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Bergamo Italy : This Is The Bleak Heart of The World’s Deadliest Coronavirus Outbreak

The streets of Bergamo are empty. As in all of Italy, people can leave their homes only for food and medicines and work. The factories and shops and schools are closed. There is no more chatting on the corners or in the coffee bars.

But what won’t stop are the sirens.

While the world’s attention now shifts to its own centers of contagion, the sirens keep sounding. Like the air raid sirens of the Second World War, they are the ambulance sirens that many survivors of this war will remember. They blare louder as they get closer, coming to collect the parents and grandparents, the keepers of Italy’s memory.

The grandchildren wave from terraces, and spouses sit back on the corners of now empty beds. And then the sirens start again, becoming fainter as the ambulances drive away toward hospitals crammed with coronavirus patients.

“At this point, all you hear in Bergamo is sirens,” said Michela Travelli.

On March 7, her father, Claudio Travelli, 60, was driving a food delivery truck all around northern Italy. The next day, he developed a fever and flu-like symptoms. His wife had run a fever in recent days, and so he called his family doctor, who told him to take a common Italian fever reducer and rest up.

For much of the prior month, Italian officials had sent mixed messages about the virus.

On Feb. 19, some 40,000 people from Bergamo, a province of about a million people in the region of Lombardy, traveled 30 miles to Milan to watch a Champions League soccer game between Atalanta and the Spanish team Valencia. (The mayor of Bergamo, Giorgio Gori, this week called the match “a strong accelerator of contagion.”) Mr. Travelli and his wife didn’t take the threat of the virus seriously back then, their daughter said, “because it wasn’t sold as a grave thing.”

But Mr. Travelli could not shake his fever, and he got sicker.

On Friday, March 13, he felt unbearable pressure on his chest and suffered dry heaves. His temperature spiked and his family called an ambulance. An ambulance crew found her father with low levels of oxygen in his blood but, following the advice of Bergamo’s hospitals, recommended he stay home. “They said, ‘We have seen worse, and the hospitals are like the trenches of a war,’” Ms. Travelli said.

Another day at home led to a night of coughing fits and fever. On Sunday, Mr. Travelli woke up and wept, saying, “I’m sick. I can’t do it anymore,” his daughter said. He took more fever suppressant but his temperature climbed to nearly 103 degrees and his skin became yellow.

This time, as the ambulance arrived, his daughters, both wearing gloves and masks, packed a bag with two pairs of pajamas, a bottle of water, a cellphone and a charger. His oxygen levels had dipped.

Red Cross workers hovered over him on a bed, where he lay below a painting of the Virgin Mary. They brought him into the ambulance. His granddaughters, 3 and 6, waved goodbye from the terrace. He looked up at them, at the balconies draped with Italian flags. Then the ambulance left and there was nothing to hear. “Only the police and the sirens,” his daughter said.

The ambulance crew that took Mr. Travelli away had started early that morning.

At 7:30 a.m., a crew of three Red Cross volunteers met to make sure the ambulance was certified as cleaned and stocked with oxygen. Like masks and gloves, the tanks had become an increasingly rare resource. They blasted one another in sprays of alcohol disinfectants. They sanitized their cellphones.

“We can’t be the untori,” said Nadia Vallati, 41, a Red Cross volunteer, whose day job is working in the city’s tax office. She was referring to the infamous “anointers,” suspected in Italian lore of spreading contagion during the 17th century plague. After sanitizing, Ms. Vallati and her colleagues wait for an alarm to sound in their headquarters. It never takes long.

Indistinguishable from one another in the white medical scrubs pulled over their red uniforms, crew members entered Mr. Travelli’s home on March 15 with tanks of oxygen. “Always with oxygen,” Ms. Vallati said.

One of the biggest dangers for coronavirus patients is hypoxemia, or low blood oxygen. Normal readings are between 95 and 100, and doctors worry when the number dips below 90.

Ms. Vallati said she had found coronavirus patients with readings of 50. Their lips are blue. Their fingertips turn violet. They take rapid, shallow breaths and use their stomach muscles to pull in air. Their lungs are too weak.

In many of the apartments they visit, patients clutch small oxygen tanks, the size of SodaStreams, that are procured for them with a doctor’s prescription by family members. They lie in bed next to them. They eat with them at the kitchen table. They watch the nightly reports of Italy’s dead and infected with them on their couches.

On March 15, Ms. Vallati put her hand, wrapped in two layers of blue gloves, on the chest of Teresina Coria, 88, as they measured her oxygen level. The next day, Antonio Amato, an outlier at the age of 40, sat in his armchair, holding his oxygen tank as his children, whom he could not hold for fear of contagion, waved to him from across the room.

On a Saturday, Ms. Vallati found herself in the bedroom of a 90-year-old man. She asked his two granddaughters if he had had any contact with anyone who had the coronavirus. Yes, they said, the man’s son, their father, who had died on Wednesday. Their grandmother, they told her, had been taken away on Friday and was in critical condition.

They weren’t crying, she said, because “they didn’t have any tears left.”

On another recent tour in the highly infected Valle Seriana under the Alps, Ms. Vallati said, they picked up a woman of about 80. Her husband of many decades asked to kiss her goodbye. But Ms. Vallati told him he could not, because the risk of contagion was too high. As the man watched the crew take his wife away, Ms. Vallati saw him go into another room and close the door behind him, she said.

While those suspected of infection are taken to hospitals, the hospitals themselves are not safe. Bergamo officials first detected the coronavirus at the Pesenti Fenaroli di Alzano Lombardo hospital.

By then, officials say, it had already been present for some time, masked as ordinary pneumonia, infecting other patients, doctors, and nurses. People carried it out of the hospital and into the city, out of the city and into the province. Young people passed it to their parents and grandparents. It spread around bingo halls and over coffee cups.

The mayor, Mr. Gori, has talked about how infections have ravaged his town and nearly broken one of Europe’s wealthiest and most sophisticated health care systems. Doctors estimate that 70,000 people in the province have the virus. Bergamo has had to send 400 bodies to other provinces and regions and countries because there is no room for them there.

“If we have to identify a spark,” he said, “it was the hospital.”

When an ambulance arrives, its crew proceeds with extreme caution. Only one of the three, the team leader, accompanies the patient inside. If the patient is heavy, another helps.

This weekend, a group of doctors from one Bergamo hospital wrote in a medical journal associated with The New England Journal of Medicine that “we are learning that hospitals might be the main Covid-19 carriers” and “as they are rapidly populated by infected patients, facilitating transmission to uninfected patients.”

Ambulances and their personnel get infected, they said, but perhaps show no symptoms, and spread the virus further. As a result, the doctors urged home care and mobile clinics to avoid bringing people to the hospital unless absolutely necessary.

But Ms. Vallati said they had no choice with the gravest cases. The authors of the paper work at Bergamo’s Papa Giovanni XXIII, where Ms. Vallati’s crew have taken many of the sick.

Dr. Ivano Riva, an anesthesiologist there, said the hospital was still admitting up to 60 new coronavirus patients a day. They are tested for the virus he said, but at this point the clinical evidence — the coughs, the low oxygen levels, the fevers — is a better indicator, especially since 30 percent of the tests produced false negatives.

The hospital had 500 coronavirus patients, who occupied all 90 I.C.U. beds. About a month ago, the hospital had seven such beds.

Oxygen flows everywhere through Lombardy’s hospitals now, and workers are constantly pushing carts of tanks around the corridors. A tanker truck filled with oxygen is parked outside. Patients are jammed next to supply closets and in hallways.

Dr. Riva said 26 of his hospital’s 101 medical staff members were out of work with the virus. “It’s a situation that no one has ever seen, I don’t think in any other part of the world,” he said.

If people don’t stay at home, he said, “the system will fail.”

His colleagues wrote in the paper that intensive care unit beds were reserved for coronavirus patients with “a reasonable chance to survive.” Older patients, they said, “are not being resuscitated and die alone.”

Mr. Travelli ended up at the nearby Humanitas Gavazzeni hospital, where, after a false negative, he tested positive for the virus. He is still alive.

“Papi, you were lucky because you found a bed — now you have to fight, fight, fight,” his daughter Michela told him in a telephone call, their last before he was fitted with a helmet to ease his breathing. “He was scared,” she said. “He thought he was dying.”

In the meantime, Ms. Travelli said she had been quarantined and had lost her sense of taste for food, a frequent complaint among people without symptoms, but who have had close contact with the virus.

So many people are dying so quickly, the hospital mortuaries and funeral workers cannot keep up. “We take the dead from the morning till night, one after the other, constantly,” said Vanda Piccioli, who runs one of the last funeral homes to remain open. Others have closed as a result of sick funeral directors, some in intensive care. “Usually we honor the dead. Now it’s like a war and we collect the victims.”

Ms. Piccioli said one member of her staff had died of the virus on Sunday. She considered closing but decided they had a responsibility to keep going, despite what she said was constant terror of infection and emotional trauma. “You are a sponge and you take the pain of everybody,” she said.

She said her staff moved 60 infected bodies daily, from Papa Giovanni and Alzano hospitals, from clinics, from nursing homes and apartments. “It’s hard for us to get masks and gloves,” she said. “We are a category in the shadows.”

Ms. Piccioli said that in the beginning, they sought to get the personal effects of the dead, kept in red plastic bags, back to their loved ones. A tin of cookies. A mug. Pajamas. Slippers. But now they simply don’t have time.

Still, the calls to the Red Cross crew do not stop.

On March 19, Ms. Vallati and her crew entered the apartment of Maddalena Peracchi, 74, in Gazzaniga. She had run out of oxygen. Her daughter Cinzia Cagnoni, 43, who lives in the apartment downstairs, had placed an order for a new tank that would arrive on Monday, but the Red Cross volunteers told her she wouldn’t hold out that long.

“We were a little agitated because we knew that this could be the last time we saw each other,” Ms. Cagnoni said. “It’s like sending someone to die alone.”

She and her sister and her father put on a brave face under their masks, she said. “You can do it,’’ they told her mother, she said. “We will wait for you, there are still so many things we need to do with you. Fight back.”

The volunteers brought Ms. Peracchi down to the ambulance. One of her daughters urged her stunned grandchildren to bid farewell with louder voices. “I thought a thousand things,’’ Ms. Cagnoni said. “Don’t abandon me. God help us. God save my mother.” The ambulance doors closed. The sirens sounded, as they do “all the hours of the day,” Ms. Cagnoni said.

The crew drove to Pesenti Fenaroli di Alzano Lombardo, where Ms. Peracchi was found to have the coronavirus and pneumonia on both sides of her lungs. On Thursday night, her daughter said she was “holding on by a thread.”

Ms. Peracchi is a woman of deep Catholic faith, said her daughter, who spiked a temperature herself the night the ambulance took her mother away and has remained quarantined since.

It pained her mother, she said, that if it came to it, “we cannot have a funeral.”

To contain the virus, all religious and civil celebrations are banned in Italy. That includes funerals. Bergamo’s cemetery is locked shut. A chilling backlog of coffins waits in a traffic jam for the crematorium inside the cemetery’s church.

Officials have banned changing the clothes of the dead and require that people be buried or cremated in the pajamas or medical gowns they perish in. Corpses need to be wrapped in an extra bag or cloaked in a disinfecting cloth. The lids of coffins, which usually cannot be closed without a formal death certificate, now can be, though they still have to wait to be sealed. Bodies often linger in homes for days, as stairs and stuffy rooms become especially dangerous.

“We are trying to avoid it,” the funeral director, Ms. Piccioli, said of home visits. Nursing homes were much easier because you could arrive with five or six coffins to be filled and loaded directly into the vans. “I know it’s terrible to say,” she said.

Through a network of local priests, she helps arrange quick prayers, rather than proper funerals, for the dead and the families who are not quarantined.

That was the case for Teresina Gregis, who was interred at the Alzano Lombardo cemetery on March 21 after she died at home. Ambulance workers had told her family that there was no room in the hospitals.

“All the beds are full,” they told the family, according to her daughter-in-law, Romina Mologni, 34. Since she was 75, she said, “they gave priority to others who were younger.”

In her last weeks at home, her family struggled to find tanks of oxygen, driving all over the province as she sat facing her garden and the pinwheels she adored.

When she died, all the flower shops were closed because of the lockdown. Ms. Mologni instead brought to the cemetery one of the pinwheels her own daughter had given her grandmother. “She liked that one.”

Photo editing by David Furst and Gaia Tripoli. Design and development by Rebecca Lieberman and Matt Ruby.

Obituary from L’Eco di Bergamo, March 13, 2020.

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Source: ‘We Take the Dead From Morning Till Night’

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Sky News’ Chief Correspondent Stuart Ramsay is in Italy’s coronavirus epicentre – the town of Bergamo. Watch his report about life in the town residents are describing as ‘apocalyptic’ where the ambulance sirens never stop. MORE FROM SKY NEWS: Last week, Stuart and his team visited the town’s hospital, which is at the centre of the coronavirus crisis. You can watch that hard-hitting report here: https://www.youtube.com/watch?v=_J60f…

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What Is Coronavirus & What Happens Now It Is a Pandemic

The disease appears to have originated from a Wuhan seafood market where wild animals, including marmots, birds, rabbits, bats and snakes, are traded illegally. Coronaviruses are known to jump from animals to humans, so it’s thought that the first people infected with the disease – a group primarily made up of stallholders from the seafood market – contracted it from contact with animals.

Although an initial analysis of the virus that causes Covid-19 suggested it was similar to viruses seen in snakes, the hunt for the animal source of Covid-19 is still on. A team of virologists at the Wuhan Institute for Virology released a detailed paper showing that the new coronaviruses’ genetic makeup is 96 per cent identical to that of a coronavirus found in bats, while an as-yet unpublished study argues that genetic sequences of coronavirus in pangolins are 99 per cent similar to the human virus. Some early cases of Covid-19, however, appear to have inflicted people with no link to the Wuhan market at all, suggesting that the initial route of human infection may pre-date the market cases.

The Wuhan market was shut down for inspection and cleaning on January 1, but by then it appears that Covid-19 was already starting to spread beyond the market itself. On January 21, the WHO Western Pacific office said the disease was also being transmitted between humans – evidence of which is apparent after medical staff became infected with the virus. Since then, evidence of widespread human-to-human transmission outside of China has been well established, making chances of containing the virus much harder.

What exactly is Covid-19?

Coronaviruses are a large group of viruses that are known to infect both humans and animals, and in humans cause respiratory illness that range from common colds to much more serious infections. The most well-known case of a coronavirus epidemic was Severe Acute Respiratory Syndrome (Sars), which, after first being detected in southern China in 2002, went on to affect 26 countries and resulted in more than 8,000 cases and 774 deaths. The number of people infected with Covid-19 has now well surpassed those hit with Sars.

While the cause of the current outbreak was initially unknown, on January 7 Chinese health authorities identified that it was caused by to a strain of coronavirus that hadn’t been encountered in humans before. Five days later the Chinese government shared the genetic sequence of the virus so that other countries could develop their own diagnostic kits. That virus is now called Sars-CoV-2.

Although symptoms of coronaviruses are often mild – the most common symptoms are a fever and dry cough – in some cases they lead to more serious respiratory tract illness including pneumonia and bronchitis. These can be particularly dangerous in older patients, or people who have existing health conditions, and this appears to be the case with Covid-19. A study of 44,415 early Chinese Covid-19 patients found that 81 per cent of people with confirmed infections experienced only mild symptoms. Of the remaining cases, 14 per cent were in a severe condition while five per cent of people were critical cases, suffering from respiratory failure, septic shock or multiple organ failure. In the Chinese study, 2.3 per cent of all confirmed cases died, although the actual death rate is probably much lower as many more people will have been infected with the virus than tested positive.

How far has it spread?

China has borne the brunt of Covid-19 infections (so far). As of March 11, Chinese health authorities had acknowledged over 81,250 cases and 3,253 deaths – most of them within the province of Hubei. On March 17, China recorded just 39 new cases of the virus – a remarkable slowdown for a country which, at the peak of its outbreak in mid-February, saw more than 5,000 cases in a single day.

But while things were slowing down in China, the outbreak started picking up in the rest of the world. There are now confirmed cases in at least 150 countries and territories. Outside of China, Italy has seen the highest number of cases, with 47,035 confirmed infections, mostly in the north of the country, and 4,032 deaths – more than in China. The entire country is now on lockdown after the quarantine covering the north of the country was extended on March 9.

Spain is also in the grip of a significant outbreak. The country has 20,410 confirmed infections and 1,043 deaths – the second-highest number within Europe. There, citizens are under lockdown, with the government shutting all schools, bars, restaurants and non-essential supermarkets down. People are only allowed to leave their homes to buy food or to go to work. Germany has 19,711 cases and 53 deaths, with the state of Bavaria implementing a full lockdown.

Iran, too, is seeing a surge in cases. The country has confirmed at least 1,433 deaths and 19,664 cases. In the US, there have been more than 14,631 cases and 210 deaths – 74 of them in Washington State, which has become the epicentre of the US outbreak.

While the number of new cases continues to rise sharply, people are also recovering from the infection. Globally, 84,960 people have recovered from Covid-19 – about 32 per cent of all of the people who had confirmed infections, although the true number of coronavirus cases will be much higher.

What’s the latest in the UK?

As of March 18, the UK has reported 3,983 confirmed Covid-19 infections and 177 deaths. On March 16, prime minister Boris Johnson led the first daily coronavirus press conference, saying that the government now advised all UK residents to avoid non-essential social contact and travel where possible. On Friday March 20 this was extended to include a shutdown of all bars, pubs, cafes and restaurants in the UK. From the same day all schools in England, Scotland and Wales were shut until further notice. Only vulnerable children, or those who are the sons and daughters of employees in the NHS or other key industries, will be permitted to remain at school.

People who currently live alone are recommended to self-isolate for seven days if they develop a fever or persistent dry cough – the two most common symptoms of coronavirus. For families and other people who live together, the advice is that the entire household should self-isolate if any member develops either of those symptoms. This strategy is part of the government’s ‘delay phase‘ plan to flatten the peak of the virus and reduce the burden on the NHS.

A key part of this plan is shielding those who are most vulnerable to Covid-19: people older than 70, or those who have underlying health conditions. The prime minister said that this shielding may last as long as 12 weeks in order to ensure that the peak of the outbreak has passed, although modelling from Imperial College London suggests that these measures may have to be in place for as long as 18 months. Despite these measures, some have been critical that the government’s stance doesn’t go far enough. Italy and Spain have both in place widespread lockdowns, while South Korea has rolled-out extremely comprehensive testing for many of its population.

The outbreak has also had a serious impact on the UK’s stock market. On March 9 the FTSE 100 fell by more than eight per cent, knocking billions off the value of major UK companies. Cinema changes Odeon, Cineworld and Vue closed their doors while Euro 2020 was also delayed until 2021, which is an added blow to broadcasters, particularly ITV.

What are the symptoms of Covid-19?

Covid-19 shares many of its symptoms with the flu or common cold, although there are certain symptoms common to flu and colds that are not usually seen in Covid-19. People with confirmed cases of Covid-19 rarely suffer from a runny nose, for instance.

The most common Covid-19 symptoms are a fever and a dry cough. Of 55,924 early Chinese cases of the disease, nearly 90 per cent of patients experienced a fever and just over two-thirds suffered with a dry cough. That’s why the UK government is advising anyone with a high temperature or a new, continuous cough to stay at home for seven days or, if they live with other people, for the entire household to isolate for 14 days from the first onset of symptoms.

Other Covid-19 symptoms are less common. Just under 40 per cent of people with the disease experience fatigue, while a third of people cough up sputum – a thick mucus from within the lungs. Other rarer symptoms include shortness of breath, muscle pain, sore throats, headaches or chills. According to the WHO, symptoms tend to appear between five and six days after infection.

What’s happening with a vaccine?

A vaccine for Covid-19 isn’t around the corner. Bringing vaccines to the market is a notoriously slow process and any potential vaccine will have to pass multiple stages of testing for safety and effectiveness. And once we know a vaccine is safe, we will also need to manufacture it at a scale high enough to use across the world. It’s likely that any vaccine is around 18 months away.

That said, there is lots of work being done to develop a vaccine for Covid-19. The pharmaceutical firm Sanofi is trying to build on its already-approved flu vaccine and turn it into something suitable to treat Covid-19. Other approaches – such as one being trialled by the University of Oxford – are focusing on the external spike proteins on the Covid-19 virus as a way to target vaccines.

But accelerating these efforts will require funding. The Coalition for Epidemic Preparedness Innovations (CEPI) has called for $2 billion in funding to support the development of new coronavirus vaccines.

What’s going to happen next?

WHO chief Tedros Adhanom Ghebreyesus has warned that the window of opportunity to contain Covid-19 is “narrowing”. Recent outbreaks in Italy and Iran, which so far have no clear link to China, pose a significant challenge to health authorities trying to stop the spread of the virus.

After initially delaying the decision, on March 11, the WHO declared the Covid-19 outbreak a pandemic. The agency cited the rapid growth of cases outside of China and the global spread of the disease as reasons behind the designation. In January, it also declared the outbreak a “public health emergency of international concern” – the highest category of warning for an infectious disease outbreak.

Since 2009 there have only been five declarations of international public health emergencies: the swine flu pandemic in 2009, a polio outbreak in 2014, the Western Africa Ebola outbreak in 2014, the Zika virus outbreak in 2015 and another Ebola outbreak in the Democratic Republic of the Congo in 2019.

Matt Reynolds is WIRED’s science editor. He tweets from @mattsreynolds1

Source: What is coronavirus and what happens now it is a pandemic?

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And why the disease first appeared in China. NOTE: As our expert Peter Li points out in the video, “The majority of the people in China do not eat wildlife animals. Those people who consume these wildlife animals are the rich and the powerful –a small minority.” This video explains how the people of China are themselves victims of the conditions that led to coronavirus. The virus is affecting many different countries and cultures, and there is never justification for xenophobia or racism. You can find further reading on this on Vox: https://www.vox.com/2020/2/7/21126758… https://www.vox.com/policy-and-politi… https://www.vox.com/identities/2020/3…

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