A8 EZ RE THE WASHINGTON POST.MONDAY, SEPTEMBER 14 , 2020
disease clearly has full-body ram-
ifications but leaves wildly differ-
ing marks from one patient to
the next, and in some cases few
marks at all. Among the first 750
patients screened, some 30 per-
cent still have lung scarring and
breathing trouble. The virus has
left another 30 percent with
problems linked to inflammation
and clotting, such as heart ab-
normalities and artery blockag-
es. A few are at risk of organ
failure.
Beyond that, according to in-
terviews with eight Pope John
XXIII Hospital doctors involved
in the work, many patients
months later are dealing with a
galaxy of daily conditions and
have no clear answer on when it
will all subside: leg pain, tingling
in the extremities, hair loss, de-
pression, severe fatigue.
Some patients had preexisting
conditions, but doctors say survi-
vors are not simply experiencing
a version of old problems.
“We are talking about some-
thing new,” said Marco Rizzi, the
head of the hospital’s infectious-
disease unit.
One patient, Giuseppe Vavas-
sori, 65, has developed short-
term memory loss and now lives
under a mountain of Post-it notes
and handwritten reminders,
with names and phone numbers,
so he can still run his funeral
home business. A post-covid MRI
showed dot-like lesions on his
brain.
Another, Guido Padoa, 61, re-
covered well enough that he was
able to go on vacation this sum-
mer. But he sleeps four extra
hours per night and sometimes
falls asleep suddenly midday,
head on the computer keyboard.
Some patients who were self-
reliant before contracting the
virus remain so weakened that,
when they arrive for their follow-
up appointments, they’re helped
to the waiting room by relatives,
or in wheelchairs. Four people so
far were too frail to make it
through the several hours of
testing and were rushed instead
to the emergency room. Other
times, people show up months
later, having been through the
worst — oxygen support, intuba-
tions — and are, improbably,
almost fine. Doctors say one of
the virus’s mysteries is how re-
coveries can be swift for some
and brutal for others.
Venturelli mentioned a man in
his 80s who’d come in for his
follow-up visit, mostly recovered.
His son, who’d also been infect-
ed, hadn’t fared as well. When
Venturelli tried to refer the fa-
ther to a specialist, he said he was
too busy these days.
Covid-19 had turned the father
into his son’s caretaker.T
he Bergamo research is be-
ing led by the same doctors
who worked frantic 14-
hour days in March, sometimes
falling sick themselves, while
watching patients rapidly out-
number the beds. Now, wearing
just masks, those same doctorsBERGAMO FROM Aand patients are sitting down
together in a way that was i mpos-
sible months ago.
“We did feel a moral obligation
to call them back,” said Venturel-
li, who helped start the study in
early May. “It was such a tsunami
for us. What we saw in March
was a tragedy, not a normal
hospitalization.”
Bergamo, in March, was a
place with six-hour waits for
ambulances and 16-hour waits in
the ER. At one point, the hospital
had 92 people on ventilators —
compared with 182 now in all of
Italy — and so many who re-
quired breathing assistance that
it needed to pipe in oxygen from
a rush-delivered emergency
tank. In the province of 1.1 mil-
lion people, 10,000 were hospi-
talized, including more than
2,0 00 at Pope John XXIII.
“I have a picture in my mind
from that time of the ER with
eight ambulances queuing out-
side,” said doctor Monica Casati.
Inside the hospital, she said,
people were crying, moaning and
gasping for air. “It was a noise
that would remind you of Dante’s
inferno,” she said.
The hospital was admitting
only the worst cases, and to keep
pace with the influx, it some-
times had to discharge patients
before they were fully ready —
something confirmed when the
hospital started calling people
for the follow-ups. In addition tothe 440 people who died while
hospitalized, 220 died a fter being
told to go home.
The study in Bergamo is one of
multiple efforts around the
world to examine aspects of
covid-19’s lingering damage. One
German study of 100 people
found that nearly 80 percent had
heart abnormalities several
months after infection. Other
studies are underway to look
specifically at “long-haulers” — a
subset of people, some never
hospitalized, who nonetheless
have fatigue and other s ymptoms
months after the illness.
Some of the doctors in Berga-
mo see reasons for encourage-
ment in their findings, especiallygiven the severity of what pa-
tients faced in March and April
and the trial-and-error treat-
ments they were given. They say
that patients’ breathing seems to
gradually improve, even though
the lung scarring is permanent.
Doctors have found nobody with
a fever.
“Many of them coming in for
repeat visits, they are doing bet-
ter now than they were in May,”
said Caterina Conti, a lung spe-
cialist.
For the patients who have
been able to regain a semblance
of their lives, the last barrier is
the trauma itself — the raw
memory of being in a hospital
where so many were dying, andwondering if they might be next.
Padoa, a photographer, said he
remembers hearing others in his
ward struggling to breathe, and
seeing hospital workers remove
the bodies, change the bedsheets.
With his own lungs on the brink
of failure, he worried what might
happen if he let his eyes close, so
he drew on his training four
decades earlier as a paratrooper.
Under an oxygen helmet, as it
beeped and hissed, he willed
himself to stay awake for five
days, he said.
“It’s like when you are on a
high mountain in the cold,” Pa-
doa said. “If you fall asleep, you
die.”B
ut the gravest p atients of all,
like Mirco Carrara, 55, have
no recovery in sight.
By the time he arrived for his
follow-up, it was late August, and
he’d moved back into his home
on the o utskirts of Bergamo. He’d
started going to work again, as a
manager at a military parts com-
pany. But he was also coming to
terms with how drastically his
life had changed.
He had spent more than a
month in a medically induced
coma. In the middle of that, he
was transferred on a German
medevac plane to a hospital in
Cologne. Doctors there saw that
his lungs had developed not only
scars but also a fungal infection.
He was removed from the venti-lator, re-intubated after his lung
collapsed, then removed again.
By the time he returned, con-
scious, to a rehabilitation center
in Italy, Carrara had lost 45
pounds. He needed to relearn to
swallow and stand.
And even that he had felt
capable of doing, until doctors
told him one more thing. The full
trauma of covid-19 — the ventila-
tion, the treatment, the com-
pounding infections — meant
there were now fungus-filled
bubbles inside his lungs, each a
bomb-like threat that could criti-
cally impair his breathing if it
burst.
“I started crying,” Carrara
said. “Up until that point, I had
thought I’d be able to recover.”
In a n interview, S imone Benat-
ti, the doctor at Pope John XXIII
who consulted with Carrara, de-
scribed the air and fungus bub-
bles as a “bad complication” and
mentioned a separate Italian
study showing that some de-
ceased covid-19 victims were
found to have bacterial or fungal
abscesses in their lungs.
“There is an interplay between
covid and other infections,”
Benatti said.
Carrara said the bubbles were
like a “Damocles sword,” and
soon enough, in early June, a
cough sent his oxygen levels
dipping. His girlfriend rushed
him to the hospital. He had a
tube inserted into his lungs for a
week. A month later, it happened
again — dipping oxygen; another
hospital trip; another surgery to
drain his lung — except this time,
he wasn’t even sure what set it
off. He felt a rage about his body.
He said he wished the surgeon
would “just cut my lung out.”
He arrived for his follow-up in
Bergamo carrying a thick stack of
medical paperwork and figured
there was only so much more
about his body he cared to know.
Like the others, he submitted to a
CT scan, an echocardiogram and
blood tests. B ut when filling o ut a
survey about how he was feeling
and coping, he checked all the
boxes in the “middle,” he said —
moderate, good, okay.
“I lied,” Carrara said.
He didn’t mention how deep
his despair has been, as he comes
to grips with the condition of his
lungs. He didn’t mention the
guilt he felt, wondering if he
passed the virus to his father,
who had not survived. He didn’t
mention his first nights back
home, when he lay fully awake,
one night and then two nights
and then three. He didn’t say
how his partner then said
enough was enough, and went to
the pharmacy to get sleeping
pills, and how he’d a greed to take
them, because that was the one
way to briefly quiet his mind six
months after being infected with
covid-19.
“The bubbles will remain.
They’re not going anywhere,”
Carrara said, and he figured it
was just a matter of time before
he was back in t he hospital again.
“I live with this terror,” he said.
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[email protected]PHOTOS BY ALBERTO BERNASCONI FOR THE WASHINGTON POST
A patient gets an X-ray at Pope John XXIII Hospital in Bergamo, Italy. In providing follow-up care for covid-19 survivors, doctors have found that some h ave fully recovered while others have permanent damage.Italian studies show v ariation in virus recovery
Mirco Carrara, 55, still experiences effects from covid-19, the disease caused by the novel coronavirus. His daily medicines are laid
out on a table. Doctors told Carrara his lungs, already scarred from the virus, n ow contain fungus-filled bubbles.Patients wait at the Pope John XXIII Hospital in Bergamo.
Many are receiving follow-up care after surviving covid-19.