Emozioni virali. Le voci dei medici dalla pandemia

The unprecedented and unexpected Covid-19 pandemic caused by the new coronavirus Sars-CoV-2 forced medical doctors to upset their daily working routine, to convert entire hospitals in Covid-19 units and to abandon their own private daily living. During pandemic Phase 1 Italian doctors had to face up an extraordinary experience suddenly after Sars-CoV-2/ Covid-19 spread in China in early 2020. Abnegation and compassion were the mighty forces driving their unceasing work. The unmet needs of adequate coping and treating patients because of the novelty and the peculiarity of the infection/disease, along with the unpreparedness to the pandemic, found the place for discussion in a newborn social group, the so-called “The 100,00 doctors Facebook group”, that spontaneously and rapidly had become the source of information, discussion and management proposals. Meanwhile, it was also the place in which inner and  covert emotions found their wording that eventually gave rise to a collection of short stories that has become a book entitled Emozioni virali. Le voci dei medici dalla pandemia. This anthology, reporting personal and professional experiences, may serve as a history book to teach next generation, to keep memory of the unique time during the Sars-CoV-2/ Covid-19 pandemic Phase 1, to help in improving the Italian Health System and to emphasize the positive role of digital communication, when properly used.

Emozioni virali, Le voci dei medici dalla pandemia is dedicated to all victims of Covid-19 and royalties will be donated to families of doctors who did not survive the pandemic.

By the time the new coronavirus Sars-CoV-2 was expanding in China and starting its mad rush all over the world, and Codogno (Lodi, Italy) hosted the first recognized Italian Covid-19 case (February 21, 2020), a Facebook group of Italian physicians was reconverted to address specifically the new virus and the related disease (“Coronavirus, Sars- CoV-2 e Covid-19 gruppo per soli medici” https:// www.facebook.com/groups/ Coronavirusmediciitaliani/).

In a few weeks the site registered more than 100,000 physicians and was overloaded by posts from any type of medical specialists reporting the critical conditions in which they were working, describing any kind of Covid-19 symptoms, asking for suggestions, getting infected and undergoing treatments, sometimes in Intensive Care Unit from where, until possible, they described any single feature and disease progression. During the first few weeks, along with respiratory features of the disease, many other characteristics were enlightened and provided clues for recognizing Covid-19 even in the absence of respiratory symptoms in non-hospitalized people. Hypo/ anosmia and hypo/ageusia were continuously reported and were learned as the most common and heralding symptoms of the disease, showing the early involvement of the neurological system and leading to the hypothesis of a direct portal of entry of the virus from the nose to the brain that resulted in severe complication of Covid-19 (i.e., ischemic or hemorrhagic stroke) seen in hospitalized patients. Alert on those and other symptoms and signs such as cutaneous manifestations of Covid-19, was crucial for helping to rapidly identify patients who could be the source of infection for other persons. Anatomy-pathological findings were often described in the group and many of the information served to better understand the mechanisms of the disease as well as to hypothesize adequate treatment, since the Sars-CoV-2 virus and its related disease, Covid-19, were completely new.

Meanwhile, the group was the environment in which personal feelings emerged as if it was the only place where to talk about and share the emotional side of the pandemic experience. In this context, on April 23, 2020, Luisa Sodano, Epidemiologist, who had registered into the group shortly before, posted her idea of collecting somehow this emotional part of the story. Within two weeks many physicians sent their short stories, mostly from Northern Italy, 37 of which became the body of the book.

The preface written by Camillo Il Grande, Gastrointestinal Surgeon, the founder physician of the Facebook group, underlines the role of the group as the privileged hub to discuss, exchange opinions, ask and provide support. As Camillo says, the book is “the natural evolution of self-awareness and confrontation” that evolved during the pandemic “Phase 1” within the group where any doubt, any help request, any information, any feeling or fear could be collected and treasured.

The introduction, written by the editorial committee members (Patrizia Iolanda Ambruoso, Marina Bianchi, Maria Gabriella Buzzi, Giuliana Crisman, Marcello Marcelli, Stefania Mostaccioli, Luisa Sodano and Marco Solaro) outlines the content of the sections of the book expressing the condition in which any physician/writer was carrying out her/his job. The unmet needs and the spasmodic search to cope with the virus and its related disease were the core of the discussion. Meanwhile, the sense of solidarity that emerged within the group and that would result into the so called “collateral affections”, led to the idea that such a piece of history, as it was experienced by physicians (and all other health workers), deserved to be acknowledged and possibly recollected in the future. Therefore the “leading actors” had to write it down, there and then, before losing the inner emotional component. The humaneness, including sense of impotence, powerlessness, and loneliness are the leading feelings throughout the book, common to both physicians and patients.

The five sections have specific tracks on the basis of the role that any physician/ writer had in her/his medical activity. The first section of the book, “The context” is an overview of the conditions in which the Sars-CoV-2 pandemic spread in Italy. First of all, the lack of an updated Italian pandemic plan revealing the poor capacity of Italy to face up to the pandemic, and then the doubtful news from China and the uncertainty of WHO, the speedy rush of the virus in Northern Italy and the premise to the national lockdown, the difficulties in creating an adequate monitoring- tracing system to identify clusters and isolate cases, and eventually, the overwhelming daily number of victims and the need of relocating corpses outside Bergamo where there was not enough room for burying them, through the Italian Army trucks. This was, and still is, the hardest picture and the worst remembrance of Covid-19 pandemic “Phase I”. In the following sections, “With bare hands”, “Cities and countryside”, “Dear Colleague, will you help me?” and “The rearguard”, 37 stories describe the many different conditions that Doctors had to face during pandemic Phase I.

“The literary category to which the work is attributable can be identified as narrative medicine. […] Narrative medicine are also stories that look at epidemics not from a medical-scientific point of view, but, in fact, from a literary perspective. […] The narratives that come from the very experience of illness are of a different nature. In English, this production is collected under the label of “misery report”, or stories of suffering induced by pathologies and treatment paths (misery in this context means adversity, misfortune, suffering)”. This is the way Sandro Spinsanti, Bioethicist, qualifies the book Emozioni virali (https:// sandrospinsanti.eu/la- pandemia-e-i-suoi-affetti- collaterali/). In his comment, Spinsanti highlights some of the prevailing emotions that emerge in reading the stories. Among those, the sense of pride in the profession and. “no triumphalism under the much-vaunted profile of heroes and angels: simply a regained awareness, on the ground of a commitment in extreme conditions”, along with the awareness of being vulnerable.

As was said before, this “anthology” springs from the need of describing personal experiences to testify in real time a crucial worldwide moment. Emozioni virali is therefore an interesting and unique history book that may serve in the future as a teaching book to communicate with next generations.

Besides, the awareness of unpreparedness and the urge to complain about an inadequate Health System, call for a thorough revision. The reported experience may serve to lay the foundation for a renewed public Health System. As a reader of Emozioni virali said, “This book contains a 30- year project for the next Italian Health System”.

Finally, the way Emozioni virali came to life in the middle of lockdown, emphasizes the potential of digital communication. The “100,000 doctors Facebook group” is, in fact, the first and, so far, the largest, ongoing social network specifically devoted to the pandemic. Emozioni virali has been completely built through digital communication and virtual meetings of the editorial committee late at night after tough working days and amazingly it came to life as a handling and tangible object. Most of the physicians/writers have not had a chance to meet in person yet. The book has been presented mostly in virtual meetings or through mass media (newspapers, national radio and TV channels). However, among the few “in presence” presentations, it is noteworthy to recall the ones in Lombardia: in Martinengo (Bergamo) on July 16, 2020, and in Milan on September 30, 2020, a tribute to a region who experienced the worst impact of Sars-CoV-2 pandemic and the largest toll to Covid-19.

Italy’s doctors, nurses and healthcare workers have been nominated for the 2021 Nobel Peace Prize in recognition of their efforts to face a very serious health emergency.