Lockdown may return if there is second wave, says Italy medical chief

Politicians may need to reimpose lockdown restrictions if there is a resurgence in coronavirus cases, a leading intensive care specialist has said.

Maurizio Cecconi, head of intensive care at the Humanitas research hospital in Milan and the incoming president of the European Society of Intensive Care Medicine, was one of three Lombardy doctors who warned the rest of Europe to “get ready” for Covid-19 in the early days of the outbreak.

Now he says society will have to “learn how to live” with coronavirus until there is a vaccine. While he is optimistic about European health authorities’ efforts to monitor the virus, he doesn’t exclude a return to tighter social controls. “If there is an increase in transmission we need to be ready to slow down again, and maybe to put [in place] restrictive measures again,” he said.

Cecconi, a British-Italian citizen, who worked at St George’s University hospital in London for 14 years, thinks the NHS heeded warnings, including the open letter he wrote with colleagues in Milan on 4 March.

Asked about the response of the British government, he said: “I would have been happy to see lockdown sooner in many countries.” The herd immunity strategy – which the government now denies having pursued despite the evidence – was a “dangerous approach”, he said. “As a society, when you don’t have a vaccine or a specific cure, you have to try to protect [vulnerable older] people from getting the infection.”

It was 20 February when Lombardy’s doctors realised their healthcare system was on the brink of an unprecedented crisis, Cecconi recalls.

On that day an alarming case was reported across the intensive care network: a sporty man in his 30s, with no pre-existing medical conditions, was fighting for his life. The patient had tested positive for coronavirus but he had not been to China. “Just that one single case made the health authorities in the region realise that there was a problem,” Cecconi recalls. “Something had slipped through the filter of contact tracing.”

After an emergency meeting of Lombardy’s intensive-care specialists, a decision was made to increase intensive care capacity, and fast. Within six weeks Lombardy had increased fivefold beds offering respiratory support to 4,000. “What was difficult for us was that we didn’t have the time to prepare,” he said. “Our ‘get ready’ message was trying to give those hours, those days that we didn’t have, to other people to prepare.”

In those early days, Cecconi and his team were “a bit scared”. They had seen reports of medical staff in China catching and dying of coronavirus, but didn’t know how far they could trust Chinese data. At his hospital, painstaking effort went into training and supervising “donning and doffing” (taking on and off) of personal protective equipment – because “one of the most dangerous moments with PPE is not when you put it on, but when you remove it”. He said that very few staff in his hospital had been infected with Covid-19.

But the most difficult times for him and his staff came from families being unable to see their loved ones at their bedside – a reversal of two decades of medical practice. “I get goosebumps now thinking about it,” he said. “It breaks your heart not to have their loved ones holding their hands. We have been the ones who have been holding hands and saying to people, ‘It’s fine, don’t worry you are not alone’.” Meanwhile, doctors and nurses had to explain to family on the end of the line what was happening. “People on the other side of the phone, they knew that their loved ones were dying and we tried to be there with them as much as possible.”

There were happier moments. He remembers the man who was able to see his wife for the first time in two months, and a recovering patient speaking to his children on video call.

Cecconi, who became one of the NHS’s youngest-ever consultants in 2008, is the president-elect of the European Society of Intensive Care Medicine, which brings together 10,000 specialists across the continent. Setting out his visions for a “healthcare army”, he would like to see greater harmonisation of training and practice, to allow professionals to move between countries, including in the event of a future pandemic. As a British citizen he remains “very sad about Brexit” and hopes future immigration law will not stunt the free movement of healthcare professionals.

In any pandemic, intensive care is only part of a picture. The most important thing is what happens outside hospitals to slow down virus transmission, he said. “Statistically a country that moves together and citizens that move together can make a huge difference. That is why the individual responsibility of citizens is crucial and governments need to guide in a manner that is responsible.”