Covid-19 in Italy: “Here, everybody is truly alone”

In early February as the coronavirus ravaged Wuhan, Roberta Brivio drove around northern Italy and saw the early signs of anxiety. A 74-year-old semi-retired psychologist, Brivio chose her profession after seeing the suffering of people held in Italy’s asylums, and spent 30 years serving in psychiatric wards before taking a step back. She still treated a few people at her office in Melegnano in Lombardy and sometimes went to see patients in towns further south whose obscure names were unknown to most Italians – places like Codogno and Casalpusterlengo.

Visiting a school near Melegnano, she talked to the teachers about the coronavirus outbreak in China and asked whether the locals were worried. The teachers confirmed that the children talked about the virus a lot, an unmistakable sign that their parents were alarmed. Keen to reassure them, Brivio considered giving talks about how panic can easily spread about events which are unlikely to pose a threat. “I thought about organising nights talking about mass-media contagion – when people see something happening in another country and start to be afraid,” she says.

Yet the threat to Brivio’s own region was all too real. When the first coronavirus outbreak appeared in the West, it did so in Italy, in those remote and sleepy towns of the Po Valley: Codogno, Casalpusterlengo and Fombio. On 18th February, a 38-year-old Codogno resident with no apparent links to China went to the local hospital with flu-like symptoms. The likelihood of a coronavirus outbreak in Codogno must have seemed remote: he was given painkillers and sent home. He returned to A&E a second time, two days later, and was admitted to hospital, from which he would not emerge for over a month. On 21st February, the Italian government put Codogno and ten other towns under strict lockdown.

My wife is desperate and she can’t stop crying. I think she could use a friendly voice”

Brivio realised the enormity of what was happening when she saw some of the areas where her patients lived being cordoned off, the residents unable to leave and the army being deployed. She thought of the people struggling to cope while trapped in the “red zone” and of how she could use her skills to help.

By 4th March, Italy had more than 3,000 cases and 100 deaths. On that day Brivio and four other members of the Italian Society for Emergency Psychology, of which she is president for the Lombardy region, decided to open a mental-health hotline for the red zone’s residents. Brivio bought a new SIM card, put it in an old phone, publicised the number on Facebook – and waited. In the next few weeks her soft, calm voice would become the first source of comfort for hundreds of Italians struggling to process the cocktail of fear, anxiety and trauma created by the pandemic.

Panic was the keynote of those early days, the seeming illogicality of the events fuelling the fear. After the outbreak in China and a few minor outbreaks in other Asian countries, why had the disease suddenly appeared in Italy? And why in Codogno of all places? Why was the rest of Europe seemingly untouched?

“Good morning, I need counselling,” reads a message sent to Brivio via WhatsApp on 5th March. “My disabled brother is in hospital with the coronavirus. He’s being assisted by my cardiopathic mother, who has also become infected now. Because of the isolation in hospital, my mother has fallen into depression. Please contact me.” Another person wrote: “Good evening, I’m self-isolating at home with the coronavirus. My wife is desperate and she can’t stop crying. I think she could use a friendly voice.”

One woman called saying: ‘Today my husband died. I have two children of three and five years old. How do I tell them?’”

The phone began to ring non-stop: “I’m Paola’s aunt. She’s a student away from home. She lost her dad two years ago. He got an infection in the hospital after having a transplant. She has a lot of anxiety because of the virus. She checks her temperature every day and wants to be tested. How can I help her? How can I reassure her?”

And another: “I’m Marco, a 40-year-old in quarantine because I tested positive. I can’t bear this any longer, I really can’t.”

In the weeks that followed, Brivio was working every day from 8am to 9pm. Her old phone started to light up the moment she switched it on each morning. “I didn’t have the time to end a call before I had received another ten missed calls,” she says.

She responded to each one according to a process she and her colleagues had designed. First, she would send a brief, reassuring reply over WhatsApp. (“We’ll call you tonight. Coraggio!”) Then she and her fellow volunteers would assess each case, prioritise the most urgent ones, decide who should take each one on and call back to arrange up to three appointments, all free of charge. They sought to reassure callers and give them the tools they needed to stay well. If three appointments wasn’t enough, Brivio and others referred them to psychologists in Italy’s national health service.

Many mental health professionals recognised the importance of the hotline and began to get in touch to volunteer too. Brivio and her colleagues trained the new recruits how to work in emergencies and held debrief sessions each evening to help the therapists process what they were experiencing.

The epidemic was spreading and the death toll was growing at a frightening pace. The 6pm news bulletin by the Protezione Civile, the national body that deals with emergencies, became essential viewing for Italians, with its daily litany of deaths. On 6th March, Italy recorded 778 new cases and total deaths neared 200, having doubled in just two days. By 8th March, total deaths had almost doubled again, and the country had more than 7,000 cases, most of them in Lombardy. On 8th March, the Italian government put the whole of Lombardy and other northern provinces under lockdown. The whole country followed suit a day later.

Roberta Brivio, psychologist

Calls poured in to the hotline, not only from the original red zone but from across the region. “People were calling out of anxiety and fear,” Brivio tells me. “We were seeing many panic attacks, even during calls. One woman called on her way home from work, then stopped her car and put the warning lights on because she was having a panic attack. Sometimes the callers wanted advice on grief and mourning. One woman called saying: ‘Today my husband died. I have two children of three and five years old. How do I tell them?’”

On top of feeling scared, Brivio noticed, people felt lonely, which made everything more difficult – and the hotline more important. Here was a friendly voice who would listen, understand and help callers to express their feelings. In her work with the Italian Society of Emergency Psychologists, Brivio had worked in the aftermath of earthquakes across Italy, helping people who had lost everything to build resilience and process trauma. She noticed how different the coronavirus felt. “In other catastrophes, there are moments of solidarity – you meet at the field camp, at the canteen, you do things together,” she says. “Here, everybody is truly alone. You have no contact with anyone, there isn’t a person who hugs you and breaks down crying.”

As night fell, Italians under lockdown tried to reach out to each other. Many sang from their flats or balconies. Some sang the songs of their youth; others the national anthem.

I call the ambulance and nobody picks up. I call my GP and nobody picks up. I call everywhere, and nobody answers”

The news kept getting worse. In mid-March, reports surfaced that many hospitals in Lombardy – Cremona, Bergamo, Brescia – were at breaking point. Doctors described facing an overwhelming number of patients checking in each day. Intensive care units filled up in a few days. Medical staff raced to create new beds for coronavirus patients, freeing up wards, corridors and operating theatres – but no matter how many beds they found, they were still short. Authorities scrambled to move patients to less-affected hospitals by ambulance and helicopter. They brought back retired doctors and sent new graduates to the frontline. Doctors arrived from other EU countries, Cuba and Russia. In Bergamo, the cemetery and crematorium were so busy that army trucks had to transport bodies to other cities. Some funeral workers had nervous breakdowns and struggled to sleep at night.

Brivio saw the size of this collective trauma in her work. Paratroopers deployed to help the region told her they were struggling to deal with anxiety. They were trained to fight an enemy, they said, but where was the enemy this time? When she visited the headquarters of the Protezione Civile in Seriate, near Bergamo, Brivio says that a director told her, “Every family has had a death. You have no idea what it’s like to have 200 coffins here, see people come outside at night, ask why they are here and be told, ‘Because my mother is inside’ – and you have to send them away.” Brivio remembers that the director’s eyes were swollen. In many cases, Protezione Civile workers had also lost family members and friends.

The most difficult thing, says Brivio, was “accepting our impotence. Accepting that we can’t do what we would like to do – we can’t help people, we can’t save them.” At least seven people called the hotline threatening to take their lives.

Once, as Brivio drove home, she spoke with her colleagues about a young man who wanted to commit suicide. Her colleagues spoke to him several times and sent trusted people to his place before realising that the task was too big for them. One day they kept him on the phone while sending an ambulance to collect him, only hanging up when they heard the voice of the doctor on the line.

At other times, Brivio realised that she was speaking with someone she knew was going to die of Covid-19. “They also knew,” she says. They would call in desperate attempts to find help. “I know I’m dying and I have nobody, I’m at home alone,” Brivio remembers one caller saying. “My wife has already died. My parents have died. I call the ambulance and nobody picks up. I call my GP and nobody picks up. I call everywhere, and nobody answers.”

We’ll roll up our sleeves and keep doing what we can”

“Those are situations that challenge you,” says Brivio. “You realise that there is absolutely nothing you can do. You can only be there.”

At this difficult moment, says Brivio, she and her colleagues found strength in one another. Hundreds of volunteers asked to join the hotline, and what had started as an initiative of five psychologists became a 250-professional-strong collective. In their daily 6pm call, the group shared their emotions, their sorrow, their worries about the future. Many thanked Brivio because during a lockdown and a global tragedy they had been able to become part of a community.

Some patients also sent thank-you messages and drawings. One showed a man on the roof of his house, speaking on the phone under the moon, symbolising how the hotline had helped Italians at a time of loneliness.

To date, Brivio and her team have been the first and sometimes only source of comfort for more than 1,200 people in distress. When the virus recedes and the economic consequences of lockdown come into focus, Brivio expects calls to the hotline to continue. “There will be big social changes,” she tells me. “Because of the economic depression, all the destroyed families, all the people who have to process a loss, all those who will lose their job and will be desperate about not having an income,” she says. “We’ll roll up our sleeves, and keep doing what we can. I have seen a lot of solidarity [in the crisis]. I think this is not going to end.”

Posted on Thursday, November 19th, 2020 - Categories: #38 - Jan-Mar 2020, Long reads.