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The first wave is over, thousands have been buried, and in a city that was once the world’s coronavirus epicenter, the hospital is calling back the survivors. It is drawing their blood, examining their hearts, scanning their lungs, asking them about their lives.
Twenty people per day, it is measuring what the coronavirus has left in its wake.
“How are you feeling?” a doctor recently asked the next patient to walk in, a 54-year-old who still can’t ascend a flight of steps without losing her breath.
“I feel like I’m 80 years old,” the woman said.
Six months ago, Bergamo was a startling warning sign of the virus’s fury, a city where sirens rang through the night and military trucks lined up outside the public hospital to ferry away the dead. Bergamo has dramatically curtailed the virus’s spread, but it is now offering another kind of warning, this one about the long aftermath, where recoveries are proving incomplete and sometimes excruciating.
A patient gets a CT scan in Bergamo, Italy. (Alberto Bernasconi for The Washington Post)
Those who survived the peak of the outbreak in March and April are now negative. The virus is officially gone from their systems.
“But we are asking: Are you feeling cured? Almost half the patients say no,” said Serena Venturelli, an infectious-disease specialist at the hospital.
The follow-ups with the once-hospitalized patients are the basis for medical research: Their health records now fill 17 bankers’ boxes, and scientific reports are on the way. Bergamo doctors say the disease clearly has full-body ramifications but leaves wildly differing marks from one patient to the next, and in some cases few marks at all. Among the first 750 patients screened, some 30 percent still have lung scarring and breathing trouble. The virus has left another 30 percent with problems linked to inflammation and clotting, such as heart abnormalities and artery blockages. A few are at risk of organ failure.
Beyond that, according to interviews with eight Pope John XXIII Hospital doctors involved in the work, many patients months later are dealing with a galaxy of daily conditions and have no clear answer on when it will all subside: leg pain, tingling in the extremities, hair loss, depression, severe fatigue.
Some patients had preexisting conditions, but doctors say survivors are not simply experiencing a version of old problems.
“We are talking about something new,” said Marco Rizzi, the head of the hospital’s infectious-disease unit.
Funeral home owner Giuseppe Vavassori, 65, developed short-term memory loss in the aftermath of the coronavirus. (Alberto Bernasconi for The Washington Post)
One patient, Giuseppe Vavassori, 65, has developed short-term memory loss and now lives under a mountain of Post-it notes and handwritten reminders, with names and phone numbers, so he can still run his funeral home business. A post-covid MRI showed dot-like lesions on his brain.
Another, Guido Padoa, 61, recovered well enough that he was able to go on vacation this summer. But he sleeps four extra hours per night and sometimes falls asleep suddenly midday, head on the computer keyboard.
Some patients who were self-reliant before contracting the virus remain so weakened that, when they arrive for their follow-up appointments, they’re helped to the waiting room by relatives, or in wheelchairs. Four people so far were too frail to make it through the several hours of testing and were rushed instead to the emergency room. Other times, people show up months later, having been through the worst — oxygen support, intubations — and are, improbably, almost fine. Doctors say one of the virus’s mysteries is how recoveries can be swift for some and brutal for others.
Venturelli mentioned a man in his 80s who’d come in for his follow-up visit, mostly recovered. His son, who’d also been infected, hadn’t fared as well. When Venturelli tried to refer the father to a specialist, he said he was too busy these days.
Covid had turned the father into his son’s caretaker.
Patients in a waiting room at the Pope John XXIII Hospital annex in Bergamo. (Alberto Bernasconi for The Washington Post)
THE BERGAMO RESEARCH is being led by the same doctors who worked frantic 14-hour days in March, sometimes falling sick themselves, while watching patients rapidly outnumber the beds. Now, wearing just masks, those same doctors and patients are sitting down together in a way that was impossible months ago.
“We did feel a moral obligation to call them back,” said Venturelli, who helped start the study in early May. “It was such a tsunami for us. What we saw in March was a tragedy, not a normal hospitalization.”
Bergamo, in March, was a place with six-hour waits for ambulances and 16-hour waits in the ER. At one point, the hospital had 92 people on ventilators — compared with 143 now in all of Italy — and so many who required breathing assistance that it needed to pipe in oxygen from a rush-delivered emergency tank. Subsequent antibody sampling, according to the government, indicated that one-quarter of Bergamo’s 1.1 million people were infected with the virus.
LEFT: Eugenio Poletti de Chaurand, a surgeon at Pope John XXIII Hospital, contracted the coronavirus in March and spent eight days using an oxygen helmet. He knew he needed the support — “I could feel myself suffocating,” he said — but he grew so agitated that he tried again and again to remove it. Doctors sedated him. He’s made almost a full recovery and returned to work in mid-May. RIGHT: Poletti de Chaurand said he has “only one lingering consequence” from his fight with the disease — a sensation, both strange and marvelous, that can suddenly overwhelm him, even during surgeries. In those moments, he becomes acutely aware of his lungs at work. “I draw deep breaths,” he said, “and feel great relief.” (Photos by Alberto Bernasconi for The Washington Post)
“I have a picture in my mind from that time of the ER with eight ambulances queuing outside,” said head nurse Monica Casati. Inside the hospital, she said, people were crying, moaning and gasping for air. “It was a noise that would remind you of Dante’s inferno,” she said.
The hospital was admitting only the worst cases, and to keep pace with the influx, it sometimes had to discharge patients before they were fully ready — something confirmed when the hospital started calling people for the follow-ups. In addition to the 440 people who died while hospitalized, 220 died after being told to go home.
A patient gets his respiration rate checked. Among the first 750 patients screened, about 30 percent exhibited breathing trouble and permanent lung scarring. (Alberto Bernasconi for The Washington Post)
The study in Bergamo is one of multiple efforts around the world to examine aspects of covid’s lingering damage. One German study of 100 people found that nearly 80 percent had heart abnormalities several months after infection. Other studies are underway to look specifically at “long-haulers” — a subset of people, some never hospitalized, who nonetheless have fatigue and other symptoms months after the illness.
