“Write about Munda, physician of Nembro”

"Write about munda, physician of Nembro"

House-to-house and no deaths, Dr. Munda's story

Article by Francesca Borri

Photographs by Maurizio Milesi

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Doctor Munda, a year later
A year later, nothing changed. His phone is still ringing constantly. Only, now he is not getting calls just from Nembro, but from all over Italy.
Riccardo Munda is 39, with a leather bag like movie doctors. And yet he is real. Last March, when Nembro had a Covid-19 death in every 61 people, in a 11,000 population, and doctors were advised to look after patients by phone, not to get infected and infect, he was the only GP not to suspend home visits. With $650 of masks purchased out of his own pocket, and a steam cleaner. He arrived, and while he was with a patient, word spread quickly: and there was already a neighbour knocking on the door. Of his choice to be among the sick, he said simply: And where should I have been? Among the healthy?
In March, none of his patients died.
And a year later, still none of his patients have died.
A year later, in Nembro funeral announcements do not blanket walls anymore, there are advertising posters again, but in the evening you look at windows, and for every light turned on, another one is off, another house is empty, and in any bar, in any shop, that’s still what you talk about, you sneeze and you are asked: Are you OK? Can you breathe? – next to the till, edged in black, a portrait of a father, of a son: or both. Everyone has a story for reporters here, a scar, everyone has been swept over by Covid-19 – we are a short drive away from Bergamo, and this is still today the area which had Europe’s highest excess mortality rate. And yet everyone says: But don’t write of me, write of Riccardo Munda.
Because only the authorities in charge of the Covid-19 response have never called him.
The virus here hit so hard that antibodies were detected in 42% of the population. And there was nearly no second wave. But in the rest of Italy, it’s been a deadly winter. In the first wave, the dead were 34,278. Now they are 97,945. And a third wave is starting. “And you have this feeling that it’s been all in vain”, says Riccardo Munda at dawn as the light up stars, in the main square, turn out, and he gets off his night shift. They are not Christmas remainders: they are one for every dead. “We have yet to understand Covid-19, but one thing is clear: you defeat it outside hospitals. By enhancing not only ICUs, but all that avoids you ending up in ICUs: because epidemics are about math, not just about medicine,” he says. Not just about falling sick, in other words: but about falling sick all together. “And instead, rather than funding doctors, in the last months we funded scooters.”
He refers to the scooters bought with a $600 state bonus. And that are now everywhere. To relieve pressure on public transport, the government subsidized bikes and cars as well. But then also holidays. New windows. Even taps.
“Meanwhile, we have about 1,400 patients each,” he says. “And I’ve said it all.”
And he switches on his phone. There are 142 WhatsApp notifications.
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In March, one doctor in four got ill. And phone visits are now allowed by law. Listened on speakers, yet, they are often like that of Greta. Who is 40, and has been under ventilation for long, and has lost her father too to Covid-19. And a year later, has always a fever. “At the beginning, she went back to the hospital regularly for follow-up care. But each time there was a different doctor, and it was like starting from scratch. Because her GP, instead, no: he never picks up the phone,” says Riccardo Munda, as he tries to figure out why her blood oxygen level drops with even minimal exertion. But first he gets interrupted by one of the children, then by Amazon delivery man, and then by DHL delivery man, and then by another one of the children, and then by a cat – with the pulse oxymeter that reads different numbers on different fingers. “Nothing. Tomorrow I’ll pass by, there’s no other way,” he says. Then he says: And out of a moral duty, not only a medical one.
“Because you might think: It is just a mild fever. No, it is not. We think through categories. But with a mild fever, a single mother of three cannot even enter a grocery.”
And then, look at this, he says as he goes through the latest WhatsApp messages. A patient forgot to tell him that his father and uncles are all cardiopathic. And perhaps, it is useful information, he texts. “Perhaps?”, he says. “For many of you, a GP is something old-fashioned: the doctor who reaches your home in a stormy night on a horse-drawn carriage. But he is actually the doctor who knows his patients, and their medical background. And their family background as well,” he says. “While now you call an emergency number, and what they know of you, is only your blood oxygen level.”
But no way. Most doctors do not even pick up the phone.
Now they fear to end up in court, rather than in a hospital ward – in Italy there are roughly 400,000 doctors, and 36,000 damages actions per year: one for every 11 doctors. “And even though it is dangerous especially for over 70s, this virus is basically unpredictable. And so, not to run any risk, if you test positive your GP applies Covid-19 protocols straight off. Bombarding you with drugs,” he says, as he answers the call of a friend’s friend of a cousin of the neighbour of one of his patients, who explains that her temperature is 37.4°C, and she is about to take a second Tylenol. “Wait. For a couple of days, just wait,” he says. “Because fever is a symptom, right? And a symptom is a signal. And if you remove it, how can I understand what it is signalling? And figure out what the most likely development is? I might accidentally do more harm than the virus.”
But now everybody panic, he says. And panic too fills up hospitals.
The experts of Bergamo’s Papa Giovanni Hospital examined 767 patients of the first wave. And one in two has still problems. Breathing problems mainly, as if lungs were not working at full capacity anymore, but also heart and neurological problems: it is the so-called Long-Haul Covid. And sometimes it is a side effect of intensive care, or other patologies. Sometimes it is just a psychological issue. But other times, it seems to be a result of wrong treatments. The trial-and-error ones of the early days. But also today’s.
And of those 767, 16% lost independence.
“We are dealing with the first cases. And we are still in uncharted territory. But listen to this message,” he says, and I listen to a patient who now, finally, she says, can breathe again. “I looked at her X-ray over and over again. And in the end, I wondered if it could be a kind of dormant pneumonia. Because you are often treated with cortisone. Which reduces inflammation, yet. It does not cure. And so when you test negative you believe it is over. While it is not,” he says. “And you ruin yourself.”
“Many cases are much more complicated, of course. And yet, many others are manageable”. Can I say it?, he says. “This virus prevails rarely on its own merits.”
Riccardo Munda is not the only one. Largely forgotten, and left for long on their own without any guideline, over two hundreds GPs have now set up a WhatsApp group to help each other. About 5,000 doctors never suspended home visits: and the more they could work door-to-door, the more hospitalisations for Covid decreased. And now, for Long-Haul Covid. But amid all statistics of these months, these are the only data no one mentions. “Because research is mainly on vaccines, rather than drugs and treatments. But most of all, because widening ICUs, building new hospitals, is easier. And with a stronger impact,” he says. Dispensing tenders and contracts. Cutting ribbons. While I am here just with my $100 stethoscope, he says. With me, you don’t impress anyone.
You don’t win elections.
“I don’t treat the virus. For it, there is no therapy. I treat its complications. I treat pneumonia. So that the immune system can focus on the virus: and do what science for now can’t do,” he says. And after all, it the same principle of intensive care. He does not fool anyone. He does not promise anything. “I look after my patients, that’s all. And I try. Day by day,” he says. And actually, more than once a day. We see twice a 81-year-old, and as he adds two drops and eliminates a pill, I do some math. One of the drugs he uses the most is $8.38, two per day for twenty-two days. The other one is $9,44. Three boxes. It is $396.
Against the $2,500 per day of hospital care.
He never says that among his patients, dead are zero. Because to be honest, that’s not my point, he says, as he gets into the bakery of Salvo Mazzola: who called the emergency number, and asked if his father was still breathing, replied: Well, yes, I think so, while no, he was not breathing at all, and he died – and a year later, he repeats only: But more or less, really, I swear, he could breathe. He tells him it was not his fault. “That zero is also a matter of luck,” he says. “The point is: trying to be with patients. As much as possible. Because many dead could die better. And now, the alive too would live better.”
“Don’t write of us. Write of him,” says Salvo Mazzola, while Riccardo Munda is already on the phone again. With a man who’s been prescribed only some Augmentin.
Only a pain killer for toothache.
“And should he die,” he says, “truth is he will die from Augmentin.”