How this Italian doctor found Europe’s Patient One and became a national hero

March 13, 2021
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Mattia Maestri wasn’t feeling well last February. He had a cough and a low-grade fever and was short of breath.

The Unilever project manager wasn’t particularly worried. He was 38, strong and athletic – an ardent runner. It was influenza season, and it seemed everyone in his town, Codogno, 60 kilometres southwest of Milan, had the bug. It would pass.

It didn’t. His breathing became laboured.

On Feb. 18, a Tuesday, he stumbled into the emergency ward of the Codogno hospital and was given antibiotics, but insisted on going home to his pregnant wife. He was back that evening. He could hardly breathe, and his fever was high. He was given oxygen and more antibiotics.

By Thursday morning, Mr. Maestri was in dire shape – his blood oxygen level had plummeted. The doctor in charge of the ICU that day, Annalisa Malara, an intensivist and anesthesiologist from the nearby town of Lodi, was called in as Mr. Maestri was undergoing a CT scan. Dr. Malara, who was just six months younger than the patient, was shocked by what she saw. “Both lungs were literally invaded by pneumonia … an opaque, shapeless mass that [covered] every centimetre of both organs,” she said.

Mr. Maestri knew he was in critical shape. “Am I dying, doctor?” he asked her. “I can’t die, not now. I and my wife, Valentina, in a few days we will have a child … I can’t leave her alone.”

Dr. Malara swung into action. The patient was wheeled into the ICU and intubated.

What Dr. Malara did next may have saved hundreds, perhaps thousands, of Italian lives. She called Valentina and learned that her husband had dined two weeks earlier with a colleague who had recently returned from China. Dr. Malara immediately suspected COVID-19 and ordered a test. In the meantime, she isolated Mr. Maestri, and she and her two ICU nurses wrapped themselves in personal protective equipment. She wasn’t even wearing a mask when she first encountered him.

The test broke protocol. At the time, only Italians and foreigners who had been to China were to be tested. At 9 p.m., the swab came back positive – and the pandemic was suddenly on. Dr. Malara had officially confirmed the first Italian – the first European, for that matter – COVID-19 infection. Mr. Maestri would become known as Paziente Uno – Patient One.

The local health authorities immediately declared an emergency and the Codogno hospital was put into lockdown. The next day – Feb. 21 – Codogno and 10 other towns in Northern Italy were isolated, their access roads blocked by the military. The same day, Europe recorded its first official COVID-19 death when Adriano Trevisan, an elderly resident of Vo’ Euganeo, a town in Italy’s northeast, near Padua, died hours after being diagnosed with the coronavirus. Panic set in and all of Italy imposed a tight lockdown on March 9, the first European country to do so.

Today, Italy is still in the thick of the pandemic, with almost 95,000 deaths – the second-highest toll in Europe, after the United Kingdom’s – and more than 2.7 million cases.

It has vaccinated only 5.3 per cent of its population and anxiously awaits new supplies as the European Union’s vaccine rollout proves embarrassingly slow.

Since the alarming, dreadful days of February, March and April, when the pandemic’s first wave was at its peak, everything – and nothing – has changed in Dr. Malara’s life.

She is a national hero. In October, in a ceremony at the Quirinale Palace in Rome, President Sergio Mattarella bestowed her with the country’s top civilian award, Cavaliere dell’Ordine al Merito della Repubblica Italiana (Knight of the Order of Merit). She was named “Personality of the Year” by the Sky TG24 news channel.

She also wrote a short and riveting memoir, In scienza e coscienza (In Science and Consciousness), about her discovery of Patient One and the subsequent 3½ months, when she worked 14-hour days with almost no time off. The book reads like a thriller, with the medics coming to realize that what they had assumed were flu cases were actually potentially deadly coronavirus cases, and Dr. Malara immersing herself in what felt like a war zone.

“There were moments when I said to myself, ‘I can’t do this any more,’” she said in a Zoom interview with The Globe and Mail last week. “But this was my job. This is what I was meant to do. My colleagues gave me strength.”

What hasn’t changed is her career and her life.

In spite of her celebrity, she remains devoted to saving lives and working long hours as she risks exposure to the virus – miraculously, she has never tested positive.

In November, she moved to the emergency hospital set up at the Fiera di Milano, the city’s exhibition centre, where she works in an ICU ward. The temporary hospital opened in October to serve as an overflow site for the region of Lombardy, which has been the hottest of Italy’s hot spots.

Looking back on the pandemic’s frenetic early days, when the virus exploded across Northern Italy and convoys of army trucks transported coffins from hospitals to mass burial sites, Dr. Malara is astounded by how little Italian health authorities knew about the disease and how poorly prepared they were, even though by then it was apparent that Europe could not insulate itself from the virus.

In late December, 2019, the health commission in Wuhan, China, informed the World Health Organization of an acute pneumonia outbreak. A month later, Italy’s first COVID-19 cases were confirmed when a Chinese couple from Wuhan tested positive at a Rome hospital (they survived). Three weeks later, Northern Italy was the European pandemic’s ground zero. Local ICU and sub-ICU wards reached breaking point within days of Mr. Maestri’s positive test.

“We knew very little about the virus,” Dr. Malara said. “We didn’t even know there were asymptomatic patients.” (University of Padua microbiologist Andrea Crisanti’s study of Vo’ Euganeo residents at the start of the outbreak revealed that 40 per cent of positive cases were asymptomatic, a crucial finding.)

The first weeks of the crisis were a blur for Dr. Malara. After Mr. Maestri tested positive, she stayed with him in quarantine for 36 hours because she did not want other doctors exposed. Instinct told her to flip him into the prone position – on his belly, which improves lung function – a method that would be widely used in ICUs for intubated COVID-19 patients. “I think the prone position probably saved his life,” she said.

By then her patient was in a coma that would last almost three weeks. Dr. Malara went home and self-isolated for three days, fearing she had picked up the virus. When she returned to work, the Codogno hospital was overwhelmed. On Feb. 20, the hospital had only seven ICU beds; by mid-March, there were 27, all of them occupied.

She and her colleagues had to learn on the job: when to intubate (early), which drug treatments to use (anti-inflammatories such as dexamethasone) and how to deal with dying patients who could not see their families (not easily). Dr. Malara saw a lot of death. “We were not just clinicians – we were their family because they were alone,” she said. “I cried a lot.”

She also had to endure the death of colleagues. By mid-February, 313 front-line Italian doctors and more than 45 nurses had died – a few by suicide – treating COVID-19 patients. Dr. Malara’s book is dedicated to the medics “who never stopped fighting.”

There was good news. Dr. Malara and her ICU colleagues saved a lot of lives. One of them was Mr. Maestri, who is back to near-perfect health after a physically and emotionally gruelling experience that included the death of his father from the disease in March. “For three weeks I was dead,” he told a TV reporter in September, referring to his long coma.

That month, a 180-kilometre relay running race took place in memory of the victims. It went from Codogno, where Mr. Maestri was identified as Patient One, to Vo’ Euganeo, where the first confirmed COVID-19 death occurred. As if to prove the disease could be beaten, Mr. Maestri ran one leg of the race. “I feel lucky,” he said at the start line.

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