The storm has passed, now we must go back to living


The point of view of Andrea Badaracco, a doctor who works in a COVID department of Clinica Luganese Moncucco

The storm has passed, now we must go back to living
@ Archivio CdT

The storm has passed, now we must go back to living

@ Archivio CdT

The following is my idea. It is mine alone, highly questionable and subject in any case to more authoritative judgement. I have the impression that insecurity often prevails (reopen or not reopen? How to protect yourself?), completely understandable and justified but sometimes dysfunctional and paralysing. I’d rather convey a little positivity and courage.

Follow the captain

A first dutiful premise: during the storm we always follow the captain, so the only responsible attitude is unconditional obedience to those who give us directives. What is needed is not passive and listless but active obedience, as a grateful identification in those in charge, which helps to find new and creative solutions in problem management. But now we are out the storm, the sea is calming down, the good weather is slowly returning and there is room to listen to the crew’s ideas about recovering the tormented ship. The weather forecast predicts at worst a rough sea and at best a calm lake but no more storm.

The peak in late March

A second premise concerns the information now available: a good indicator for assessing whether containment has been effective is the number of new hospitalisations in Ticino within 24 hours, since the ratio between cases requiring hospitalisation and every new infection is relatively constant. The peak of new hospitalisations was without any doubt and without discussion on March 25th (over 70 per day), then the curve collapsed within a few days (less than 10) confirming that the “lockdown” worked very well. The population reacted very well and really deserved the compliments from the cantonal doctor. I remember that the aim is not to stop the contagions but to avoid overloading the health system. A vaccine is not on the horizon at the moment and we still do not have any effective antivirals waiting for which it would make sense to try to reduce the contagion to zero at any cost.

Disaster narrowly avoided

Third premise, with immense admiration and gratitude: disaster narrowly avoided. This virus, left free in a population without immunity (without containment measures), can double the number of new admissions every 4 days. That’s why “lockdown” is the crux of it all. Closing everything was essential and the timing was perfect. A simulation carried out in our facility showed that a delay of only 4 days in Ticino (hospitalisations multiplied by 2, i.e. 140 per day instead of 70) would have led to an overburdening of the maximum capacity of the system; it would have been a catastrophe like in Lombardy with patients in the corridors and without intensive care places. We must be extremely grateful to those who read the situation correctly and were able to persuade the authorities to ‘shut everything down’ when the benefit of such drastic measures was still under discussion. We have never exceeded the capacity of the wards and intensive care but came close to the limits. Now hospitals are emptying. Moncucco has closed most of the COVID wards and, about two weeks later as is normal, patients in intensive care are gradually returning to the ward.

Lower risk

Fourth premise based only on hypothesis, therefore less solid than the previous ones: an unknown but important part of the population has now come into contact with the virus without getting sick or being cured, so the risk of contagion is certainly lower than before (when nobody was immune). At the reopening there will be new cases, but less so than in March. It isn’t changing our contagion curve anymore from April onwards, so the benefit in terms of flock immunity, of these very few residual infections that occur despite the containment measures, is very questionable. The more isolated we are, the longer the epidemic lasts. This does not mean that we have to get infected on purpose, but that in a few months’ time the situation may not be very different from April 2020 from a health point of view and it may become dramatic and irreversible from other points of view if we don’t dare. Our curve is two weeks ahead of most cantons, so now the Confederation is lagging behind Ticino when it reopens. The fact that the infection was more aggressive here in the beginning means that it will be less aggressive now, not the other way around. Moreover, the behaviour of our people today is much better adapted to the situation of potential contagion than in the carefree times of Rabadan and this is a central point.

The crippling “don’t do”

After the necessary premises, what I wanted most to say. The mantra “stay at home” is a simplification that’s fine at the beginning, but later on it becomes more important to understand how to leave home in this new situation. The “how to” becomes more useful than the crippling “don’t”. In reality, the purpose of the mantra is simply to avoid contact at risk of infection. In Moncucco we only have 1% of staff infected (infections that certainly occurred partly outside the clinic). We’re in the middle of COVID patients all day. We protect ourselves with the surgical mask alone, with an additional gown that changes in each room and very thorough and very regular hand disinfection. These two simple measures (mask and hand hygiene) are in my opinion essential to protect those who are healthy from those who are sick or could be carriers of the virus. But there are those who want to be “more papist than the pope”. Advise against any trip and close all the lakes of the Lugano area and various cycle routes can be politically profitable and, in some ways, understandable in the face of repeated reports of “there are too many people around”, but it is also treating the public as morons and arbitrarily refuse them access to central, beautiful and, above all, useful places especially in these secluded times. The risk of contagion on the shore of a lake or at Parco Ciani with the necessary precautions is acceptable. The positivity of being able to stay in those regenerating places in addition to the effects on health of a regenerating walk in nature are very evident. With regard to the risk of accidents in outdoor activities, hospitals are now working at a very low rate. Orthopaedic surgery has been stopped for almost a month. Rega has greatly reduced “common” interventions. Who can say that it would be a problem to cure someone (very few as we have seen) who, while being careful, slipped on the shore of the Origlio lake or fell during a bike ride? Orthopedists would rub their hands ankylosed from inactivity for the joy of finally being able to return to the operating room. Many elderly people have told me: “I don’t want to spend precious months for me, you see, my months are more precious than those of a young person, in total isolation. I’d rather die than stay long without grandchildren.” And I understand them very well. Those who would like to keep them inside for the whole year should have been born in China. Future visits by healthy grandchildren with clean hands (disinfected or washed very well) to their grandparents with a mask are welcome.

Ai bambini serve il contatto

It now seems to me dramatically urgent that we also take account of needs that go beyond the health problem. What does a restaurateur do? What happens to a child who lives for months isolated from his peers? The mayors of the canton’s major cities and some doctors consider the reopening of schools in mid-May to be premature. But children are sick and tired of being away from their friends and the school structures their lives. Children need contact like the air they breathe.

With these reflections I do not want in any way to influence the agenda of the authorities with regard to the timing and modalities of the reopening, only humbly recall the importance of an attitude that treats adult citizens as such, that considers their freedom and ability to be active in a responsible way, to be creative within the limits imposed. I would like to shift the focus a little from the health problem, which seems to me to be under control, to other problems (catering, tourism, economy, schooling) which are getting worse every day and now urgently need to be solved. In Ticino we have already won the most difficult battle that the current generations have ever faced together. Now it is no longer the time for generals to impose without discussion, it is time to rebuild. It is the moment of creativity that comes from below, but which requires the recognition and trust of those above. It is time to restore freedom to those who have made great sacrifices so that they can solve problems that can only be understood in the field (can you open a restaurant with tables spaced apart? How can we protect elderly teachers at the reopening of schools?) and has no interest in betraying the trust given.

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