Michael S. Saag, a world renowned AIDS and virus expert based at UAB, had some disturbing reports from Italy before he sounded the alarm Friday that Alabama was not prepared for what he believes will be a ‘major storm’ of coronavirus infections peaking here in about six to 10 weeks.

Saag has offered up a few of his correspondences that show the extraordinary stresses on Italy’s health care system, a system deemed to be one of the better ones in the world. The correspondences in detail describe a health system bursting at the seams, people dying without treatment in the hospital.

” My friends call me in tears because they see people dying in front of them and they can only offer oxygen,’’ an Italian health care worker says.

A key lesson for Alabama is to slow the rate of infections – because infections will come in a devastating wave. The goal is not to have one big spike in infections that forces providers to make decisions on sending, for example, an elderly patient home or turning them away because their survival rate is lower.

Jason van Schoor, an anesthesiologist at University College London, received the following message from a doctor friend in northern Italy, passed on to Saag.

“I feel the pressure to give you a quick personal update about what is happening in Italy, and also give some quick direct advice about what you should do. First, Lombardy is the most developed region in Italy and has extraordinarily good healthcare.

I have worked in Italy, UK and Austria, and don’t make the mistake to think that what is happening is happening in a 3rd world country.

“The current situation is difficult to imagine and numbers do not explain things at all. Our hospitals are overwhelmed by COVID-19, they are running 200% capacity.

We’ve stopped all routine, all ORs have been converted to ICUs and they are now diverting or not treating all other emergencies like trauma or strokes.

There are hundreds of patients with severe respiratory failure and many of them do not have access to anything above a reservoir mask. Patients above 65 or younger with comorbidities are not even assessed by ICU, I am not saying not tubed (intubated), I’m saying not assessed and no ICU staff attends when they arrest.

Staff are working as much as they can but they are starting to get sick and are emotionally overwhelmed. My friends call me in tears because they see people dying in front of them and they can only offer oxygen.

Orthopedists and pathologists are being given a leaflet and sent to see patients on vents. PLEASE STOP, READ THIS AGAIN AND THINK. We have seen the same pattern in different areas a week apart, and there is no reason that in a few weeks it won’t be the same everywhere, this is the pattern: A few positive cases, first mild measures, people are told to avoid crowds but still hang out in groups, everyone says not to panic.

Some moderate respiratory failures and a few severe ones that need tubes, but regular access to ED is significantly reduced so everything looks great. Tons of patients with moderate respiratory failure, that over time deteriorate to saturate ICUs first, then vents, then CPAP hoods, then even O2.

Staff gets sick so it gets difficult to cover for shifts, mortality spikes also from all other causes that can’t be treated properly. Everything about how to treat them is online but the only things that will make a difference are: do not be afraid of massively strict measures to keep people safe, If governments won’t do this at least keep your family safe, your loved ones with history of cancer or diabetes or any transplant will not be tubed if they need it even if they are young.

By safe I mean YOU do not attend them and YOU decide who does and YOU teach them how to. Another typical attitude is read and listen to people saying things like this and think “that’s bad dude” and then go out for dinner because you think you’ll be safe. We have seen it, you won’t be if you don’t take it seriously. I really hope it won’t be as bad as here but prepare.