As of Monday night, Italy had reported more than 27,000 cases of coronavirus with more than 2,100 related deaths. It is considered the hardest-hit country after China. The nation of 60 million is on national lockdown and its hospitals, particularly in northern Italy, have been overwhelmed with the sick and dying.
Over the last few days, I connected with Tanya Castagna, a Baltimore native and nurse on the island region of Sardinia, about 250 miles from Rome. Though Sardinia, with a population of 1.6 million, has so far only a small portion of the country’s coronavirus cases, authorities there are preparing for more. The pace of community transmission has been shocking, with 3,600 new cases and 368 deaths reported throughout Italy in a 24-hour period Sunday into Monday.
Tanya Castagna grew up in Little Italy, graduated from the Catholic High School of Baltimore and from Stevenson University, earning a bachelor’s degree in nursing in 2004. She trained at Johns Hopkins Hospital and worked in the operating rooms there for about three years. She met her husband, Antonello Capalozza, an Italian engineer, while he was in Baltimore in 2001. After three years, Castagna and her husband moved to Sardinia. They live in the island’s capital of Cagliari.
Tanya Castanga is 45, the mother of two children. She works as an OR nurse at the University Hospital of Cagliari, where all elective surgery has been cancelled. In an exchange of emails, Castagna talked about the national emergency and issued a warning to Americans fearful of a crisis like the one that has gripped Italy.
When did you first become aware of COVID-19?
In early January while watching the news. We were simply comparing it to the flu that we all know so well. I realized it was a new virus but statistically it seemed to be less dangerous than the regular flu. We all strongly held on to this thought even when things were going very bad in China. However, I do remember feeling vague anxiety when they built a new hospital in just 10 days. I continued to deny there was a future medical threat to the world.
But then it hit Italy.
There were reports on Jan. 31 of two Chinese tourists who were hospitalized in Rome and tested positive, Italy’s first two cases of coronavirus. Still, no worries. A week later, an Italian man who recently traveled to Wuhan was hospitalized and confirmed for coronavirus, and now there were three. Still, no worries.
When did you realize this was a much bigger problem than that?
A cluster of 16 cases were detected on Feb. 16. On Feb. 22, an additional 60 cases were confirmed, including Italy’s first reported death. My heart started to sink. Within the next 10 days, the number of positive cases doubled every two days, including our very first case in Sardinia. On March 4 they closed all schools and universities. As a medical professional, I was finally facing the fact that we could [have] a disastrous epidemic. Human beings have a funny way of avoiding unwanted pain and suffering, especially from something overwhelming like this. It’s called denial. It’s what the entire world had for weeks regarding Wuhan and the coronavirus. For weeks we were thinking that it was not our problem, it was their problem. I believe with all my heart that it was simply just too big to comprehend. It was easier to be in denial. I’m a nurse and I was the first one to say that it was nothing to be concerned about, perhaps because it was in China and not in Italy. When it arrived in “casa,” things changed dramatically.
When and how did you receive your first on-the-job directive about the virus?
On March 6, I received an official document stating that my hospital was discontinuing all non-emergency services in order to prepare for the emergency. We have been planning for days, working with other hospitals in Sardinia on how we will be handling this pandemic. They set up two tents outside of the emergency room that resemble a war zone. The government has given us strict guidelines to follow if we suspect that we may have the virus or have similar symptoms. The key in Italy is to follow the rules and to remain calm.
What has the state of emergency been like there?
The entire country is at a standstill. The only services available are the supermarkets, pharmacies, banks and the postal system. Everything else is closed. Only a few people can enter [an establishment] at a time while the others have to wait in long lines outside. Food is not a problem for us, just the inconvenience of waiting in line. The police are roaming the streets and demanding explanations on where we are going and why. We need to carry documents stating that we are leaving for work or necessities. You can risk being arrested without having a valid reason. All national and international flights are off limits. Monday [March 9] morning was sad. There were hardly any patients in the hospital and the streets were empty. My first tears of despair surfaced. We are facing a national emergency and I finally was accepting this. It felt surreal.
Based on your experiences and observations so far, what advice would you give to Americans who are just now feeling their daily lives disrupted by the pandemic?
It’s super contagious. It’s a new virus and we have no immunity to it. Ten to 15% of patients will need to be hospitalized and there are not enough beds in the ICU to handle this volume all at once. The hospitals become completely overwhelmed and stressed. A normal flu affects many but in a span of four to five months. This virus is transmitting like wildfire in just a matter of weeks. This is extremely important to understand because it creates an extreme overload in hospitals and its human resources. I repeat: There are not enough beds in the ICUs to handle this type of flow all at once! We were put on lockdown because we need to slow down the transmission to help the hospitals who are in desperate need. It’s a medical catastrophe. Italian doctors and nurses are literally begging the citizens to stay at home. There is no other way to help the overload in the hospitals. In the north of Italy, Italian doctors are being forced to make extraordinary decisions on who to treat and who not to treat. Those who are too old or too sick to have a high likelihood of recovery could be left to die. The situation in Lombardy seems like a horror story. The hospitals are being slammed with a tsunami of positive and very critical patients. I’ve never seen anything like this in 15 years of nursing. I remember studying about epidemics and pandemics in nursing school, but I never imagined in my wildest dreams that I’d see one in my career. We still haven’t hit the peak yet. The situation is horrific.
So, your advice to Americans?
Stay at home as much as possible. You need to have less contact with others to help slow down the transmission. Listen to your government and cooperate to your maximum potential. If they do not issue mandatory lockdown, you can make a huge impact just by limiting your contact with others and washing your hands frequently. The sooner we accept what is happening the sooner this madness will stop. You can make a difference. In Italian, we say, “Io sto casa” which means “I stay at home.” We are taking full responsibility as citizens because we are helping the hospitals and we are helping our community and above all we are helping our country. It is your responsibility to help reduce the spread of this virus.
What’s happening at your hospital in Sardinia?
We are only doing emergency cases and taking care of patients with life-threatening conditions. All other patients who are healthy and stable must wait. The hospital is slowing down as much as possible not only to prepare for an emergency, but also to decrease the flow of people in and out of the hospital, as little contact as possible for healthcare professionals and patients. We currently [Monday morning] have 84 cases of coronavirus in Sardinia. I have not physically treated any patients yet because the situation is under control for now. In a matter of days, that will change and I will be ordered by the hospital to take service in an area that will need my care. I feel honored to be a part of this emergency. It’s exactly why I decided to be a nurse, to help the ill. I’m not scared of getting the virus, I’m only scared of passing it on to another. Italy’s prime minister, Giuseppe Conte, told the people that we need to stay inside to save our country. He said, “Stay inside today for a better tomorrow.” There are many Italians coming together during this difficult time. I hope the same for all of you. It’s important to find the beauty in all of this sadness.
Being in quarantine has helped me in so many ways. It’s allowed me to stop and to reflect a little on the real importance of life, which is the fact that I am here and healthy. The rest seems useless in these difficult days. … The sooner you cooperate the sooner you will be able to rebuild your life again. There is a famous phrase being said all over Italian social media which is, “Tutto andrà bene,” which means, “Everything will be OK,” and it will be with time.