A nurse at the heart of Italy's coronavirus outbreak has told Euronews hospitals are under so much pressure they are having to prioritise patients with the best chance of survival.
Mauro D'Ambrosio, who works at Fatebenefratelli Hospital in Milan, was speaking as the country's COVID-19 death toll passed 1,000 people.
He said COVID-19 sufferers were spending more than 15 days in intensive care, much longer than the average five to six days for other patients. This, he said, was leading to a huge turnover issue and leaving hospitals at near capacity.
D'Ambrosio said: "If we understand the patient has a severe health issue to the point of having no chance [to live] and we need to give the bed or divert resources to someone who has more chances to survive, [then] this is a choice that — despite being ethically hard to accept — from a clinical point of view can be done to give the possibility to survive [to someone] compared to someone who would have zero chance."
D’Ambrosio is a member of the Nursing Up trade union. “Our staff is under stress”, he adds. “In some hospital wards, the ratio between patients and nurses is 1 : 12-14, while it should be 1 : 6. Since the ICU require more nurses, other wards don’t have the necessary staff to look after patients”.
Monica Trombetta, a nurse working for the same trade union in Como, told Euronews that “we're very tired and afraid. Government decrees change every day. Personnel does not have clear guidelines for dealing with this new virus and feel a little abandoned – not by our hospital, but it’s just as a general feeling. Nurses are afraid to go home and potentially infect their relatives”.
Both point out that hospital staff is also quarantined more often since many are in direct contact with patients. This creates greater stress on the system.
Another nurse working in another hospital in Lombardy, the Italian region the worst hit by COVID-19, told Euronews the situation was "dire" and far worse than it is being portrayed in the media.
Speaking to Euronews on the condition of anonymity, she said: "We have hundreds of cases in our hospital. Half of our operating block has been dedicated to COVID-19 patients. The situation is dire.
"Anesthetists – despite them playing it down a little bit on the media – have to choose who they attach to the machine for ventilation, and who they won’t attach to the machines"
Italy now has more than 10,000 cases of COVID-19 with more than 1,000 deaths. The country is under lockdown, with travel restricted and workplaces, shops and public buildings closed.
Amid a surge of cases, Italy's healthcare system is at breaking point, with medical staff describing chaotic conditions at under-resourced hospitals.
A 60-year-old doctor, Roberto Cosentini, told Italian newspaper La Republica that between 60 to 80 infected people come to his hospital daily.
"If this new wave does not subside, the health system is heading towards collapse: triggered by what we can compare to a natural catastrophe," he said.
'He's gone now'
"Every day between 4 pm and 6 pm a shock arrives, that is, a wave of concentrated urgencies. A similar situation occurs only during earthquakes."
Christian Salaroli, an anaesthetist resuscitator in Bergamo, told Corriere that the situation was "like war".
Survival, he said, “is decided by age, and by health conditions".
Many COVID-19 patients are treated with intubation, by which oxygen is pumped into the lungs via a tube.
Salaroli said that the most severe patients become hypoxic, meaning that they no longer have sufficient levels of oxygen in their body. At that point, he said, doctors are forced to withdraw intubation as an option and accept that the patient is going to die.
"Unfortunately there is a disproportion between hospital resources, ICU beds, and critically ill people, not all are intubated," he said.
"If a person between 80 and 95 has severe respiratory failure, you probably won't proceed. If he has multi-organ failure of more than three vital organs, it means he has a one hundred per cent mortality rate. He's gone now.
"This is also a terrible sentence. But unfortunately, it is true. We are not in a position to tempt what are called miracles. It is a reality."
iPads needed so people don't die alone
Meanwhile, patients are left to die alone after a final video call with loved ones.
Dr Cortellaro, head of the emergency room of the Borromeo hospital, told the Journal.
"Do you see the emergency room? COVID-19 patients enter alone, no relatives can attend and when they are about to leave they sense it. They are lucid, they do not go to narcolepsy.
"It is as if they were drowning, but with plenty of time to understand it."
He described a patient who was a grandmother and wanted to speak to her granddaughter. The only way to speak to her was via video call.
"I pulled out the phone and called her on video. They said goodbye. Shortly after she left. By now I have a long list of video calls. I call it the farewell list. I hope they give us mini iPads, three or four would be enough, not to let them die alone."
'The bells don't ring'
In Bergamo, the worst-affected province in Italy with 1,815 cases and 142 victims, Corriere della Sera reported that the church of Ognissanti has been transformed into a huge mortuary chamber, with at least 40 coffins with corpses waiting to be cremated.
Until last Thursday, the crematorium - the only one in the province - still worked normal hours, but the municipality has ordered that it must work 24 hours a day.
But even it is not possible to keep pace with the terrible mortality of the virus: 146 people in five days.
Even working day and night, between death and cremation it is now necessary to wait five days, some of the bodies have been transferred to nearby Varese.
Meanwhile, in Zogno the local church has stopped ringing every time a casualty of coronavirus is announced and now rings only once a day, while the list of the deceased of the day is read on the parish radio.
The bodies are then brought to the little church of the Confraternity or to that of the Foppa, and the burials take place without a funeral.