On Feb. 18, just over three weeks ago, Italy had three confirmed cases of the novel coronavirus.
Today, Italy is in the throes of a public health emergency with the highest rate of infection outside of China. There were 15,113 cases of the virus as of Thursday, according to the Italian Civil Protection Department. More than 1,000 people have died from COVID-19 in Italy, including 189 deaths in the past 24 hours alone.
In Boston, doctors are looking at the crisis in Italy with increasing foreboding and alarm. The dramatic spike in coronavirus cases is pushing Italy’s health care system to the brink, particularly in Lombardy, the country’s hardest-hit region, as hospitals struggle to care for the flood of critically ill patients. Intensive care units are reporting shortages of beds and ventilators, which are needed to supply oxygen for patients who can’t breathe on their own. The number of dead is surging.
Doctors here warn that unless dramatic action is taken now to slow the spread of the coronavirus, the outbreak threatens to dangerously overload the Massachusetts health care system. Several measures have been implemented across the state to decelerate the pace of contagion. Colleges are sending students home. School districts have suspended classes. Companies have asked their employees to work remotely. Concerts, parades, and gatherings of all kinds have been canceled or postponed.
Still, the lack of widespread testing in the US for diagnosing the coronavirus means the true size of the outbreak is unknown.
“This is really a serious situation and this is not a time for people to be living their lives as they usually do. Everybody needs to contribute now to stemming the spread of this,” said Dr. Bruce Walker, the founding director of the Ragon Institute of Massachusetts General Hospital, MIT and Harvard, which conducts research on immunology and infectious diseases.
"The worst-case scenario will be we’ll have more patients than we can deal with, with the existing infrastructure we have,” he continued.
In Lombardy, the wealthy northern region around Milan where more than half of Italy’s current cases are concentrated, all efforts are being marshaled to battle the coronavirus outbreak. Elective surgeries have been postponed. Routine medical appointments have been canceled. Doctors and nurses are exhausted, and many are falling ill. Because resources are stretched so thin, doctors are being forced to make difficult decisions about who receives the most intensive care and who goes without.
“It’s a tough situation,” said Dr. Stefano Rusconi, an infectious disease specialist at the Luigi Sacco Hospital in Milan, about the severe constraints at hospitals in Lombardy. “It’s a situation where we have a very large amount of clinical ethical issues, meaning that if we have a definite number of ventilators and you have two people, one of which is 80 years old with comorbidities and the other is 42 without comorbidities, which way do you go in order to select the ventilator use?”
Dr. Ashish Jha, the director of the Harvard Global Health Institute, has been collecting data on capacity at Massachusetts hospitals, and the numbers don’t look good. He warns that the US is following a trajectory similar to Italy’s — except that Italy exceeds the US in the number of hospital beds and doctors per capita. Experts believe the US, where the number of coronavirus cases surpassed 1,500 on Thursday, is just 10 to 16 days behind Italy in the progression of its outbreak.
According to statistics from the American Hospital Association, there are roughly 10,000 hospital beds and 600 ICU beds in eastern Massachusetts, Jha said, and the average occupancy rate is 75 percent.
“That leaves 2,500 beds and 150 ICU beds at any given point,” Jha said. In the midst of a pandemic, that is a tiny fraction of the number of intensive care beds that will be needed in eastern Massachusetts.
Modeling by Marc Lipsitch, an epidemiologist at the Harvard T.H. Chan School of Public Health, indicates that between 20 and 60 percent of the global adult population will contract the coronavirus. In eastern Massachusetts, that could translate to staggering numbers: There are roughly 4.875 million people in the Greater Boston metro area alone, according to the most recent Census estimates.
If 40 percent of adults here — about 1.9 million people — become infected, it’s plausible that 20 percent, or 380,000 people, would require hospitalization and 4 percent, or 76,000 people, would need ICU care, according to Jha, based on data from China, South Korea, and Italy. That’s why it’s imperative, he and other public health experts say, to “flatten the curve,” or slow the growth of coronavirus cases, so not to suddenly inundate hospitals.
“These are crazy numbers,” Jha said. “What this data shows us is without very aggressive action, we are in pretty serious trouble in terms of hospital capacity in eastern Massachusetts. If we take very aggressive action, open up a lot more capacity, really slow down infections rates, we have a shot at not overwhelming the system, but it’s not a given.
“No matter what optimistic scenario you come up with, as long as you’re staying within the range of what is reasonable, even the most optimistic scenario says we have nowhere near the bed capacity to manage what is coming,” Jha continued.
Rusconi, the doctor in Milan, offers this advice for Americans hoping to stem the tide of infection here: Stay at home.
“This will have a large economical impact, but if you want to confine this infection, you have to tell people to stay home and force people to stay home,” he said. “I’m talking about work. I’m also talking about amenities, restaurants, movies, disco clubs, etcetera.”
In the meantime, Rusconi added, he and his colleagues will continue to work exhausting 12-hour days at the front lines of the pandemic, “without drinking, without eating, with brief stops to go to the bathroom.”
“This burden has been very deep," Rusconi said. “What’s happening in four weeks or six weeks? We don’t know. Of course, we will need some, I think, psychological help afterwards.”