CASTELBUONO, Sicily (CN) — In his years as a mountain climber, he’s learned to not look up toward the summit in expectation, anxiously hoping the peak is closer. His mantra is to keep his eyes on the ground and put one foot in front of the other.
Now, surrounded by a seemingly never-ending wave of sickness and death, Antonio Saiz, a 43-year-old family doctor on the front lines of the coronavirus pandemic in Madrid, is relying on the same logic.
“Everyone in Spain is following the news and everyone is expecting the peak when the famous curve is going to flatten,” Dr. Saiz said over the telephone to me, a reporter in lockdown in Italy. “That information is useless for me in my daily routines. I decided a few days ago I don’t want to be updated on the numbers.”
I am fascinated, and listen.
“I try not to look at the top. If I try to look to the top, I will get desperate,” he says in perfect English. “So that is how I am doing it now. I look at my colleagues, I focus on my work, because I cannot see the end.”
Dr. Saiz works in a primary care center in the heart of Madrid and for the past month he and his colleagues have been plunged into a nightmare of mounting patients, ghastly home visits where people are dying in their beds, telephone lines full of desperate calls, medical workers falling sick, and doctors and nurses having to stretch their supplies because they lack vital protective equipment.
“We are suffering so much,” he said on a recent April morning, preparing for another day of human misery that even he, trained as a doctor, finds hard to fathom. “You cannot imagine this.”
Madrid, a city of 3.3 million, is the epicenter of Spain’s outbreak of the novel coronavirus, which has infected more than 1 million people and killed more than 50,000 from the respiratory disease known as Covid-19.
More than 4,000 people have died in the Spanish capital since the outbreak began and more than 33,000 people have contracted the virus, making it the hardest hit city outside of Wuhan, China.
The scale of infection is certainly far higher than officially reported, Dr. Saiz said. Doctors and nurses across Madrid are on the telephone with more than 120,000 people suspected of having contracted the virus, yet reporting mild symptoms.
“These people will never know if they are positive or not,” he said. That’s because mild cases are not getting tested.
The sheer volume of sick Madrileños’ suffering is staggering.
“In my primary care center, it is like watching four to five hundred people who are exactly the same, suffering the same complications,” Dr. Saiz says. “We are seeing a huge number of ill people every day with the same pattern.”
The disease causes an acute form of pneumonia that quickly exacerbates underlying health problems.
“Its potential of destabilizing chronic diseases — that is where we are our losing our grandparents,” Dr. Saiz says.
March 2. That was when he had his first confirmed Covid-19 patient, displaying now-familiar symptoms.
Looking back, he believes he had been seeing patients with Covid-19 before that day — the first Monday in March — and treating them as people sick with common colds and flus.
A month later, his world is upside down.
When the outbreak began, there were 13 doctors and 12 nurses at his clinic. Then, five doctors and seven nurses contracted coronavirus. One colleague was hospitalized.
“It’s incredible how many colleagues have got this virus,” he says.
About 12,300 Spanish medical workers have contracted the virus, an enormous number representing about 15% of Spain’s cases, the highest rate in the world. It’s so bad that many primary care centers have been closed because there’s no one left to run them. He suspects he may have had it too, but he wasn’t tested. All he ever had was a sneeze.
After that first Covid-19 patient, Dr. Saiz and his colleagues followed the instructions handed down by the health ministry: In handling the growing number of Covid-19 patients, they carefully covered themselves in protective gowns, gloves and masks, a time-consuming procedure requiring a colleague’s help.
On and off the protective gear went. But the patients kept arriving. On and off the gear went. The sick kept arriving.
The stocks of medical gear — known as PPEs, or personal protective equipment — disappeared. Still, the sick mounted, one after another. The calls for help were nonstop.
That was then. Dr. Saiz and his colleagues don’t have enough proper protective layers now.
“You are seeing people improvising with trash bags,” he says. “Many people are sewing trash bags and making suits with that.”
Plastic sheeting on emergency room beds has been adopted. People bring face shields made with 3-D printing technology for medical workers to wear.
“Between nothing and one of these screens, all of us prefer one of these screens,” he says.
As a doctor, he feels almost naked against this enemy. Worse yet, he knows he is endangering patients not infected with Covid-19 who need his help.
“My patients are still having heart problems, kidney problems, every day,” he says. “With this lack of protection, it is probably the public health service professionals who are the best vectors of the [Covid-19] illness.”
Dr. Saiz doesn’t just wait for sick patients to come to him. He and his colleagues go out into narrow streets and into the courtyards of old Madrid to see the sick.
As he talks, I get chills as I envision masked medical teams venturing into a spooky city paralyzed by a virus that’s emptied the streets. Ambulance sirens wail along boulevards between stores closed and empty.
“Our work is to go to the houses of the diseased when they are not able to come to the health center,” he says. “We have many patients who are immobilized in their homes because they are very old or they live alone.”
It’s here where Dr. Saiz faces terrible choices. In three or four homes a week, he and his colleagues find people struggling to breathe. They take a reading of oxygen levels. Time and again it’s the same: Covid-19 is sapping a person’s life.
It’s up to him, the doctor. He tries as best he can to tell the truth: Some of these people are going to die. He’s had to advise families against sending feeble elderly loved ones to hospitals because they will likely die alone in wards crammed with other Covid-19 victims or in a hospital corridor.
“More or less everyone knows once you take a patient to a hospital, to give him a phone with a charger because you will not see that patient until he is well or dead,” he says, heavily.
He gives families sedatives to help their loved ones die more peacefully.
There he is in his protective gear inside homes, his face covered in a mask, uttering words he never thought he’d have to utter.
The virus keeps people from touching one another, but he takes the hands of his patients and comforts them.
“How am I not going to do that in such circumstances? It would be inhuman! I have a relationship with these people,” he says. “I’ve known my patients for 13 years. I know this one is unemployed. I know this person has social problems. I know when someone is doing well at studying or not. I am not their friend, but I know them. So it is really hard.”
I try to see his patients, people I will never know.
I envision Madrid’s oldest population, people who can remember the war and the dictatorship, how life was before automobiles, before electricity. I see people surrounded by mementos, family portraits, history: vibrant plants, paintings, old silverware.
“So a lot of your patients are from some of Madrid’s oldest families, its original families?” I ask.
He hesitates, trying to understand what I’ve asked.
Then he responds. “Our population is more varied,” he says. “There are some gatos, from the original population of Madrid, but there are many students. The night life is there. There are artists, actors. There are many European migrants there too. There is a Latin American population as well. In the center, it is the oldest part of the city, our population is especially varied.”
I nod and imagine all these faces and stories, all this suffering.
The nightmare. It is all he can think about. It is his life.
Every waking moment, he is working through this human tragedy. This human riddle. At every turn, there is bad news. Another patient he knows has died.
There he is at the door of another cramped apartment in Madrid, faced with more suffering. There he is telling the family of a 94-year-old grandfather the end has come. There he is prescribing more medicine over the telephone.
He talks. I listen.
He says Spain has a good public healthcare system built around primary care doctors. He says doctors like him are making this disaster less bad. Just imagine, he says, if every infected person went straight to the hospital because there was no primary care system. As a family doctor, he goes to homes, assessing who should go to the hospital and who should not —he is at the front line, helping hospitals cope.
“All the hospitals are at their limits,” he says. “Hundreds of thousands of people are being checked by phone by their family doctors and being visited in their homes by their family doctors.
“You need that. If not that, you will have hospitals that are completely overwhelmed.”
Is it like a war? It’s a simple question. It’s what so many are asking.
“It’s probably like a war, but it is even worse,” he says, and pauses. “It’s like a war being practiced by kamikazes.”
I ponder what he means. I say nothing.
“Because we don’t have enough protective material.”
Now I understand: He and his colleagues are the kamikazes, going into battle without the protection they know they need.
“We are not heroes, we are doing our work,” he says. “We are trained to do this. Everyone is doing their job as best as they can. We don’t like to be called heroes.”
A flash of anger rises in his voice.
“If only our responsible authorities gave us the amount of protection we need, this would be simply our work,” he says. “We are doing our best, but last year we were doing our best too.”
Nothing has changed except the enemy.
“We don’t feel ourselves to be heroes. We just would like to be protected.”
He offers an analogy. “I don’t consider a fireman a hero because he put a fire out. But I consider him a hero when he fights a fire naked.”
He adds: “I prefer to blame the regional government for not dressing the fireman. If we are heroes, it’s only because we don’t have enough protection.”
His shift at the clinic runs from the early afternoon until after dark.
There are emergency meetings before and after work. There are video conferences to attend. There are new medical studies about this new disease to study in the morning.
“For all of us, it is constantly trying to be updated with the latest protocols, the latest lines of treatment, the latest theories about the behavior of the minor cases, the worst cases,” he says.
I see his mind racing. I see him tackling this mysterious disease’s riddle. He’s reading, thinking, reading, thinking, reading. Consumed.
There are early morning and late night conversations with colleagues. There are directives from the Ministry of Health to study. There are protocols to read, to issue and follow. There are family members to call.
“We are the ones who take the organizational decisions, the clinical decisions,” he says. “It’s like a war in terms that it’s us who are in the front lines taking the decisions.”
Are you ever angry? I ask.
He is quiet for a moment.
“It is obvious that we have underestimated the risk,” he says. “Our politicians and our responsible [authorities], thought: ‘This is a big problem in China, but it is really far away. It will be a minor problem here.’”
Then he adds other factors: He blasts governments, politicians and anyone else responsible for forcing countries like Spain to cut essential health services.
“I would love to denounce here in Spain, but also in many other places in Europe,” he says, “how we have been suffering brutal cuts of human resources and material resources.
“And this [pandemic] is partly the result of these cuts. If you take your public services to the minimum, then when you have a problem you will have a big problem. Now we are suffering the consequences of these cuts, these privatizations. This is clearly a lesson to learn.”
I ask him about his experience with younger people who get Covid-19.
“It’s affecting young people,” he says. “I am seeing young people daily. Yesterday I visited a man who was 28 years old and he had bilateral pneumonia. This man is not going to die but he will need seven to eight days of hospitalization and between 12 hours and three days of intensive care.
“If I was a journalist,” he says, “I would dispel this idea that young people are not in danger.”
He points out that “if you are young and get sick, you will occupy a bed that is needed for more serious patients.”
“The only difference between you and your grandmother is that you most probably won’t die.”
I ask how he is doing.
“None of my colleagues are doing well,” he says. “I’m working, I’m concentrated. I’m doing my best and I’m proud of how my colleagues are handling this. However, emotionally we’re bad.”
“I’m OK, I’m healthy, but I am bad,” he continues. “I am suffering. I am suffering every single day and so are my colleagues, if only because we are direct witnesses of the amount of suffering that surrounds us. It’s not only from a health point of view, but also from a social point of view.
“We’re starting to collapse here,” Dr. Saiz says. “The sanitary system is starting to collapse.
“We are in the fourth week. We are supposed to withstand this for another three weeks. The famous curve started to flatten March 31, and the peak of intensive care admissions is expected next Thursday.
“It’s a sad place and a stressful place,” he says. “My colleagues are making it easier, sweeter; we are struggling; we eat together; we cry together; we are together. We need to be like that.
“Yesterday, some PPEs arrived, so today I hope we don’t need trash bags.”
He says it is mainly his beleaguered colleagues at hospitals who must protect themselves this way, as they see more serious cases.
Today, he readies himself for another day at work — carrying trash bags. He doesn’t want to be naked when he meets this microscopic enemy.
Courthouse News reporter Cain Burdeau is based in the European Union.