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Vol. 27. Issue 4.
Pages 281-282 (July - August 2021)
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Vol. 27. Issue 4.
Pages 281-282 (July - August 2021)
Editorial
Open Access
The cruel journey through the COVID-19 INFERNO
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Michele Vitaccaa,
Corresponding author
michele.vitacca@icsmaugeri.it

Corresponding author. Istituti Clinici Scientifici Maugeri IRCCS, Via Salvatore Maugeri 4, 27100 Pavia, Italy.
, Nicolino Ambrosinob
a Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy
b Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Montescano, Pavia, Italy
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Dante Alighieri died in 1321. His three-part masterpiece, “The Divine Comedy”,1 tells about his journey through Inferno, Purgatory and Paradise, meeting famous and symbolic personalities along the way. After 700 years, are there similarities between the Divine Comedy and our times?

The COVID-19 pandemic has dragged the whole world's population down into the Circles of Hell. At the end of his journey, Dante “came forth to see again the stars” whereas we are still stumbling about “in a gloomy wood“. All are living a suspended life, marked by anxiety and anguish, experiencing personal and collective human and professional dramas. This is especially so for us health professionals who are fully aware of the situation, or supposed to be, and have the duty to maintain the “path which leads aright”.

Like Dante, the healthcare world is still on its own journey of knowledge through the painful and difficult events and ethical dilemmas caused by COVID-19. What happened worldwide in 2020 and still is happening is a real “health hurricane” that has put overwhelming pressure on the health system with an intense ongoing healthcare demand. The huge need for hospitalizations has led to a real assault on hospitals, the only places in such a crisis that can provide care.

Patients plummet down through the hell circles of COVID-19 in a long trail that begins with initial symptoms, then the discovery of virus positivity, then serious illness, hospitalization and isolation, and the need for acute medical treatment2 including invasive or non-invasive support.3 And finally, if and when they survive, there is a long process to recover mobility, lung function and the capacity to swallow, health status.

One of the most despicable sins in the COVID era has been the scorn – or, even worse, the hatred – poured out against Science. In the darkest night, as a retort to the Negationists, Reductionists, No Vax and/or No Mask people, why don't we quote to them Ulysses’ words: “Bethink you of the seed whence ye have sprung; for ye were not created to lead the life of stupid animals, but manliness and knowledge to pursue“? In contrast to the pursuers of knowledge, the above COVID-19 sinners are all well represented in Dante's Inferno by figures like the heretic Farinata degli Uberti, the “workers of magic” and the “sowers of discord “.

Even more dismaying, what about the so-called “No Vax doctors“? They are represented in Dante's Inferno too, e.g. by Boniface VIII, a pope in hell who was supposed to fight for the truth and instead…, or by Count Ugolino, a traitor to his country (Science). Not to leave out the politicians (followers, not leaders) who, like Celestinus V, for a fistful of votes “through cowardice the great Refusal made“, promoting, consenting to, or not sufficiently curbing inappropriate behaviors like mass shopping or the street cocktail crowding of people like the “injurious guilty-of-gluttony Ciacco“.

Like Dante we, the health professionals, have been compelled to descend, with our personal protective equipment,4 down through the hell circles of material and moral bewilderment in the awareness of our fragility and often impotence to fight against the ferocious claws of this new Lucifer. However, we are not alone in our fight. We have a Virgil, a “teacher and authority”: Science with its principles and evidence. With the support of Science, we may hope to rise up and meet Beatrix, a “teacher of truth”. To achieve this target, the vast majority of the medical and scientific community is giving of its best and paying a high cost in terms of lost lives of doctors, nurses and other professionals, making great organizational efforts and investing increasing energy into research.5–7 Speaking of Pulmonology alone, last year we received almost 200 papers on COVID-19.

The Divine Comedy is Dante's first-person recall of an unbelievable journey. Virgil and Beatrix (to us: an allegory of Science and Health Care) have the ability to hear Dante's thoughts and they often answer his deep, unspoken questions. Dante's journey winds its way through Purgatory and Hell to “pool” his story with that of other humans. We also need to communicate, to share and reflect on what happened and still is happening.

What did Dante Alighieri learn after his journey? He rose up reborn and purified. And what will we learn from our present journey? That we need to make a fresh start, we need to “reason” our approach to healthcare to decide new priorities and care paths to follow once everything has “calmed down”. A reflection on these dramatic times would enable us to avoid future mistakes by organizing new healthcare paths: this is a slow, tiring and methodical process requiring observation, data collection, measurement, description, analysis and evaluation. The call to the entire scientific community is to contribute with experience and ability in order to overcome this difficult moment. The challenge is, first, to completely rethink the different health systems, considering a wide range of flexibility and the strong need to develop new models of hospital organization, home care and telemedicine.8 Secondly, to develop a specific “Recovery Plan” for health services, strong enough to cope with the devastating impact that the COVID-19 pandemic will have on human and economic resources.9,10

Funding information

This work was supported by the “Ricerca Corrente” funding scheme of the Italian Ministry of Health.

References
[1]
Alighieri D. The Divine Comedy. English translation by Courtney Landon. https://oll.libertyfund.org/title/langdon-the-divine-comedy-vol-1-inferno-english-trans. Accessed April 5th, 2021.
[2]
A. Cortegiani, M. Ippolito, M. Greco, V. Granone, A. Protti, C. Gregoretti, et al.
Rationale and evidence on the use of tocilizumab in COVID-19: a systematic review.
Pulmonology, 27 (2021), pp. 52-66
[3]
J.C. Winck, N. Ambrosino.
COVID-19 pandemic and non invasive respiratory management: Every Goliath needs a David. An evidence based evaluation of problems.
Pulmonology, 26 (2020), pp. 213-220
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M. Ippolito, F. Vitale, G. Accurso, P. Iozzo, C. Gregoretti, A. Giarratano, A. Cortegiani.
Medical masks and respirators for the protection of healthcare workers from SARS-CoV-2 and other viruses.
Pulmonology, 26 (2020), pp. 204-212
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M.N. Boschiero, T.A. Carvalho, F.A.L. Marson.
Retraction in the era of COVID-19 and its influence on evidence-based medicine: is science in jeopardy?.
Pulmonology, 27 (2021), pp. 97-106
[6]
T.A. Carvalho, T.M. Lima, V.F. Melani, M.F. Mendes, L.R. Pereira, F.A.L. Marson.
The scientific production during 2009 swine flu pandemic and 2019/2020 COVID-19 pandemic.
Pulmonology, 26 (2020), pp. 340-345
[7]
F. Guimarães, J.C. Winck.
COVID-19: Once upon a time in Portugal: a brief atlas of ongoing pandemic Portuguese research.
Pulmonology, 26 (2020), pp. 257-258
[8]
N. Ambrosino, M. Vitacca, M. Dreher, V. Isetta, J.M. Montserrat, T. Tonia, et al.
Tele-monitoring of ventilator-dependent patients: a European Respiratory Society Statement.
Eur Respir J, 48 (2016), pp. 648-663
[9]
S. Mazzoleni, G. Turchetti, N. Ambrosino.
The COVID-19 outbreak: from "black swan" to global challenges and opportunities.
Pulmonology, 26 (2020), pp. 117-118
[10]
S. Harari, M. Vitacca.
COVID-19 spread: the Italian case.
Respir Med Res, 78 (2020),
Copyright © 2021. Sociedade Portuguesa de Pneumologia
Pulmonology

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