Los Angeles Times - 18.03.2020

LATIMES.COM WEDNESDAY, MARCH 18, 2020A

THE WORLD

ROME — In parts of Italy,
the coronavirus means the
local cemetery keeps its cre-
matorium running 24 hours,
the newspaper adds far
more obituary space than
normal and families yearn to
touch loved ones in hospital
isolation wards.
Hospital staffs often find
themselves filling in where
relatives and spiritual lead-
ers cannot, even as they face
their own risks of infection.
In some cases, doctors in
overflowing hospitals are
facing the toughest choice of
their lives by determining
which patient gets a lifesav-
ing ventilator when there are
not enough for everyone in
need.
That is the kind of
wartime decision-making
that is now part of the shift
at Bergamo’s Papa Giovanni
XXIII hospital, where Dr.
Fabiano di Marco has not
had a day off since Feb. 21,
the day the city realized the
virus was in its midst.
“With so many locals get-
ting sick we have faced an
earthquake that would over-
whelm the best hospital and
which has made the last
three weeks seem like years,”
Di Marco, 46, the head of the
hospital’s respiratory unit,
said in a phone interview
Monday night. With a total of
3,993 cases reported Tues-
day — a leap of 233 over the
previous day — the province
of Bergamo has had more in-
fections than anywhere else
in Italy, which in turn has
seen a total of more than
31,500 cases and 2,
deaths.
“This time last year we
had four deaths a day here.
Now you can quadruple that
number,” Di Marco said.
To cope with the unex-
pected number of deaths,
Bergamo’s cemetery has
closed to members of the
public wishing to visit a
grave for the first time since
World War II, turned its
chapel into a morgue and is
keeping the crematorium
operating 24 hours.

Despite a growing num-

ber of cases in Bergamo,

which is in the region of

Lombardy, it was not in-

cluded on a list of 11 towns in

Lombardy and the neigh-

boring region of Veneto that

were ringed with roadblocks

and locked down last month

when infections soared. In-

fections in and around Ber-

gamo continued to rise,

while the situation stabi-

lized in the 11 towns.

On March 9, Italy’s gov-

ernment announced travel

restrictions across the coun-

try and closed most shops,

but that was too late for pa-

tients who had already died

at the Bergamo hospital.

The hospital has not re-

leased coronavirus-related

death statistics.

This week, 78 coronavirus

victims were using ventila-

tors in the hospital’s inten-

sive care wards, 12 were in

semi-intensive care and

more than 100 in wards with-

out ventilators. Some pa-

tients were placed in beds in

the emergency room be-

cause of space limitations.

The rush has forced doc-

tors to make hard decisions.

“Access to intensive care is

always reserved for patients

who can really benefit, but at

a moment like this, with so

many requests, the selection

becomes crucial,” Di Marco

said.

“Beds are not infinite and

they are often given not to

the most serious case, but to

people with the best chance

of survival. Lombardy has

1,100 intensive care beds and

about 900 are now taken up

by virus cases. We are facing

very difficult choices,” he

said.

“That alone creates

stress for doctors, as does

losing patients, who are

often relatives or acquaint-

ances of staff,” he said.

Dozens of staff members

at the hospital have been in-

fected despite wearing pro-

tective gear during long

shifts, he said. Dr. Stefano

Fagiuoli, who manages the

virus crisis unit at the hospi-

tal, said in a phone interview

last week that he continued

to work from home after be-

coming infected with the co-

ronavirus until severe mus-

cular pain in early March

made it too painful for him to

sit at his computer. He said

he was recovering slowly in

bed.

“Don’t underestimate

this virus,” said Fagiuoli,

who is 60 and lives in Ber-

gamo. “There are clusters

out there in Europe right

now and it won’t be doctors

and ventilators that stop it,

it will be our ability to reduce

contact.”

Di Marco has stayed free

of infection. “You have to

wear the masks tight to be

effective, then you change

them when you take them

off, but since there is a short-

age you have to keep them on

for hours. That’s why we all

have red marks on our face,”

he said.

Meanwhile, local news-

paper Eco di Bergamo has

increased its pages devoted

to obituary notices from

about one to 10. Families who

are unable to visit loved ones

in isolation wards, or talk to

them while they are hooked

up to ventilators, are also de-

nied seeing them when they

are dead since family mem-

bers must self-isolate.

Di Marco said he remains

concerned about the world-

wide response.

“To stop this thing there

are no half measures,” Di

Marco said. “You either do

all or nothing. If you do noth-

ing you will have hundreds

and thousands of deaths. Or

you try and slow it down by

acting in a fast and radical

way, like Italy is doing now.

Unfortunately I can see the

rest of the world still using

half measures.”

Kington is a special

correspondent.

Italy’s hospitals see wartime-era stress

A HEALTH WORKER sets up equipment at a hospital for COVID-19 patients before the facility’s opening in Casal Palocco in Rome.

Antonio MasielloGetty Images

Doctors face one of

the toughest choices

of their lives: Who

will get a ventilator?

By Tom Kington

‘Don’t

underestimate

this virus.... It

won’t be doctors

and ventilators

that stop it, it will

be our ability to

reduce contact.’

— Stefano Fagiuoli,

60-year-old doctor who has

COVID-19 and is suffering from

severe muscular pain

GUATEMALA CITY —
Guatemala on Tuesday be-
came the first Central
American nation to block
deportation flights from the
United States in an effort to
prevent the spread of the co-
ronavirus, a dramatic turn-
about on Trump adminis-
tration policies barring en-
try to asylum seekers from
the region.
Guatemala’s Foreign
Ministry announced that all
deportation flights would be
paused “as a precautionary
measure” to establish addi-
tional health checks. Ahead
of the announcement, Presi-
dent Alejandro Giammattei
said in a Monday news con-
ference that Guatemala also
would close its borders com-
pletely for 15 days.
“This virus can affect all
of us, and my duty is to pre-
serve the lives of Guate-
malans at any cost,” he said.
Guatemala, a major
source of migration to the
United States as well as a
primary transit country for
people from other nations
headed to the U.S.-Mexico
border, in recent days has
blocked travelers from the
U.S., as well as arrivals from
Canada and a few European
and Asian countries.
The Guatemalan govern-
ment under Giammattei’s
new administration had
confirmed six coronavirus
cases as of Monday morning.
But it has taken a hard tack
in its response to the pan-
demic to try to prevent the
rapid spread seen in North
America and elsewhere, be-
coming among the first in
the region to bar entry of
Americans.
Other nations in the
Western Hemisphere, in-
cluding El Salvador, Hon-
duras, Panama, Colombia,
Ecuador, Argentina, Chile

and Peru, also have taken

steps to bar foreigners and,

in some cases, to shut their

borders, including to their

own returning citizens.

Guatemala’s move to

refuse deportations will

have a significant impact on

the Trump administration’s

efforts to ramp up a contro-

versial agreement under

which the United States

sends migrants who are

seeking asylum in the United

States to Guatemala in-

stead, even those who aren’t

Guatemalan citizens.

The deal between the

U.S. and Guatemala, called

the Asylum Cooperative

Agreement, denies the asy-

lum seekers the opportunity

to apply in the United States

for refuge and instead allows

them only to seek asylum in

Guatemala.

Guatemala’s highest

court initially blocked the

agreement. Since Novem-

ber, the U.S. has sent Guate-

mala more than 900 men,

women and children who

have arrived at the border

from El Salvador and Hon-

duras.

Before the decision to

block deportation flights,

the Guatemalan govern-

ment had posted a schedule

for 10 flights this week from

the United States. One ar-

rived Monday afternoon

from Brownsville, Texas,

carrying 56 Guatemalans

and 17 Salvadorans, but an-

other set for Tuesday was

canceled, according to Ale-

jandra Mena, a spokeswom-

an with Guatemala’s immi-

gration institute.

Guatemalan authorities

said previously that they

had been assured by U.S.

Immigration and Customs

Enforcement that they

would not send people to

Guatemala who were sick or

displayed symptoms of the

virus.

Returning immigrants

receive health screenings

before boarding deportation

flights and after arriving in

Guatemala City, said

Joaquin Samayoa, spokes-

man for the foreign minister

in Guatemala. Those found

to be sick would be quaran-

tined, he added.

Officials at the U.S. De-

partment of Homeland Se-

curity and the Customs and

Border Protection agency,

which implement the asy-

lum agreement, directed a

request for comment on

Guatemala’s decision to the

U.S. Immigration and Cus-

toms Enforcement agency,

which administers the

flights. The agency did not

immediately respond to re-

quests for comment.

U.S. Homeland Security

officials have held meetings

in recent weeks to prepare to

add Mexican migrants to the

groups being sent back to

Guatemala — despite oppo-

sition from Mexico — and to

roll out similar agreements

with El Salvador and

Honduras, sources told the

Los Angeles Times, speak-

ing on condition of anonym-

ity for fear of retaliation.

Those plans appear to

have been derailed by the

pandemic.

The Honduran govern-

ment announced last week

that three of its citizens

who were deported from

the United States had exhib-

ited symptoms of co-

ronavirus and were put into

isolation. The country sus-

pended repatriation flights

from Mexico.

As of Monday, the U.S.-

Mexico border remained

open, to both vehicle and pe-

destrian traffic and flights,

but the governments of

Mexico and El Salvador

wrangled with each other

over stranded travelers.

Officials in the region and

even within the Trump ad-

ministration, as well as

health professionals and

immigration advocates,

have expressed fears that

Trump’s focus on immigra-

tion enforcement could

worsen the pandemic.

Casa del Migrante, a shel-

ter in Guatemala City that

since November has housed

hundreds of Salvadorans

and Hondurans returned

under the U.S.-Guatemala

agreement, announced over

the weekend that it would

stop receiving immigrants

who had been deported from

the U.S. or Mexico.

Mauro Verzeletti, direc-

tor of the shelter, declared

Guatemala’s action “ex-

traordinary” and “a victory.”

For days, he had called

for the U.S. to stop deporta-

tion flights to Guatemala,

to slow the spread of the

virus.

He said the immigrants

were already vulnerable to

illnesses because they ar-

rived from the U.S. phys-

ically exhausted and simply

“in a really bad condition.”

On Monday, Verzeletti

met with Guatemalan offi-

cials and diplomats to dis-

cuss what he described as a

“high-level humanitarian

crisis.”

The Trump administra-

tion previously favored a pol-

icy known as Remain in

Mexico, which, combined

with other initiatives, has

forced about 80,000 asylum

seekers back to Mexico

and often stranded them in

dangerous border cities as

they await processing of

their cases in the United

States.

But that policy is bogged

down in litigation — though

the Supreme Court last

week allowed it to continue

until an ultimate ruling on

its legality. Amid a signifi-

cant drop in apprehensions

at the U.S. southern border,

Trump administration offi-

cials have increasingly

turned to the asylum agree-

ment with Guatemala.

On Monday, the ACLU

and other groups filed suit

against ICE, seeking the re-

lease of immigrants in de-

tention who are particularly

vulnerable to COVID-19. Im-

migration judges, prose-

cutors and lawyers also

called on the Justice Depart-

ment to close immigration

courts.

Judge A. Ashley Tabad-

dor, president of the Na-

tional Assn. of Immigration

Judges, said judges had been

told to continue holding

hearings with immigrants

during the health crisis.

“Call DOJ and ask why

they are not shutting down

the courts,” she said, refer-

ring to the Justice Depart-

ment.

O’Toole reported from

Guatemala City and

Carcamo from Los Angeles.

Times staff writer Maura

Dolan in Orinda, Calif.,

contributed to this report.

Guatemala shuts border, rejects U.S. deportees

By Molly O’Toole
and Cindy Carcamo

A PASSENGER gets a temperature check at Aurora International Airport in

Guatemala City this month. Guatemala in recent days has restricted entry.

Johan OrdonezAFP/Getty Images