Ask Your Goth Doctor: An introduction to COVID-19 from an Italian doctor on the front lines

By Dr. Laura Franceschetto

In the summer and fall, Dr. Laura Franceschetto can often be found at goth and punk festivals and squat shows across Europe, enjoying their favorite music. But they are also a doctor based in Italy, and as such have been working long hospital hours on the frontlines of Italy’s COVID-19 epidemic. During an interview, we asked Dr. Franceschetto to describe the basic science of COVID-19 for the lay person, and the answer we received was so in-depth that it became its own article. So here is one of two articles featuring Your Goth Doctor, with an upcoming interview describing current conditions in Italy from their own perspective.

MEET MR. COVID-19

The correct name for COVID-19 is SARS-CoV-2 and it belongs to the genus of Coronaviruses, a subfamily of viruses. He’s a sneaky virus that doesn’t know what boundaries are. Whether they are national, social or gender …. it doesn’t care. It doesn’t even care if you are well (you may have no fever nor difficulty breathing): it can nest in each of us regardless. And how does it get there? With droplets, droplets that we emanate into the air by coughing or talking, and which settle on the objects we use. And, let’s say more. It has been shown that it is also capable of isolating itself in the stool and urine. So everything that involves a gathering of people and close contact between two people would have an aerosol effect. And aerosol is his big party — travel through droplets and aerosols. And does he care if you’re young or old? Absolutely NOT! He doesn’t give a damn. If he likes you, he attacks you. He can cause serious damage to you, or use you as a vehicle to reach others.

What does it do in your body if it likes you and goes wild?

We said that you might feel good as always, and therefore you could feel alien to all this. It’s not true. Why then be a vehicle to flood others with infection? Suddenly, you might manifest some sign that something has changed in you. Fever above 37.5 ° C…. It can be him. But don’t panic. You have taken all precautions because you know it can:

1. LUNGS: Inflame the alveoli (where there is oxygen recharging our organism, allowing it to live), plugs them, inflates and flakes them, until the alveoli hemorrhages and death of the tissue occurs. It can thus create thrombi up to the hemorrhagic infraction. Or all this inflammation can consolidate and form a picture of pulmonary fibrosis and cysts. In short, the lungs can become like those of a person who smokes an entire cigarette factory in the blink of an eye ­— until complete collapse.

2. SPLEEN, BONE MARROW: They are our defense weapons factory, they are our army. And COVID reduces them by volume, it tithes or renders our soldiers ineffective in the defense attack.

3. HEART, VEINS and ARTERIES: The pump of our life ignites until the degeneration of their cells, until their death. And its ducts, veins and arteries, flake off inflammation or create microthrombi that obstruct or disrupt blood flow.

4. LIVER and GALLBLADDER: The liver is a scavenger but also a maker of our red blood cells. With COVID it swells and dies from inflammation. The gallbladder, important for digestion, relaxes and becomes ineffective.

5. KIDNEYS: A fibrous foam is formed, making the tubules flake and degenerate.

6. OTHER ORGANS: The brain floods with blood, and neurons degenerate. The adrenals become inflamed. The mucous membranes of the esophagus, gastric and intestinal have, with large variables, degenerations up to necrosis (death).

O my God, doctor, will I be sick?!

Let’s clear it up right away. In the current state of knowledge and practice I cannot tell you that YES, you are sick, you are infectious, you are its carrier. But you likely are. Even if you have no symptoms. Even if the swab they subjected you to is negative. Yes. You are sick. Your friend. Your partner. Your children. Your grandparents. You. Them. WE. I. I am also sick. So I will treat you as if you were:

You could incubate it for 1 to 14 days without manifestations. And I already worry. I’m alert if you have a fever, dry cough, asthenia (feeling of exhaustion as after intense exertion), changes in taste and smell, nasal obstruction, runny nose, myalgia (muscle pain)…

…. Too generic, doctor ….

That’s why I say that the virus is sneaky and is a bastard. Because it can be associated with anything else. But it’s about a week after the beginning of the disease that it becomes an emergency for me: dyspnea (breathing altered by rhythm or frequency, which occurs with fatigue or suffering). There it is. But it still may not be him …. and then we do blood tests. Hypoxemia: blood is not well oxygenated.

Why?

Let’s do an x-ray and your lungs will show it to us. The sign is clear: There is frosted glass in your lungs. There it is. It’s COVID. Now, it’s an emergency. Because the progression is rapid up to ARDS (Acute Respiratory Distress Syndrome), septic shock, metabolic acidosis which is difficult to correct, coagulation deficiency, and finally MOF (Multiple Organ Failure). And then it is still not so simple and straightforward: those who have a very severe case can have only a mild fever or even have no obvious fever. Some children and infants may have an atypical clinical presentation which consists of gastointestinal symptoms such as vomiting and diarrhea or drowsiness and tachypnea (rapid breathing).

Of course, even your doctor is sick. If not positive, she is still ill —even at work, finding answers to all these questions about how it can exist as a subtle disease.


You are the cure

You are always on the internet, finding advice and suggestions. You hear from experts who also tell you to wear grandma’s red shirt. I know. But don’t trust me. There is little official literature on this because we are studying it now, experimenting and testing. You don’t see the results right away and none of us at the hospitalists are willing to shout to “Eureka!” to the world. So using what’s right in front of us, though it is unofficial, the research we are doing is a controlled and guaranteed means of finding out more about this virus. We are citizens of the world, and we contribute to the dissemination of our experience, the solutions we reach as well as the failures.

And, as a citizen of the world and your friend, I urge you to become simpler. To acquire those rules of civil life that we had forgotten: Respect and love for ourselves and for others. That means starting (and not getting tired of ) taking care of yourself, your own hygiene and that of others. Keep yourself clean with soap, wash your hands often. We must disinfect our home and the objects we use with chlorine or alcohol-based products. Keep as far away from others as possible (at least 2 meter = 6 ft). Cover your mouth when coughing with the inside crease of your elbow if you don’t have a mask. And also the mask: If you have just one bandana, be careful of how you use it. Don’t take it off or drop it on your chin when you answer the phone. The virus is sneaky and can’t wait to get into your mucous membranes.

And at what point are the cures? What you hear from the media is nothing but antiviral and anti-inflammatory. Their actions of these medications is to cushion the effects of the virus, not to eradicate it. This is the simple truth. But we are hopeful. Not optimistic but hopeful. That the virus becomes less severe and that everyone helps. Because the cure is prevention, now and for who knows how long. It’s us. Insulation, distance and hygiene. It’s up to you, me … WE.

A selfie of Dr. Franceschetto at work.

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