Editor’s Note: This interview was translated from Italian to English.
Dr. Duccio Alessandro Marchi is a general practitioner, with a specialization in psychiatry. He practices in Urbino, Italy, a city in the Le Marche region. He graduated from the University of Bologna and has been a practicing physician for more than 37 years.
Marco Schaden (MS): What is the current situation of the coronavirus in Italy?
Dr. Duccio Alessandro Marchi (DM): The situation is difficult because it’s a moment where the disease is growing exponentially. Every day that passes, the cases augment. The numbers doubled from yesterday to today.
MS: How many patients are you seeing every day with symptoms? How many are you sending to get tested every day for the coronavirus?
DM: I have 1,500 patients. Every day is different. One day last week, I saw symptoms in six people. Yesterday (March 11), I started the process of sending two people to get tested. Today (March 12), for example, I didn’t send any patients to get testing. The important thing to understand is that coronavirus testing does not change the outcome of the disease. It is there to help and protect others who may have been in contact with that person, to try to contain it.
MS: How are you meeting with patients and has that changed over time?
DM: With my patients, I try to take precautions for myself, but also for them. The most important thing is distance; I try to keep three to six feet of distance between me and the patient. I only let one patient into the office at a time, with only one person in the waiting room. I wear a mask, gloves and lab coat that is washed daily. Because the Italian state was not able to provide this gear for every medic, each doctor had to take the necessary precaution into their own hands.
MS: How has this virus affected day-to-day life in Italy?
DM: The Italian way of life is virtually unrecognizable at the moment. We are a social society, Italians love to congregate. Now, there are no public gatherings, they recently closed restaurants and bars, people don’t walk in the streets without special permissions. The situation is evolving every day, with increased restrictions. Most people are homebound. Even if it’s difficult, we are doing this to save people. To go out, you have to have a valid reason, along with a printed certificate stating your reason. Whether that is a doctor visit, caring for elderly, food shopping or a trip to the pharmacy, you must have a purpose to be out of your home.
MS: Why do you believe it is spreading so quickly?
DM: The main reason is that this is a new virus and nobody has antibodies, so it naturally expands very quickly through the population. But there is also mismanagement, not just in Italy, but seemingly on a global scale. The right measures where not taken at the right time. We had to do more sooner. We were not able to organize ourselves in a timely manner. The Italian state was not ready for a pandemic like this. In Italy, we are hoping to see the effects of these drastic measures in a few weeks and hopefully see a reduction of cases.
MS: Being in the medical field, are you fearful that you might get infected as well?
DM: I don’t have fear. This is the work you put in as a physician and this is my profession. If I had fear, I would not be able to do my job. But it is a stressful situation and moment. I very much feel the need to help others, not only with their physical ailments as we try to contain [the coronavirus], but also the psychological effects of this pandemic.
MS: Is there enough medical equipment and coronavirus tests to deal with the outbreak?
DM: There is a system in place for testing, which is a good thing. The issue we are having is that masks, equipment and protective gear is in short supply, but high demand. Beyond that, the country has reached a point where hospitals have limited room for those who need treatment—the system is completely overwhelmed in certain regions where the coronavirus spread is more severe. Here in Urbino-Pesaro the hospitals are at full capacity, and those who need medical attention are being sent to other hospitals.
MS: Was Italy ready for a public health crisis like this? What, if anything, could have been done better?
DM: We could have done things better in the years leading up to this. We should have never cut budgets. We should have never closed hospitals. The healthcare and hospital system could have been supported and given more funding in the years before this pandemic hit, always with the idea that this could have happened. This was always a possibility.
MS: Are doctors making life-and-death decisions for patients with the virus and potentially using resources on other patients that have a better chance to live?
DM: For my particular job, no. My patients are all treated. But I have heard that in hospitals overwhelmed by this pandemic, doctors do need to make decisions and will opt to take someone who has a better chance of recovery. Those are decisions that doctors are needing to make many times on a daily basis.
MS: What should other countries do to avoid the situation that Italy is currently in?
DM: It’s difficult to say. Prepare for a restrictive lifestyle—isolation and containment is the only way to slow this down. Try to have masks and supplies for medical staff and the general public. Make sure you have the capability to care for the sick, at hospitals and ICUs—with ventilators and equipment. Contain the virus before it gets to this point. Gloves, masks and protection are key. We hope that in the next few weeks, we will see the results of isolation and containment and watch the spread of this disease slow down.
