On 4 January 2020, a few days after the New Year celebrations, I returned from a trip around Sicily to my girlfriend’s parents’ home in Pizzighettone, sixty kilometres or so south-east of Milan. After picking us up from the train, her parents suggested we might surprise her uncle with a visit to the provincial hospital where he worked nearby. Her father dropped us at the small entrance. We walked past a distracted receptionist alone at her desk and strolled down a long corridor. The hospital was sleepy on that winter afternoon, almost completely empty.
Coming from Ireland and the UK, where even the mention of a hospital is a cause of stress, it had a welcoming feel to it. Quiet, and relaxed. There were the usual laminated sheets of medical advice tacked up on the walls. Directives for handwashing and the proper procedures for discarding used needles. Pictographs and signs for counselling groups. We came to a closed door, through which Fedy’s mother shouted in Italian that we’d arrived. A yell came back and we waited a few steps away. A few moments later, a slim man in blue scrubs, sixty years old, came from his office, and immediately descended upon both Fedy and her mother, covering them with kisses and hugs. He greeted me warmly, and as we walked towards a more open spot down the hall, he placed Fedy into what could only be described as a headlock, dragging her playfully along with him as he kissed her forehead. His name was Dr Daniele Dainesi and he was working in Codogno Hospital, which in six weeks would become the epicentre of the coronavirus outbreak in Europe, one of the worst-hit regions in the world. As we stood together he grabbed his niece about the shoulders and gave her one last big hug, the pair of them laughing in the empty hall.
The next time I met Daniele it was June, four months after the outbreak, three weeks or so after the Lombardy region had reopened. I was expecting a frazzled shell of the man I’d met. I’d been told that he’d lost a lot of weight, his health severely impacted after his Covid-19 diagnosis. That he’d spent forty days in isolation, mourning his colleagues and patients, possibly blaming himself for the spread of the virus. But the man who entered my girlfriend’s house looked tanned and strong in a navy T-shirt and shorts. Fedy and her mother met him at the door, loudly exchanging greetings. I welcomed him in the office, the coolest place in the house on a hot summer’s day. He greeted me happily with an elbow bump and gave Fedy a gift of a handful of masks. We sat and I tried to continue the conversation in my slow and poorly pronounced Italian. He insisted we should use English, if I could just speak a little slowly, and Fedy sat to one side to translate if needed. As we talked, we drifted back and forth between languages, Fedy forced to act as translator as our words failed us.
After our trip to Sicily in January, we’d returned to London and gone back to work. On 21 February, Fedy got word that Daniele had come into contact with the coronavirus at his hospital in Codogno and was now being tested for it himself. It would take a few hours. We lay in the dark in our bedroom, Fedy scrolling her phone and looking up news results for Codogno Hospital, texting her mother. We’d barely been paying attention to coronavirus stuff. That was for other people, elsewhere. There were a few isolated cases showing up in Europe, mostly linked to travel abroad, and the vague threat of it landing in the UK. No one, apart from scientists and epidemiologists, was taking it very seriously. But what was unfolding at Codogno was hugely serious. This small hospital, unknown to the world, was soon going to be a buzzword for sickness and tragedy. By 24 February, the government had quarantined the hospital, then the villages surrounding the hospital. Pizzighettone, two towns over from Codogno, had been left off the list of ten towns under quarantine. The red zone, la zona rossa, finished at Maleo, a couple of miles away. Soon though, the entire Lombardy region and then all of Italy would be locked down. People were saying it didn’t matter all that much where you were, you’d be locked down just the same. But in the villages surrounding Codogno, it did matter. It was impossible to sleep at night with the sound of ambulances blaring by near-constantly, their sirens waking you as they careened down the streets outside your home and back again, bringing the residents of your town, your friends and neighbours, to a place few thought they’d return from.
I was wary about having Fedy with us as we talked: Daniele hadn’t told her anything about what had happened at the hospital. I was worried that he might hold back his thoughts, wanting to spare his niece the details, or be too embarrassed or self-conscious to answer me honestly. I asked him how his health was, how much he’d recovered, if indeed he had at all, from corona. He told me yes, physically, he was better. But psychologically, no.
Many of his friends were dead, he said.
He said it simply. Without minimising it or dramatising it, or doing anything with it. It didn’t seem like he wanted to get it out of the way early, or to warn me about the nature of the conversation we were going to have. He just said it. And he talked for the rest of the interview in this way. Simple, factual and heartbreaking.
Their first coronavirus patient, that they knew of, was Patient One. He’d presented with flulike symptoms and been sent home twice due to their relatively minor nature, initially by his GP, then again by the hospital on 18 February. He was seen that day by several different doctors, including Daniele, who couldn’t figure out what was wrong with him. No one had even thought of Covid-19 being a possibility. That was way off, half the world away in Wuhan, not in this small hospital outside an agro-industrial commuter town. When Patient One returned to the hospital on 19 February his condition had deteriorated. One doctor, Laura Ricevuti, heard the patient’s wife say he’d had dinner with a colleague who’d just come back from China. As he was transferred to a new ward, Ricevuti recommended he be tested for coronavirus. The doctor who returned the diagnosis, Annalisa Malara, would later be interviewed repeatedly on TV and radio. They would both eventually be honoured as Knights of the Republic, heroes. At the time though, Patient One’s health continued to worsen, and suddenly the number of patients admitted to the hospital with pulmonary and other coronavirus symptoms was going up, and up, and up. Patient One’s original GP fell sick, as did his friends and family. The doctors in Codogno were all tested, but while they were waiting for the results they went to work, treating as many patients as they could.
It was chaos. They set up a clean zone and a dirty zone, but, with so many patients needing help, the staff were moving back and forth between them. In the beginning Daniele was working without proper protective clothing or equipment. There were pictures in the news of Chinese doctors in bodysuits, treating patients like they’d been sent in to defuse a bomb. Daniele was working in a simple face mask, in situations where viral load can have a huge impact on the health and potential contagiousness of a physician. It was almost inevitable he’d get corona, if he didn’t already have it. They carried on anyway. And the World Health Organization, the EU, the government . . .
Yeah, when did they arrive? I asked.
They didn’t, he said.
The WHO were helping others maybe. The government was containing things. No one came to help them. As far as he could see, no one cared. He said it again.
In my head I’d imagined big jeeps screeching to a halt outside Codogno Hospital. Men in blue hazmat suits jumping out and ploughing in to sort out the chaos, running past the confused workers to set up triage areas, seal everything off, erect plastic sheets and say, ‘We’re taking over. Sit this one out.’
They had no idea what was going on. By the time help came, it was much too late.
In the first week of March, I went to my boxing club for the last time, having become sufficiently worried about the amounts of biohazard that come with being in a low-ceilinged room with forty other individuals gasping for air, doing push-ups and trading body shots, pools of sweat seeping into the mats under your feet. At my last session, our instructor, answering a question down the far end of the room, yelled, ‘CORONA? Mate if you’re putting your face on those mats, corona is the least of your worries.’ We laughed, because it was funny and he’d delivered it with excellent timing. The club kept running its sessions, though I stopped going.
Underneath a Facebook photo promoting the club’s ‘senior session’ a week and a half later, days before England officially locked down, a few people tentatively asked about the wisdom of continuing such close-contact work during an epidemic. The club’s manager replied that they were following best practices, and that other council-run fitness clubs were remaining open. The government hadn’t told gyms to close. At that stage the virus had already taken hold in the UK, was tearing silently through its nursing homes and hospitals, with cases and deaths just a few days away from spiking. I disagreed with the manager, could see it was a terrible choice. But also I could see his reasoning. In a time of misinformation and conflicting health advice being shared across Facebook, Twitter and WhatsApp, he trusted the government. Simple.
Sitting in the sweltering office in June, it was clear Daniele was still confused about things, what happened when. He’d known within three or four days that what was happening was going to get worse, that it would spread all over Italy, and the world. His first test for Covid-19 had come back negative so he’d continued working. He can’t remember the worst day. It was all bad, and too fast. Patients kept coming, more and more, worse and worse.
What was your main priority, I asked him. In the first days of the outbreak, were you trying to treat people, or get them out of the hospital so it could close?
Priority? There was no priority. There was no time to think, no time to prioritise anything. They were just trying to treat as many as they could. They were on double, triple shifts. No time to sleep or rest. And it was getting worse. Somewhere in the middle of it all, they must have started to receive help, though Daniele doesn’t say when.
There was a line of ambulances, he said. Waiting to get into the hospital, so they could drop off patients and return with more. The line stretched down the road. He’d never seen anything like it.
Cuban doctors would eventually fly in to help them, to replace the Italian physicians who were coming down with Covid-19. Médecins Sans Frontières arrived, Russian military doctors. There were issues with translation, so they worked in English. I wondered how they’d managed to coordinate life-or-death medical care while trying to mentally translate from Italian to English, English to Russian, then back again.
As people came in with symptoms, their chests were X-rayed. One day, 200 people’s X-rays showed they needed intensive care in order to survive. They didn’t have enough space or equipment, so the doctors decided who to treat based on age. The youngest were given care. The old were made comfortable and left to die on beds in the hallway. Their bodies would be taken from the corridors and put straight into coffins.
At one point Daniele went to the mortuary and found it filled with coffins. Enough that he couldn’t open the door all the way to get in. Too many to walk around the floor. Soon after, he tested positive for Covid-19. He already had a fever, and was working knowing he probably had it. It didn’t matter. All those he was treating were infected.
He left the hospital and went home to isolate alone in his apartment in Lodi. He didn’t tell his mother he was sick. He told Fedy’s mother, who was texting and ringing him daily, that he’d been misdiagnosed. He wouldn’t answer Fedy’s texts, as we sat out and watched the news in London, where life was continuing completely as normal, people making jokes about toilet roll running out, Boris Johnson announcing he was happily shaking hands with corona patients. For the first two weeks Daniele suffered a fever, his temperature wavering between thirty-nine and forty degrees. He’d get calls from the hospital checking on him. A woman two doors down, on whose husband he’d done a knee operation, left meals outside his door every day: lasagne, pasta, meat.
He isolated for forty days. For two weeks he didn’t turn on the news, or listen to the radio, or read a paper. The hospital, however, kept him informed about his friends. Doctors and nurses and other workers who were falling sick, their immune systems unable to cope with such heavy exposure to the virus. He stayed in. Alone, on a cocktail of antibiotics, antiretrovirals and antimalarial drugs, his fever out of control, he was afraid he was going to die. Fedy translates this, looking at her uncle. He nods his head. She hadn’t even known he was sick at the time. He’d told them it was only the flu.
He sat up one night, on maybe the tenth night of his isolation, thinking about his fellow doctors. He had a fever of thirty-nine degrees. Beside the television were two bottles of Valpolicella he’d been given as a gift. He drank both bottles of wine, his fever running so high he couldn’t even taste them. He would never recommend alcohol as a treatment, he said. But it worked for him. It stopped the pain. He didn’t feel as much.
One of the things that came from the pandemic were the odd stories that resulted from thousands of people forced into strange, unexpected interactions with the world around them. As we drove to Pizzighettone, Fedy had stopped off in a roadside cafe for a bottle of water and came back reporting that sitting inside was an old man in a World War II era gas mask enjoying an afternoon spritz. In Pizzi we were told stories of patients who’d fallen unconscious in Italy and woken up in Germany, having been transported there overnight due to bed shortages. They came to, in a fever, and thought that the afterlife was being run by Germans. During a lockdown, another said, the latest fashion item in Milan had become a large yellow bag from Esselunga, a national supermarket chain, that could be used as an excuse for an illicit walk. There were accounts of dogs collapsing from exhaustion, having been borrowed for walks by dozens of people. The longer time went on, the more these stories seemed to make up the main narrative of the affected areas. Like the famous videos of people singing from balconies, they were distractions from the obvious pain and tragedy that was taking place. You’d be forgiven for hearing those stories and thinking what wonderful spirit in trying times. I heard them and thought as much. But late into every evening, my girlfriend was on the phone to her mother, who talked for hours about the stories she was hearing from her neighbourhood. Bodies being buried in mass ceremonies. Physicians flipping coins to decide who would receive treatment. Her best friend, a GP in Pizzighettone, begging emergency services every night to send ambulances for her dying patients, but being told there were none available, all were in use.
When we reached the house in Pizzi, as I was inside prepping for the interview, a neighbour in her seventies came out to say hello to Fedy and her mother through the fence. The neighbour’s husband was known for his love of the outdoors. After three months of lockdown, of ambulances and death notices, he’d stopped talking. When people called by, he hid from them. Fedy told me that as they chatted to their neighbour through the fence, they saw her husband inside the house and called to him. He quickly left through the front door, climbed into his car and drove off without a word, his wife watching him go. These stories don’t warm your heart. They don’t help you sleep better at night, or make you want to share them online. They make you want to sit in a dark room by yourself, the lights off, no sound of TV or radio or music to take you away.
While we were travelling in Sicily back in December, six weeks before the outbreak, we’d gone walking around Catania, a beautiful, hot city on the east coast. I was struggling through a flu I’d managed to contract over the Christmas holidays in Dublin. Two days before I’d left for Sicily, the cold my body had been fighting off for the best part of a week finally presented itself. I coughed constantly as I lay in bed or scruffed through the house in a bed sheet feeling sorry for myself. I flew to Italy in a daze, meeting my girlfriend and her parents at Bergamo airport before we boarded another flight to Catania, where I collapsed into bed.
The next morning, though the temperature was into double digits, I was shivering and cold. As we walked through the early-morning streets we passed by a protest. A large group of men were chanting on a street corner. A man with a bullhorn was shouting through the streets, as the men around him held up signs and bellowed. Written on a banner behind them, in large red and black letters was the phrase:
abbandonati dalle istituzioni
Abandoned by the institutions.
They’d been fired from a local grocery chain. Let go over the holidays and denied even their back wages. They held signs accusing the local unions, by name, of not caring, of doing nothing. Where were they now when they needed them?
Sitting in front of Daniele, he also used this word, abbandonati. The healthcare workers in that hospital had not protested like those men, nor would they. Daniele had repeated that the idea of a healthcare worker as a hero is misplaced. He waxed lyrical about the heroic nature of raising a family instead. I told him of our experience in the UK, where every Thursday night, spurred on by the government, the nation went outside to clap for the NHS, giving them applause, when what they really needed was protective gear. Masks, gloves. Guidance. Structures. Help. The government would clap for the NHS, but it wouldn’t protect it.
Daniele shook his head. Their government and Giuseppe Conte, its leader, had early on blamed the hospital at Codogno for mismanagement. For not doing enough to spot the virus earlier, which had led to an increased death rate. They apologised officially the next day, as more and more evidence pointed to the fact that the virus had been dormant in the entire region for weeks, if not months. That Patient One was only the first known case of a huge undercurrent of cases. In Italy and abroad, there was a kind of lurid fascination with Patient One. His details were circulated constantly in news reports and papers, updated endlessly. He was thirty-eight years old. Healthy. Ran marathons. Socialised. He had infected several doctors and patients. There were line graphs and flow charts, a single dot labelled Patient One, which spread outwards and outwards showing those he had infected. Even the phrase used to describe him, ‘superspreader’, reeked of judgement.
I thought of my own health on that trip around Sicily. I’d taken two flights from Dublin while sick. My nose running while I coughed and my eyes bulged, bloodshot and streaming. During my trip, I’d slept in different people’s homes. Played foosball in the middle of a packed hostel. I’d taken intercity trains and local buses. I’d boarded an overnight ferry to Naples, where I drank a beer among a crowd of seventy or so firefighters – critical workers – returning from an official presentation. I’d celebrated New Year’s in Palermo, dancing in a crowd of thousands of people cheering and hugging and kissing. I’d exposed my own family and the family of my girlfriend to what I’d considered a mild flu, and I’d visited Codogno Hospital, which in less than two months would be brought to its knees by a pulmonary virus and subsequently blamed for its spread.
What I’d done, travelling while sick, was not something I’d even considered to be immoral. If anything at the time it seemed like a testament to my strength. Now, retrospectively, it could be considered an act of gross selfishness and stupidity. Patient One had attended three meals and played a game of soccer. Judging him for his unknowing and unwilling role in a crisis beyond his control seems deeply unfair. In any case, the new models showed he was just one dot in a continuum. That there were likely hundreds of dots before him. Patient Zero was never found. They could have been from France, China, Germany, anywhere. Despite this, Patient One’s full name and details were leaked to the press and broadcast all over the world. He was an easy excuse, a convenient way to make sense of it all. One guy, a superspreader, had been careless, and now thousands were dead.
In his case, I would say Abbandonati. All known details about him were released and reported on again and again. It’s so much easier to point to one thing, one person and one hospital, and pin it on them, than it is to address a massively complicated and interconnected series of institutional and political failures. The government had blamed hospital workers for lax standards as they fell sick and died after working near constantly without protective gear, fighting a virus they had very little idea how to treat. Meanwhile in the UK, the government, wary of disrupting the economy, resisted calls to close down, letting packed trains run and pubs remain open. You can still go for a kick-about, they said, just go easy on the slide tackles.
Daniele wasn’t angry. At the government, at getting blamed. He was convinced that the WHO had kept secrets, that the government could have done more. But he wasn’t angry. He was proud of what he and his colleagues had done for their town and their country, despite the terrible cost. In the first wave, Lombardy accounted for almost half of all coronavirus deaths in Italy, more than 16,000 people. They’d tried to save them.
When he returned to work after his isolation, his co-workers went with him to visit the graves of those who’d died at their hospital. He said he would never go back to that graveyard. It was too much.
I asked him finally about the psychological problems he’d mentioned. About his colleagues. It was then that he told me the numbers, his niece watching. In Codogno, it hadn’t been the hospital workers who’d died, but the GPs from the surrounding area, who’d kept seeing patients as the hospital doctors had fallen sick.
At least four doctors from the towns around Codogno had died. In Casalpusterlengo, Maleo, Pizzighettone. Dr Marcello Natali, a GP in Codogno, had died after speaking out about the lack of protective equipment for healthcare workers. He told reporters he’d been treating patients without gloves, using a single-use mask for a week.
More of Daniele’s friends and colleagues from different areas across Lombardy were gone. In the first two months of lockdown, more than 150 doctors died, and over thirty nurses. A large majority of those were in Lombardy.
He said he had a nodo alla gola, a knot in his throat. It was lodged in at the bottom of his windpipe, and it kept his head separated from his heart, his stomach, his lungs. He carried this knot in his throat with him everywhere. When he thought of his friends and patients. When he’d visited their graves. He said many of his colleagues also had this knot in their throat. Men and women who’d intubated and ventilated those who’d fallen sick. It was there, constantly. They carried on with their jobs same as before, only now with a knot caught deep down in their throats, not letting them breathe.
I wondered if he felt he had changed, if he felt like a different person. No, he said. Not at all. He was just deeply wounded.
There’s a field of academia devoted to the study of trauma, reaching across psychology, sociology, biology and world literature. The language Daniele used around the nodo alla gola, the deep wound he felt, matched other accounts I’d read about trauma. I asked him if he was aware of the reports of post-traumatic stress disorder in care workers and survivors. Patients who had recovered from the virus, those who’d been intubated, were waking up screaming in the middle of the night, feeling like they were drowning, or being crushed. He said no. No. He just had this knot in his throat. This wound.
I left my attempts at diagnosis there. I didn’t see what could be gained by trying to name something so intimate and brutal. He was hurt. That was it. He’d been due to retire next year, he said. But now, he couldn’t even think of doing so. The only way he could think of getting better was to keep working, to keep treating people.
Spero, he said. If I keep working, I can heal the wound. If I keep helping people, it’ll get better. He didn’t look too hopeful, as he added, again, Spero.
Spero spero, spero spero.
I hope I hope, I hope I hope.
In the months since the outbreak, and in light of the subsequent devastation caused by the virus worldwide, views about the workers at Codogno have changed. Back in June, Daniele had voiced a concern that Italy, in his eyes the centre of culture in the Western world, of history and art and language, had become a laughing stock. That they had been ridiculed and their advice ignored. At the time, I’d seen a lot of memes, from Italians themselves, about the outbreak, and specifically Codogno. In subsequent months, those memes had faded away, as other cities and then countries fared worse than them. The brutal time they had gone through had enabled them to give, to those who had listened, a fair warning of what was to come. Hospitals unable to cope with the sheer volume of patients, health workers stretched too thin as they ran out of equipment, the dead piling up in corridors, in churches and in crematoriums. That lesson came from Italy, from Codogno and Bergamo. The talk became of flattening the curve, which, by and large, appears to have succeeded, if only temporarily.
In the early days of the virus, as Italy locked down but much of the rest of the world did not, Fedy and I watched the news and heard the stories coming out of Italy, and wondered why, around the world, our leaders seemed not to be paying attention. We have elected officials, governments, for a reason – to manage, to look ahead and plan. The region of northern Italy where Codogno is located is relatively wealthy, with excellent hospitals and health care. What had happened to them could easily, easily happen to others. As we came into the middle of March, anyone who knew anyone in Italy was watching the news constantly, and looking around packed streets and pubs in the UK, wondering what the fuck was going on. A Stereophonics concert went ahead, thousands of people pushed in on top of each other. The races at Cheltenham, with tens of thousands of people attending, went ahead. On national television, Boris Johnson bounced around the idea that we could ‘take it on the chin’ if the virus spread. In practice, that meant accepting countless avoidable deaths, of old people and medical workers. These gestures, of what was said to be a fighting spirit, laughing at hygienic habits gone mad, would be the very thing that accelerated the disease, and they came from the top of the country’s leadership. Despite constant warnings from those who were in the middle of a vast emergency heading our way, the message was YOLO: you only live once.
Some countries, like New Zealand and South Korea, reacted early and saved their citizens. Some like Ireland, reacted late but comparatively well, getting things under control. Others, like the US and the UK, did not.
This is what it means to be abandoned. To trust those in positions of power to help you when you need it most, but find that when the time comes, help isn’t there, and it’s all far too late.
When the first wave ended, experts warned us the worst was yet to come. As winter approached, our governments told us that they were prepared, that we’d be grand. That it’d all be fine.
Artwork © Tom Hammick, The Unending Sky, 2020, Courtesy of Lyndsey Ingram Gallery