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On February 21, 2020, Italian ‘patient one’ tested positive for COVID-19 at a hospital in Codogno, a town in Lombardy – and that was the day the lives of millions of people around the world changed at- beyond imagination.
The team from the small hospital quickly realized that this was not an isolated case. The virus had long since spread outside the city of Wuhan, China, which had been strictly closed for more than a month.
It took another 20 days for Italy to announce a general lockdown, on March 9, shutting down all business activities and confining citizens to their homes.
The life that Europeans took for granted in peacetime changed almost overnight: access to healthcare, freedom of movement and visiting friends and family were no longer a given.
A year later, more than 88,000 people died after contracting the virus in Italy, the second highest death toll in Europe after the United Kingdom.
Inequality and poverty are increasing as the economy, which never fully recovered from a 2008 crisis, weakens.
“By the time he was confronted with the pandemic, the national health system had been severely weakened by a decade of budget cuts,” said Nino Cartabellotta, a prominent Italian public health specialist, professor and president of Gruppo Italiano per la Medicina Basata sulle Evidenze. (GIMBE – Italian Evidence-Based Medicine Group).
Between 2010 and 2019, the public health sector in Italy faced cuts and lost revenues of 37 billion euros ($ 45 billion). Doctors who have reached retirement age have not been replaced, leading to a shortage of specialists such as anesthesiologists and weak local health networks that have overwhelmed hospitals.
“The virus has always traveled faster than politics and bureaucracy,” Cartabellotta told Al Jazeera.
Al Jazeera spoke to four people whose lives were turned upside down by the events of the past year:
- Annalisa Malara, the doctor who discovered the first case
- Stefania Principale, a young woman looking for answers to the death of her husband, 41
- Antonella Cicale, an overwhelmed family doctor in Naples
- Lorenzo Stocchi, a healthy young man struggling with the aftermath of the infection
The anesthesiologist who discovered a patient: “ It was clear that the case was not common ”
Annalisa Malara, 39, from Codogno, Lombardy
That day, I was on duty at Codogno, a small provincial hospital. I received a call from a colleague in the medical department saying that there was a young patient with very severe pneumonia.
The images I saw showed very severe interstitial pneumonia, with the typical appearance of viral pneumonia. On top of that, I had seen his chest x-ray 36 hours earlier. What I was looking for was very rapid progression. He looked strange, he had bad conjunctivitis and bloodshot eyes, which we later saw in many other patients. He said he was having trouble breathing, but his condition seemed considerably worse after his exams. He was surprised when I told him he needed to be hospitalized in intensive care.
It was clear that the case was not common. When his wife arrived, she told me that two or three weeks earlier her husband had been to a dinner party with a colleague who had recently returned from China. Alarm bells started ringing at this point.
But the link was actually very weak. This colleague was in an area 800 kilometers (497 miles) from Wuhan.
At first we hoped this was an isolated incident, but that night we realized it wasn’t. We hospitalized three other patients who were unrelated to the first one. A colleague of mine in intensive care had had a fever for a few days. He came to A&E for the sample and tested positive.
The first few weeks were a shock. We were completely overwhelmed with the number of patients coming to A&E, with peaks of over 100 people per day.
The hardest part was realizing that the virus could strike anyone – young, old, healthy or sick. Particularly at the beginning, you had to treat these patients without really knowing what this virus was capable of.
We had to close the hospital to family members and sometimes announce over the phone that their loved ones had died. It was very difficult.
Just before reaching the plateau of the first wave we were in such a state of uncertainty that we thought it was possible that we were at the start of a complete disaster. Before that, we were really worried that the virus was unstoppable, or at least uncontrollable.
COVID widow and member of Noi Denunceremo: “He called us by video. It was a farewell call ‘
Stefania Principale, 33, from Melegnano, Milan
We lived a quiet life with our two children, Andrea and Chiara, who are eight and four years old.
March 8 arrived, it was a Sunday. My husband had a fever, we called the family doctor who was unable to visit him but prescribed medication. His temperature kept rising and he developed a cough. The doctor said COVID tests could only be done in hospitals. She suggested an x-ray. This showed the onset of bilateral pneumonia.
We mobilized, called the helplines to figure out what to do – numbers we couldn’t reach at first. On Friday, we called the doctor on duty outside of business hours as the symptoms worsened. They advised us to stay at home to avoid going to the hospital.
We have lived those days in complete uncertainty, you really didn’t know what to do.
His condition was not good, but they kept telling us to avoid hospitals. We couldn’t tell if it was in our best interests or not. But my husband insisted that he wanted to be taken to the hospital. He stayed at A&E for a day and a half, between the hallways and makeshift rooms.
He needed breathing assistance and received a CPAP mask. There was no room for intensive care. When he got the news, a place was available, he called us by video – myself, his sister and his mother. It was a farewell call.
We couldn’t have a funeral for him. I decided that I didn’t want to stay in Milan and moved to Perugia, where my brother lives. We thought we could start over from here. The first few months were a bit of a bubble. Then I found the group Noi Denunceremo (We Will Report) and read a lot of stories, all like mine. I thought I couldn’t let it pass for something ordinary, because there is nothing ordinary about it.
One thing I can’t stop thinking about is that when the ambulance arrived at our house we were in a state of utter confusion. When my husband left, I didn’t say goodbye. I did not give him a hug. I would have liked to tell him don’t worry.
The question is: who can I blame for all of this?
Family doctor with 1,400 patients: “ we didn’t have PPE ”
Antonella Cicale, 40, from Quarto, Naples
La Cicale worked 12 to 13 hours a day during the pandemic as the Italian healthcare system suffers from the impact of the pandemic [Courtesy of Antonella Cicale]
The second wave was devastating for us. My region and my city, Quarto, have been hit hard.
We were better prepared from a medical point of view. I treat patients at home and I hospitalize very few cases. If you look for symptoms and diagnose early, patients are very unlikely to need hospitalization. And if they are, they are more likely to survive.
But there were many problems in my area. There were bureaucratic issues with testing, with follow-ups and waiting times for test results.
Family physicians have largely been on their own. We were not provided with PPE, and although funds were allocated in an April executive order, we only received supplies in November.
I have 1,400 patients. The worst part is that we have had a lot of difficulty managing chronic and cancer patients. Along with some of my colleagues, I worked 12 to 13 hours a day, but doing anything is difficult in an emergency.
I took calls from patients who weren’t mine because there weren’t enough family doctors. The places left vacant by colleagues at retirement age for 2020-2021 have not yet been announced.
Patients without a family doctor who couldn’t go to A&E had nowhere to turn. An emergency in an emergency.
ICU rehabilitation patient: ‘I still go to the hospital every morning’
Lorenzo Stocchi, 35, from the province of Arezzo
Stocchi struggles with long-term symptoms of COVID-19 after being infected last year [Courtesy of Lorenzo Stocchi]
I have always been a sporty person. I played rugby in the league and last February I was diving in the Maldives. I have never smoked or been seriously ill. I was in perfect health, before COVID-19.
I was picking mushrooms with my dad and in the woods I hit the branch of a tree. A shard got stuck in my cornea. I went to my local A&E but there was no ophthalmologist there so I went to Arezzo, a COVID hospital. Fifteen days later, the symptoms started.
The fever was persisting, so my doctor advised me what to do as I couldn’t get tested for COVID right away.
Then, in just 12 hours, my condition got out of hand. Overnight I was no longer able to speak because I had to concentrate on my breathing. I was taken back to the COVID hospital in Arezzo.
I spent the first night in the infectious disease department. After a scan, I was forced to wear an oxygen helmet. The next day, I entered intensive care, where the worst of it all started.
With the headphones on, I couldn’t hear what the doctors were saying. I was so breathless that I couldn’t speak. I was completely isolated. After two days, when the man next to me died, I was destroyed. I felt alone and hopeless, and my family could not fully understand my condition.
I left the hospital on November 12. At first, even the smallest things like taking a shower were difficult because I was short of breath.
I still go to the hospital every morning for physical and respiratory rehabilitation.
These interviews have been edited for clarity and brevity.
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