It starts every day in the early afternoon: patients flock to hospitals with fevers, tremors, chills, and breathing problems. In Italy, the last country hardest hit by the new coronavirus, this is apparently happening like a clock.

“It is really difficult to see so many sick people at the same time”, Dr. Roberto Cosentini, a doctor from the city of Bergamo, north of Milan, said in a podcast for emergency physicians. “It’s like a daily earthquake.”

Is this what awaits California?

More than 2,600 cases of COVID-19 have been confirmed in the Golden State and 55 people have died from respiratory disease. This is far from the 69,000 cases and 6,820 deaths reported in Italy.

But health officials here have hinted that it was possible.

“We are going through a serious crisis”, warned Dr. Scott Morrow, San Mateo County Health Manager. “Unless everyone does their part and respects the order of refuge on the place of the county and the order of the Governor safer with us, we will very soon be confronted with a disaster of the Italian type”, has t he said in a statement. declaration released Monday evening.

In nearby San Francisco, Dr. Grant Colfax, director of the Department of Public Health, is prepare for a push in patients hospitalized within the next week or two. “The worst is yet to come,” he said.

The first coronavirus infection in California was confirmed in late January, and cases and deaths from COVID-19 have increased exponentially since early March.

On Tuesday, California county officials announced 395 new cases of coronavirus infection; the previous Tuesday, there had been only 158 new cases. Similarly, on Tuesday, 11 new deaths were reported across the state; the previous Tuesday, there had been three new deaths.

No one can be sure what the future holds for California. If residents follow Governor Gavin Newsom’s order to stay home as much as possible, illness and death can be prevented or delayed. On the other hand, if a single asymptomatic person enters the state and becomes a super-broadcaster – transmitting the virus to large numbers of people – it could trigger a new epidemic.

Anyway, there are good reasons to expect the worst to happen suddenly, like in Italy.

For weeks, King’s County in Washington State and the San Francisco Bay area have been the hardest hit areas in the United States, so, seemingly out of nowhere, the Governor of New York, Andrew Cuomo announced 5707 new cases of coronavirus on Monday evening. The next day, there was a 4,790 additional cases, bringing the Empire State total to 25,665.

“This is happening right now in New York,” said Dr. George Rutherford, epidemiologist and infectious disease specialist at UC San Francisco. “They are against it.”

In Italy, the sudden increase in the death toll is likely due to a combination of bad luck and a lack of rapid action, said Rutherford.

In fact, the death toll in Italy is more than double that of China, the cradle of the pandemic, although the Chinese population is 23 times larger.

The first sign of problems appeared on February 20 in the form of a previously healthy man in his thirties with an unusual case of pneumonia requiring intensive care. Although he has no history of travel to China, he tested positive for coronavirus at Codogno Hospital in Lodi province, about 30 miles southeast of Milan, according to a report in the Journal of the American Medical Assn.

The next day, 36 other cases of coronavirus were identified. Worse, the virus quickly spread among hospital medical staff, said Dr Maurizio Cecconi, president-elect of the European Society of Intensive Care Medicine and co-author of the JAMA report.

“Don’t underestimate this. It’s not a normal flu. It’s serious,” Cecconi said in one interview with the editor of the medical journal. “The percentage of patients requiring intensive care admission is high.”

An uneven public health response has made matters worse. The Codogno region businesses closed quickly and many stayed at home, but other nearby communities did not act as decisively. It was not until March 8 – more than two weeks later – that a stay-in-place directive was ordered for some 16 million people in northern Italy, an area that included Venice and Milan.

The delays have been fatal. Bergamo was hit hard; the chapel of the town cemetery had to be transformed into a morgue to accommodate the dead.

Italy is particularly vulnerable to COVID-19 because its population skew moreSaid Rutherford. According to the World Bank, 23% of the Italian population is at least 65 years old. Only the Japanese population is older. (In the United States, 16% of the population is 65 years of age or older; in China, it is only 11%.)

In a study of 803 people who died in Italy, about 88% of them were at least 70 years old, according to data that Cecconi shared.

Seniors and those with pre-existing health conditions are at greatest risk of serious illness and death if they are infected with the coronavirus officially known as SARS-CoV-2. If the virus settles deep in the lungs, it can leave victims unable to breathe on their own and cause septic shock and multiple organ failure. The immune system’s response to infection can make matters worse by drowning the tiny air sacs in the lungs that supply oxygen to the bloodstream.

A medical worker in protective clothing takes care of a COVID-19 patient in the intensive care unit of a hospital near Rome.

(Alberto Pizzoli / AFP / Getty Images)

In addition, Italy has been thwarted by a familiar problem in the United States – the inability to perform large-scale testing. This had an impact on “the ability of doctors to make accurate diagnoses and to allocate patients appropriately,” wrote Cecconi and colleagues.

Under these circumstances, adding critical care hospital beds is not enough, the authors said. Home-based measures “may be the only possible way to contain the spread of the infection and develop resources for time-related illness,” they wrote.

Health workers in California have been paying attention to podcasts from Italy as they prepare for an expected attack on COVID-19 patients. The podcast featuring Cosentini described conditions so intense that medical staff needed the help of a psychologist.

On a particularly bad day, the emergency department at Cosentini saw 80 patients with pneumonia. With no beds available inside the 800-bed hospital, patients had to wait everywhere in the emergency room, said Cosentini.

Treatment of COVID-19 patients takes time. A patient who cannot breathe on his own may need to be ventilated for three to 20 days. A study patients in Wuhan, China, reported that the median time from onset of illness to discharge from hospital was 22 days. (Those who died lasted 18.5 days after the onset of their symptoms.)

“Not only are we filling the beds of people with this disease and people suspected of suffering from it, but we cannot move [them] until we are sure they are negative, “said Rutherford.

Harriet editors Ryan and Sean Greene contributed to this report.

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