians regularly took to their balconies and doorsteps to applaud their hard work. Now, according to Giorgis, the Turin anesthesiologist, the attitude of the public is completely different. Too many people believe that doctors are purposely exaggerating the problem, she says, and are to blame for restrictions that are hurting the economy. Others deny the disease exists at all. “They say we invent the fact that they have Covid even if they need oxygen,” she says. “We have gone from being heroes, to being criminals.”
She is currently working from 8am to 8pm for more than 7 days in a row. After the first wave, she had “visions” of those intense times, she says — days she is now reliving, several months on. “I have continued to dream of noises, patients, alarms. Now even during the day I can no longer stand the sound of ambulances and sliding doors.”