The virus is at a dangerously high level

HIGH PROFILE INTERVIEW

Christian Garzoni Director of the Moncucco Clinic analyzes the current situation of the COVID-19 pandemic in Ticino. The circumstances for the epidemiologist are very serious and the hospital system is suffering. The number of infections in recent weeks has remained substantially stable. The director of the Lugano Clinic, Mr Christian Camponovo made a statement saying that ‘in light of the decline in tests that the situation we are currently in, where we do not know exactly what is happening is a problem’.

 The virus is at a dangerously high level

The virus is at a dangerously high level

The virus is intense. We see the effects, which is how many people end up in hospital. These numbers are increasing compared to the already very high pre-Christmas period, at least by 15%. This means that there are more cases in the population and that plenty of viruses are circulating.

I remember a patient who died in Moncucco who told me that he was infected precisely during a Christmas event. I urge you not to put yourself in this position and lose your life for an aperitif’.

‘However if we look at the number of infections, (positive swabs reported by the canton’s statistics) we tend to incorrcectly say that there is a certain stability. There is therefore a discrepancy, and the reason is due to the average age of those who go to swab: comparing the data we notice an increase in people over 50 and a decrease in those below. Put simply, young people are being tested less, probably out of fear of being quarantined or having to notify their friends if they are positive. What is certain is that the number of hospitalized people in the canton is increasing. It’s like a full-rim sink with a tap that’s on constantly. We are in a situation of slow but very dangerous growth: having 50 people in intensive care in a canton with usually 30 of these places is an exceptional situation’.

Taking into consideration that the Moncucco Clinic and the Charity hospital have increased their intensive care beds, does it mean that we are close to the feared collapse of health facilities?

‘The collapse implies that the health system no longer works we are now at the level of having to block all elective hospital activity and to transfer Ticino patients beyond the canton. Intensive care places cannot be increased indefinitely. There is still a minimum margin, but more than that much cannot be climbed. The upcoming increase in these beds implies a further shift of staff from other elective businesses, with further closures in other health sectors.

Let’s also remember that the staff of COVID facilities are exhausted. Keep in mind that a COVID patient is ten times as likely to die as a non-COVID patient. In intensive care there are patients who have been intubated for 20 or 30 days. These are very difficult situations to handle and the health care workers are wearing themselves out physically and mentally. Finally, the very high standard of quality of care unfortunately in these conditions can no longer be guaranteed’.

The English variant has also made the situation more complicated. Is this a serious problem? And to what extent?

“The English variant is a bigger problem. It is not a more aggressive or lethal virus but more sticky, more transmissible. The risk is therefore to have a new surge in infections, a third wave that overlaps the second. Ticino has absorbed the start of the second wave quite well, but we must be very careful. At the Moncucco Clinic, on Friday, we had 125 COVID patients out of 145 places. At Charity the percentage is similar, but in the event of a new surge we reach 50-70 new hospitalizations a day: as well as in the exponential phase of the first and second wave, the situation becomes unsustainable and is a health emergency and collapse. In the face of a much more transmissible virus, current containment measures are clearly insufficient. The English variant has a very high transmission potential and we must foresee the problems with more incisive measures. We know that this variant is already present and no illusion: today the confederation has specific tests available for this variant in an extremely limited way: it is highly probable that we are unfortunately diagnosing only the tip of the iceberg of a problem’.

Young people are being tested less, probably out of fear of being quarantined or having to notify their friends if they are positive.

In recent days, doctors and experts have called for more stringent measures. So, should we close? And above all: which sectors?

“Unfortunately, there is a general sense of habit on the part of the population and of politics, primarily the federal one. We have become addicted and it is seen as normal to have 50 deaths from COVID every week in Ticino, or that acute hospitals have stolen beds from “normal patients” to hospitalize more than 250 COVID patients. We also got used to having 50 COVID places occupied in intensive care. In reality this is an exceptional and unsustainable situation in the medium and long term. If the numbers increase, it means that further brakes must be put in place. As for the measures, it is up to politics to decide where it wants to invest with economic aid in order to implement them. It is clear that the theoretical measures are not that many: either we opt for a total lockdown, which is also done in many states close to us such as Germany, Italy, England, or more aggressive punctual and selective measures are imposed, without necessarily blocking everyone at home, such as the closure of non-essential businesses and compulsory teleworking. Another solution was to extend the school holidays for another ten days for post-compulsory schools. Politics must make its assessments now, but we believe that the current situation is no longer sustainable. You cannot get used to the number of deaths knowing that they could be preventable in the short term thanks to vaccines and maintain a high quality of care in these conditions for a long time’. Another solution was to extend the school holidays for another ten days for post-compulsory schools.

Staying on the subject of school, during the holidays the students changed attendance for 15 days. Now what do you risk?

“It depends on what they did during the holidays. If they have remained within the family unit, they arrive at school “clean”, but if they have had extensive contacts or perhaps have traveled it is clear that this can be a problem. The request to extend the vacation was motivated by the idea of ​​reducing the circulating virus also in the groups of young people, thanks to a selective lockdown. A study published this weekend on Swiss data shows that the movements generated by students are also relevant and will need to be taken into account more in the future”.

Making predictions is difficult, but the coronavirus will accompany us well beyond the end of 2021

Before the holidays we invited the public to be prudent and responsible. Have we been?

“I think there is a large part of the population that has paid attention and a part that has not been careful. What I can say is unfortunately Christmas or New Year period most of the hospitalizations I have witnessed were of people who knew exactly when and how they got infected, that is in the context of aperitifs or dinners related to the holidays. These are avoidable infections. Today it is dangerous to have an aperitif. I remember well a patient who died in Moncucco who told me that he was infected precisely during a Christmas event. For this reason, in the past few weeks, I have invited you not to burn twenty years of life for an aperitif’.

So was it right to decree the closure of bars and restaurants in mid-December?

“It was absolutely necessary. There are studies carried out in the United States according to which especially bars and restaurants are places with very frequent infections. The state decides on further restrictive measures on the basis of data and accumulated experience. Romandie, by closing bars and restaurants, has achieved excellent results in containing the epidemic. I understand restaurateurs and the difficulties they have, but this is a political problem and must be solved with financial aid. Now, unfortunately, we find ourselves in a situation in which it is necessary to close further’.

Your phrase ‘let’s not burn twenty years for an aperitif’ once again reiterates the danger of the virus. We are not only talking about mortality: according to a Swiss study, in which the Lugano Clinic Moncucco participated, published in the ‘European Respiratory Journal’, patients affected by severe forms of coronavirus can have to deal with an insufficient supply of oxygen for months . Are we talking about irreversible damage?

“Unfortunately, there are COVID patients who report long-term damage. There are people who have had their lungs literally burned by the virus. These patients do not fit into the death statistics and it seems that everything went well, but for the individual it can mean having to stay home on oxygen. There are patients who also need lung transplants. The damage to the individual can be very serious: at the pulmonary level, but also neurological, cardiac and psychic’.

These complications are a relatively recent discovery. How much do we still have to discover?

Very. The real problem, however, is not just the virus. There is a component of the immune system that acts against SARS-CoV-2 which, in some people, tends to cause a large part of the damage. It is like an attack by the immune system against one’s own lung. In this area there are still many questions still open. Cortisone therapies are only partially effective and we need to understand how to act more selectively and effectively’.

Put simply, a kind of ‘less intense fire’ for the immune system?

‘Yes exactly. In this context, I repeat that the use of cortisone is dedicated only to patients who need oxygen in the hospital; I have mistakenly seen many patients resort to self-medication with cortisone’.

In an interview with Corriere del Ticino, former head of the Communicable Diseases Division of the FOPH Daniel Koch said that with vaccines and rapid tests we will leave the coronavirus behind by the end of 2021. Do you agree with this forecast? How long will it take to get back to normal?

‘It is impossible to make long-term predictions, but it is likely to imagine a better control of the situation; however, COVID will accompany us well beyond the end of 2021. Some data bodes well but there are also big question marks. There are always unknowns related to the duration of immunity after the disease or given by the vaccine and the mutations of the virus that could make the vaccine no longer protective. Koch may be right if the virus doesn’t mutate significantly, but nobody knows. Furthermore, there is the problem of vaccine tolerance and the logistics of mass vaccinations, an area in which Switzerland unfortunately lags far behind other countries. In any case, in the future the situation could be similar to that of influenza, where there is a virus that changes over time and a vaccine that must be adapted and repeated at regular intervals to ensure protection. It is possible that this COVID-19 could become a kind of life partner of humanity (as happened with other infectious diseases) that will have to find a strategy, including vaccination, to live with it. These today, however, remain scenarios and there are no certainties’.

The word vaccine often rhymes with skeptics. How can you convince them of the need to immunize as many people as possible?

“It is very difficult to convince the skeptics. Switzerland has not introduced a vaccination obligation and will not. The vaccine that will arrive, and that is arriving now, is experienced differently by the population. The range of people at risk is very inclined to be immunized, as the vaccine is truly a lifesaver, while people at low risk, young people in particular, are often skeptical. There are two reasons why a person not at risk should be vaccinated: the first is that even at 30 years of age one can die of COVID; the second is linked to the principle of solidarity. I vaccinate myself so as not to infect others, but not necessarily those who do not know each other. Even if we are 20 or 30 years old and have a very low risk of serious COVID, we risk killing our parents, grandparents and older friends’.

The first wave took us by surprise but as quickly as it went up, the contagion curve went down as well. Today, however, we have been on a sort of plateau for weeks. Where did we go wrong?

“No, they are two completely different situations. During the first wave, which arrived at the end of winter, we pulled the handbrake with a total lockdown to avoid the collapse of the health system and society, having a rapid descent also thanks to the spring. The second wave has stabilized on too high numbers and still has a winter ahead, and we are in the situation we are in. The mistake now, however, is the tendency to get used to the wave and deaths, which are avoidable with the vaccine. Romandie, for example, reacted quickly with aggressive closures and now has a much better situation, with low numbers and hospitals not at the limit. Now is the time to implement more effective measures: we must protect people at risk knowing that we can save them by giving them the vaccine as soon as possible. Protection for categories at risk and rapid vaccination: from a medical point of view these are the absolute priorities’.

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