Lessons from an Italian ICU Nurse on COVID-19

Tears do not roll easily from the eyes of veteran journalists who have covered death and destruction in many parts of the world. I have reported war and catastrophe in Africa, Asia, Europe, the Americas, and the Middle East, and I was always dry-eyed at press conferences.

But I could not stifle the tears during a virtual press conference with Floriana Pino, a frontline Italian Intensive Care Unit nurse. Her wrenching experiences have many lessons for Americans, Europeans or anyone anywhere on the planet confronting COVID-19. She was explaining how she and her colleagues have toiled trying to save lives in the tumultuous past weeks during the crisis of the devious and novel coronavirus. (See William Dowell article on the suspected origins of the pandemic)

During the week, the 30-year-old who is already a true veteran of the war against the pandemic, spoke after a night shift. She addressed journalists from the Geneva UN correspondents’ association called ACANU, along with others from her profession. They spoke about the nursing profession and health workers in Italy and throughout the world. What they said indicated that many societies and governments have been riding roughshod over health and care workers for far too long. (See Andy Cohen article on Switzerland’s questionable pandemic policies)

This article is part of Global Geneva’s regular coverage of personal stories about the coronavirus crisis. A reminder: we make our content free worldwide. If you like what we do, please support us.

“Our lives are like a continuous roller coaster right now because some days we have fear; we feel fatigued; we feel anger,” Pinto recounted. “My hospital is one that has COVID and non-COVID wards to give care to everybody, infected people and non-infected people. And we had to go to the front-line, at the end of February,” she said from Milan.

ICU patients per nurse more than doubled

“I’m in the ICU and usually each nurse cares for two patients. When the emergency started, we had to rapidly get organized and had to enlarge our ICU with more beds — on two floors, having 40 beds, and with each nursing now caring for five patients,” said Pinto. “So, now you can understand how much the situation changed. Nurses are crucial in this emergency now,” said Pinto.

Pinto works in a major hospital in the northern city of Milan. Until earlier this month, Italy ranked as the worst hit country by the silent and increasingly lethal pandemic when the United States unenviably usurped that place on 12 April, 2020. In the same video press conference, Walter de Caro, president of the Italian Nurses Association, rattled off some alarming statistics.

In Italy, he declared, 15,000 health workers had tested positive to COVID-19 along with more than 7,000 nurses. To date, the disease has killed 26 nurses and 94 doctors, many likely to have infected on the first day of the outbreak in country areas due to a lack of personal protective equipment, or PPE. “More than 4,000 people are in intensive care. This is a real collapse for our health system in the north of Italy,” he said. This was echoed by World Health Organization Director-General Tedros Adhanom Ghebreyesus Tedros who recently stressed the United Nations’ concern for the large number of infections reported amongst health workers in many parts of the world.

When I was recovering from a cancer operation in Switzerland five years ago and getting chemotherapy, key ingredients that pulled me through it all was the compassion and support of the health workers at Geneva University’s Hospital, especially the nurses who seemed to run the show. But cancer is not an infectious disease and the health workers offering tender care were in their regular uniforms. They did not have to clad up masked in space suits and keep a distance.

Communicating with COVID-19 patients

“We try to do our best to find other ways to communicate with the COVID patients. We can’t talk; we can’t smile with the masks; so we find ways…(we) have learned to smile and talk with our eyes,” Pinto said with a glint in her eyes. It was hard not to be emotional as I sat in my isolated solitude, Zoomed into the current way of doing journalism. She poignantly related how Italian nurses have stretched their limits and she spoke about crying on hearing of the recovery of a patient. “Two days ago, I and a colleague of mine were having a shower after the shift, as we have to have a shower after the shift every day before leaving the hospital,” Pinto recounted. “And she said to me, ‘Today, we finally managed to awake the patient and then he talked with his wife with a tablet in a video call.”

“I started to cry, the first time I cried in a month, but I was happy. It was one of the best moments of my life. The second was after my niece was born. So, telling you this story, I want to say that nurses are like this. Nurses are in essence, lots of things, technical things, organizing things, but also relations.” With all these competencies, she added, we are “a group who are fighting against this virus.”

Pinto then shifts to the topic of the press conference: Nurses fighting COVID-19, State of the World’s Nurses Report, challenges and difficulties. “If we manage to have better working conditions and if the institution suddenly starts to recognize our profession, this would be the best one ever,” she points out.

Howard Catton, CEO of the International Council of Nurses (ICN), which represents some 130 national associations with over 20 million nurses, stressed the importance of the experience they are gaining from the frontline. “It’s given us a very good overview of what some of the key public health messages and responses need to be,” he said. Noting that 2020 is the Year of the Nurse and Midwife, he said that it was not what the sort of focus they had envisaged. Yet the COVID-19 outbreak has proven to be the most powerful demonstration as to why nurses are needed. “This is an international and global crisis,” he said. “We need cooperation across borders to get much-needed supplies to healthcare workers, to share best practice, and to ensure manufacturers step up.”

However, Catton continued: “It will be the greatest tragedy if we do not learn the lessons from this pandemic. We need to see hard actions around investment, support, and strengthening of health systems and the health workforce.” Politicians, he added, need to express themselves in the same courageous manner as those nurses currently fighting COVID-19. They need to “say ‘yes’ to implementing all these recommendations.”

Fighting for PPE and staffing

Taking Italy as an example, it is quite obvious that one of the reasons why it recently suffered the COVID-19 case and death-rate in the world was because it lacked of key resources. These included sufficient quantities of trained workers and personal protective equipment to combat the disease. “We have to fight for proper PPE, for proper staffing,” said Pinto who also noted that Italian nurses are amongst the lowest paid in Europe.

Walter de Caro further argued that the real problem lies within the community where doctors and nurses have had insufficient protection. “It’s is a tragedy for our country. Until now, we have been a donor of nurses.” Five thousand Italian nurses, for example, are working in the UK, while Italy itself has a shortage of 50,000. As a result, Italy has been obliged to seek nurses from other countries such as Albania, China, Cuba and elsehwere in Europe.

Interestingly, Britain’s Prime Minister Boris Johnson credited his country’s National Health System staff earlier this month for saving his life and described them as heroes. “I can’t thank them enough,” the British leader said after being released from the ICU at St Thomas’ Hospital in London after its doctors and nurses had taken care of him following his admission with COVID-19. “I want to pay my own thanks to the utterly brilliant doctors, leaders in their fields …. who took some crucial decisions a few days ago which I will be grateful for the rest of my life.” And yet, 18 years earlier on 17 April, 2002, he had severely criticized the financially-strapped National Health Service (NHS) for “failing” and castigated it as a state-run institution for driving people people to “use private medicine in despair.”

Perhaps the most poignant reminder as to the importance of frontline aid personnel came from Pinto herself. “We have always been here caring for people because it is our profession,” she said. “We are doing this now as the best we can. People call us heroes, But, despite our continuous struggle, we were not recognized.” She added that nurses do not want to be called heroes; they want to be considered professionals and respected as such. “In this way, we can maybe get a real health care system with every professional having respect for the other,” she said.

According to the ICN says, data from 191 countries reveals that there are 19.3 million professional nurses out of a total nursing workforce of 27.9 million. It also notes that their distribution around the globe is not uniform; there are lower nurse-to-population ratios in middle and low-income countries.

The ICN further maintains that 36 million nurses will be required by 2030, but that this target will only be reached if there is an eight per cent increase each year in the total number of nursing graduates. Without this significant rise, there will be a shortage of 4.6 million nurses, primarily in the African, South-East Asian and Eastern Mediterranean regions. In the United States, on the other hand, there are an estimated 3.1 million nurses; but according to the US Bureau of Labor statistics, registered nurseforce will need to increase bu 203,700 a year by 2026 in order to fill newly created positions and to replace retiring nurses.

South African journalist Peter Kenny covers UN, WTO and international issues from Geneva.

A version of this article first appeared in Medium on 16 April 2020.

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Lessons from an Italian ICU Nurse on COVID-19

Tears do not roll easily from the eyes of veteran journalists who have covered death and destruction in many parts of the world. I have reported war and catastrophe in Africa, Asia, Europe, the Americas, and the Middle East, and I was always dry-eyed at press conferences.

ICU patients per nurse more than doubled

Fighting for PPE and staffing

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