Why the Alzano hospital was closed and reopened: what emerges from the investigation into Covid in Bergamo

On the night of February 23, 2020, the Emergency Department of the hospital of They raise Lombard (Bergamo) was closed and reopened after the discovery of a positive patient to the COVID-19. This decision is at the center of the investigations by the Bergamo prosecutor’s office, which put 19 people under investigation, on the management of the first phase of pandemic. As reconstructed by the investigators, the provisions relating to the closure and subsequent reopening would have been given orally and by telephone.

The February 22nd it was discovered that two patients hospitalized in Alzano were positive for Covid, but they probably already were when they entered the facility. And in fact it would seem to be certain that the virus started circulating in the structure even before theirs was detected positivity.

In a report, sent to the Region on 5 April by the general director of Asst Bergamo, we read that in the “period between 13 February and 22 February some patients arrived at the Alzano hospital who passed through the Emergency Department and were subsequently hospitalized in the general medicine department with a diagnosis of pneumonia/acute respiratory failure”.

Because the two positive patients from Alzano were not swabbed immediately

Because none of them has been subjected to swab? Because, as explained by several managers of Ats, Asst or Welfare management to the investigators, the characteristics of the patients did not correspond to those highlighted in a circular from the Ministry of Health of the January 27, 2020.

Only on February 22, considering that the outbreak in the Lodi area assumed completely different traits from those highlighted in the circular, it would have come to understand that the epidemiological criterion highlighted precisely in that document of the ministry was no longer reliable. And it is at that moment that the first swabs would also have been carried out at the Alzano hospital.

The closure of the emergency room

As soon as the positivity of the two patients was discovered, he came limited the arrival of the transports at emergency room of Alzano for about two hours and it was decided not to proceed with the change shifts of the staff. In the meantime, Locati was discussing with the Region on how to proceed until deciding to reopen the first aid because it was not possible “to give up this point of care”. Some activities have instead been moved to the hospital Serial.

To support the proposal to close the emergency room, was the former medical director of They raise Marzulli who said he wanted it because “at that moment it was the only right decision that had to be taken to face an emergency which we had never encountered before. It was a precautionary measure pending decisions following the crisis unit meeting.”

The medical director of the Ats of Bergamo, answering the questions of the investigators, said that the February 23rd would have received a phone call from Locati who would have told of the discovery of Covid patients and would have referred to the proposal to close the emergency room “waiting for instructions from the Lombardy Region. I agreed with him that, in my opinion it was correct, in juncture, close the emergency room”.

The closure was shared with the crisis unit of Lombardy region: “We as health management did not have the power to close the hospital, but only to temporarily suspend its activity. We proposed to the Region the temporary closure of the emergency room and the temporary limitation of access to the wards. The Region replied to us that our closure proposal, understood as temporary, was fine Suspension of elective hospitalizations and visitor accesses”, the medical director of Asst Bergamo Est told the investigators.

In fact, a few hours later the situation was reversed: the Region would have given indications to reopen the emergency room.

Because it would be reopened

Some members of the Lombardy Region Crisis Unit explained that “for Alzano we adopted a different solution as we had also received positivity in other hospitals and therefore it made no sense to close hospitals. Among other things, the closure of Alzano would have resulted in the transfer of suspected positive patients from this facility to others”.

And again: “The closure of the Alzano hospital would not have resulted no benefitindeed it would have led to critical issues in the reception of patients from the area”.

Marzulli tried to oppose it, but was told “that this was not the time to make disruptive decisions that would have created scaremongering in public opinion”.

For his part, Locati explained that he would have been told that “if the hospital in Alzano had remained closed, a sort of ‘Domino effect‘ i.e. also other Lombard hospitals, also affected by covid patients, could have closed, with consequent prejudicial effects on the entire regional health system “.

The issue of personal protective equipment

Some relatives of the Covid victims told the magistrates how, especially on the day the first two positives were discovered, the staff would not have had masks or other personal protective equipment. Statements then denied in the report sent to the Region. In fact, Locati explained that there would be a quantity of tampons “enough to manage the emergency, also for access to the emergency room”.

Yet Marzulli and other doctors have told a different version: the hospital, despite the provision that Aria (the subsidiary of the Region) would take care of the tampons, was never adequately supplied with tampons. “They arrived in an extremely small way for the needs of the Alzano hospital. To the extent of 7/8 a day that they had to serve both for employees and for patients”.

Sanitization immediately after the discovery of the first positive Covid cases

Two employees would have said that on the evening of February 23 they would have telephoned their owner stating that they were not letting them out of the hospital for precaution. On the afternoon of February 23, one or two rooms in the emergency room would have been rehabilitated: “On February 23, the paths of the infected were not sanitized”.

On February 24, only the room where the swabs were carried out, the surgery department where there was a Covid patient, the surgery operating room and the delivery room area would have been restored.

The report specifies that the procedures of disinfection of the environments have taken place according to the existing protocols: yet many, heard by the prosecutors, would have stated that not all the environments would have been sanitized.

In short, the statements provided during the interrogations are conflicting: for this reason the relation made by the microbiologist Andrew Crisantiwho argued that the virus had already been present in the hospital since early February and that if the red zone in Alzano and Nembro had been established immediately, four thousand deaths would have been avoided.