RWC Series: "Facing Challenges from Around the Globe: Covid-19"
By Fabio Patelli, MD . Director of Vitreoretinal Surgery, ASST Santi Paolo e Carlo University Hospital in Milan (Milan, Italy).

Other affiliations include ASRS, Gruppo Italiano di Chirurgia Vitreoretinica (GIVRE), Euretina, and Retina Society

A Message from Fabio Patelli ~

Dear friends and colleagues,

I’m Fabio Patelli and I work and live in the beautiful city of Milan, Italy.
I would like to share with you my feelings as an ophthalmologist, as a doctor, and as a father in this terrible and unexpected period of our life.

Milan is the economical capital of Italy with 3 million people. You can feel in the air the energy, the beauty, the enthusiasm of the people. Milan has the most beautiful fashion district in the world. Milan is otherwise called the city of ”Aperitivo” (Happy Hour) meaning that after work around 7 pm everyone meets each other for a drink...or two.until 9 pm. Thousand of people in the streets, in the bars, in the restaurants. In springtime this energy is more powerful than ever, and you can feel the joy of life everywhere.

Well, this suddenly stopped at the end of February. The government imposed to stay at home for the epidemic covid-19. The city was locked down. Everything was closed: school, bars, restaurants, shopping centers, EVERYTHING!!! Except supermarkets and pharmacies... We started a war against an invisible enemy and still today this is surreal! People started to die!! Several hundred every day in my town, Milan...

At the beginning it seemed to be just a bad flu and only old people (around 80s) died. Day by day, I saw younger people arrive at the hospital with fever and cough and in few days develop a bad pneumonia. Now young people are dying too. Today March 27th, 80% of the patients in the ICU in my hospital are under 50 years old and 40% of the intubated patients die. Patients over 65 are not candidates for the ICU.
As an Ophthalmologist:
I decided to close my offices. When the patients call the office, they are transferred to a cell phone. My secretary forwards the messages and I call back and eventually go to visit only the urgencies. I also work as a consultant in a University Hospital where I do VR surgery. All the surgical procedures were suspended, except urgencies. Our anesthesiologists are very busy with the COVID patients and some of them are COVID positive and urged to stay at home even if they are symptomless (this was true at the beginning, now NO COVID test is done to the doctors and they work even if they are COVID positive symptomless). If there is a retinal detachment, first I have to ask the availability of the anesthesiologist, and, if I am lucky, I can do it, otherwise I have to refer the patient to another hospital…Another hospital that is in the same situation as my hospital…
We continue to do anti-VEGF injections but only for serious cases (like one-eyed patients). 
As a doctor:
We were asked to help our colleagues, general doctors, that are treating COVID patients. Our hospital is full now and every doctor tries to help each other. I spent a night in a COVID department. It was a poignant experience. Doctors are powerless, the only thing they can do is give oxygen and hope. That night, an otherwise healthy 45 y.o. man arrived at the hospital. He wasn’t too sick, and he wasn’t worried about his cough and fever. Three days later he was intubated and still in the ICU. That night, a 69 y.o. man died at 3 am, my colleagues called his son to inform him about the death. The son didn’t see the father for 2 weeks because these patients are isolated from everyone. My colleague told him that the ashes will be sent home in about a week.
I was shocked, but this is the routine right now. Hundreds of people die every day in Italy.

As a father:
I spend most of the time at home now and I can really enjoy my family and my 2 kids of 11 and 9 y.o. – this is the positive part. 
We have lost our freedom. Nobody can leave their home if not justified for legitimate reasons. Police are everywhere. 
I saw too many young patients in ICU who died, and I am scared. I’m scared to get sick, to be isolated, to die and leave my sons and my wife. This is my feeling every day, every moment!!!

In this moment in Italy we have:
- 86,498 COVID people tested positive (but probably 10 times more unknown)
- 66,414 are actually COVID positive
- 9,134 dead
- 10,950 healed
- 26,029 hospitalized
- 3,732 in ICU
- 6.213 medical doctors and nurses COVID positive
- 51 medical doctors died, all less than 70 y.o.

These are not just numbers!!!

Be safe dear friends and take care.
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