Prof. Luciano Gattinoni Chief of the Hospital Department of Anaesthesia, Intensive Care and Emergency Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico – Public-funded university hospital. , 27 aprile 2020 «Germans are no better than us and work less. But they are organized, everyone does their part, they don't talk to each other and they love to obey. They respect the rules, taking advantage of the fact that their rules are clear, and therefore they can afford more by risking less ». Diagnosis of Professor Luciano Gattinoni, luminary of anesthesia and resuscitation, who in fact works in Gottingen, after leaving the Polyclinic of Milan five years ago. «Here Merkel spoke about the Corona virus three times. The first to say that 70% of the Germans would have fallen ill, the second to close the country, the third to reopen it, stating that if the situation worsens again, it will reverse. Quite the opposite of what happened in Italy ". For this reason the Germans can afford to go to the river in groups on Sunday, while if one of us sunbathes with no one around in a radius of half a kilometer, the drone photographs him and the carabinieri arrive to fine him. Today Berlin starts again, even if it has never stopped in reality, as shown by the drop in electricity consumption in the last month, only -4%, against the -25% in Italy. Unlike us, however, in Germany nobody crosses their fingers and recommends themselves to God. Least of all there is someone who has already opened for his own business, in the void of general indications. We start again seven days later the Germans, but the feeling is that we are not ready. We do it a little because we must, being surrounded by states that return to full speed, a little because, if we had to wait to be ready, we would never leave. "Italy has 500 experts and an unknown number of commissions, but nothing transpires of their work. He lives in a perennial talk show. Even an analysis of the situation that starts from the numbers is missing. Nobody talks about sustainable risk, not having calculated it." In Italy we are too many not to decide, Professor? « If you you put ten doctors around a patient, he has no hope, he dies. When I was working in Monza, they brought me the son of the then German chancellor Helmut Kohl. He had a major breathing difficulty following a car accident. The mother wanted to transport it to Germany. The father arrived and said to me: "You are and will be the only person to have the life of my son in your hands". He understood that if he had repatriated him, competition between professors would be unleashed in Germany. ” So our commissions are lethal? «In an enlarged group everyone feels compelled to say something more intelligent than the one he has just listened to, and ends up shooting it big. If there are more than five or six people to decide, the commission becomes useless in the best case, harmful in the most frequent, because the agreement is always reached at the lowest level ". Professor, we did well to do the quarantine more rigid of all? «If they are all at home, there are fewer sick people. But the virus doesn't disappear. When you go out, you find it and you're back; unless the vaccine has been found in the meantime.” So the quarantine was in vain? "No, it served to contain the infection and ease the pressure on hospitals. It was a necessary prevention not to collapse the system. But those who stay at home do not develop antibodies, and when they go out they are no longer safe than before. Indeed ... » Why have there been more deaths in Italy than in Germany? "If the country is disorganized, its health cannot be expected to be organized. But I would ask another question: how come you died so much in Italy? " And as Marzullo would say, give an answer, professor... " For example, because Italy has ignored the alarm launched by the World Health Organization three years ago, when the planet was alerted to the probability of an outbreak in the short term. Germany bought masks and sanitary protections. We, to my knowledge, have not taken the report into consideration. On the other hand, prevention does not create consensus because it is successful if nothing happens, but how can you politely sell yourself nothing? " But is Lombardy, where there have been half of the Italian dead, not a medical excellence? «For intensive care certainly. It is on the same level as France and Germany, higher than Spain and the United Kingdom. In fact, the number of deaths we have had caused a sensation in the world of the scientific community ". The Lombard model has come under accusation. They say it gives too much space to the private sector "Something hasn't worked. To argue, as regional authorities do, that they have done nothing wrong or that they would do the same things on their way back is not very smart. Like it or not, the results have a weight.” Do you also attack the Lombard private health service? «Watch out for the distinction between public and private. Private companies are paid for the service by the Region, and therefore are also a bit public, while in public hospitals for years managers have dominated, who have begun to call health facilities "companies", importing a profit mentality . In this step, the sense of mission has been lost and the cuts have been given the go-ahead, which do not help, because both the quality of the service and that of the doctors are worse, they are overworked and no longer have time to study and prepare. Let me add that the great doctors are trained in the public, who at one time was not obsessed with expenses, then in case they move on to the private sector ». Was the number closed to medicine a mistake? «It is part of the philosophy of optimizing healthcare, a political slogan to justify cutting funds. However, an intensive care unit is not just a bed. There are seven nurses for every two patients and five doctors for every five patients. And when I talk about doctors, I am referring to specialists who know what needs to be done. Only in this way can deaths be avoided ». Matter of non-prevention and excessive cuts if we ended up on the ground, then? "You don't think so? However, it is also a question of method. If in Germany you have symptoms of Covid-19 and go to the hospital, at the entrance you will find a large sign ordering you not to enter for any reason and inviting you to ring a bell. At that point a healthcare professional comes out who takes care of you without you setting foot in the hospital and decides whether to hospitalize you, in facilities reserved for Covid-19 patients, or send you home, where your doctor is ordered to assist you. It seems to me that in Italy the detection of the virus is contracted to the patient, in self-diagnosis from home, on the phone with the local doctor. However, it was always better than in the early days, when the synothmatics were received in the emergency room without differentiated routes ». How come less people die now and the sick are less serious: has the virus become less aggressive? «The virus may have transformed, but we don't know. It certainly does not change according to our desires or moods. Its strength remains the same, it changes the viral load, and whoever is hit by more contagious molecules gets worse, and can change the resistance they encounter. Here, I would not say that it has become less lethal, rather than we have become better at treating it. For the first three weeks the doctors groped forward. " Are you telling me that many people who died a month and a half ago today could have been saved? «Decongesting hospitals has been fundamental because the fewer patients you have, the better you treat them. And of course, the more you know about the disease, the more effective the therapy is. In the first twenty days, patients arrived with severe respiratory failure and air was shot into the lungs at high pressure. Then it turned out that the situation got worse. Over time we also understood that it was essential that the blood does not coagulate and we started using heparin with excellent results. It is a path. Science proceeds by trial and error, and experience is nothing more than the critical analysis of one's mistakes ". So do we know how to cure Covid-19 today? «No, we learned how to stem it better. But until we know all the mechanisms of replication of the virus, we will never find therapy ". It is said to disappear with the heat... "We just have to wait. It may be worse in the heat than in the cold. The fact is that we have 36-37 degrees in the body, and he is perfectly fine ». How long will we have to wait for the vaccine? "Ask this to the virologists." I catch a touch of irony, don't you appreciate them? «When they talk about their profession they say very interesting things. If, however, epidemiologists, and then the resuscitators, the full scientists and perhaps even the politicians, widen and begin to do, they slide in abundance, like everyone else. But here I stop, because I would not like to re-enter the group ». But no professor, let's play a bit with philosophers, so much all of us ordinary mortals recognize the role of holy doctor to the doctor «This in Italy, where we are emotional. In fact, we had the most irrational and least scientific reaction of all to the virus ". Are you talking about politics and society, not science? "Of course". The epidemic is pain, it is fashionable to say that it will make us better. Subscribes? «We should study history at forty, not in elementary school. There have always been epidemics, they have always passed and the human soul has never changed. The emergency exalts the brutal instincts. Good and bad. Then when it passes, everything returns as before ». Professor, why do I shudder to leave but my legs tremble while if I were in Germany I would be more peaceful? "Maybe because it recognizes Merkel's authority beyond what it attributes to Conte. If so, I think it is because the Chancellor spoke less but said more. The communication from the Italian government was unclear, as if it were intended. Citizens were bombarded with rules that changed constantly and sometimes contradicted each other ». Consequently, in Italy everyone did it himself «The neck was missing and an apocalyptic tone was used to be heard. Then we hid behind the scientists' opinion, only that the virus was unknown and each professor had his opinion. There was a lot of confusion, wanting to go after everyone. Too bad that medicine is not democratic: it may be that one is right and 99% wrong ». What should we do to leave safely? «Keep calm and don't repeat the mistakes. Observing others rather than proposing oneself as a model: let's look at what happens where it reopened, and if the contagion doesn't start there, we copy. And then we have to make a calculation between the epidemic risk and the economic disaster that closure entails. " From:
Articolo di Pietro Senaldi
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