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Helping Hearts: New ECGs Prove Critical As Italian Red Cross Battles COVID

Monica Simeone can still hear the sirens, their mournful wail winding through suddenly deserted, “deathly silent” piazzas. The director of the Milanese branch of the Italian Red Cross, or Croce Rossa as it’s known locally, recalled Italy’s sense of dread as the first COVID-19 case was confirmed on Friday, February 21, 2020, in the town of Codogno.

“Just two to three hours later, we entered a new, pure emergency phase, which lasted for many months,” she says. “It was a tough year, certainly from a personal point of view for each of us, but for us as an organization, this was a year of great effort – of resilience during moments of tremendous operational stress.”

The world’s gaze quickly shifted from Wuhan, China, to the Lombardy region of Northern Italy. Milan, Italy’s economic powerhouse, known for its buzzing fashion, design and finance sectors – came to a standstill as coronavirus cases clustered in the north. Medical crews struggled to meet the needs of the increasing number of COVID-19 patients. Thousands of people lost their jobs, including many in the underground economy who were ineligible for unemployment benefits.[1] The Red Cross, a global network of humanitarian organizations that provides disaster relief, delivered groceries, medicine and supplies to isolated individuals, the elderly and families in need, in addition to caring for patients with the telltale cough. The Milanese branch provided extra support to other, smaller local branches, such as the one in Bergamo, another Lombard city under strain.

"For a time, there was really a sense of this being the end, a sense of death. But in the midst of all this madness, fear and sadness, there were so many instances of great solidarity.”

Protective gear notwithstanding, “We were very afraid that our first responders would get sick,” she adds, especially given how little was initially known about transmission of the coronavirus. “For a time, there was really a sense of this being the end, a sense of death. But in the midst of all this madness, fear and sadness, there were so many instances of great solidarity,” she adds, describing the many calls the Red Cross received from would-be volunteers, and how children would throw open apartment windows to clap for the passing vehicles. It wasn’t all COVID-19 either: Milanese Red Cross workers successfully delivered two babies inside ambulances at the height of the pandemic.

Given the Red Cross’ long-standing commitment to crisis care and engagement in pandemic relief, GE Healthcare donated two electrocardiographs, or ECGs, to the Milanese branch in January 2021, says Gianluca Liprino, business leader of GE Healthcare Italy’s Lifecare Solutions. Though many workplaces shut down during the crisis, GE was able to work closely with its international factories in Europe, the U.S., India and China to produce the devices rapidly and send them to Italy. Right now, one of the machines is at the Red Cross’ principal Milan clinic, and the other is in rotation. Simeone hopes that when the pandemic subsides, one can be used for preventive screening events open to the public.

Though people more closely associate ventilators than ECGs with pandemic emergency care, Liprino says, “During the first wave, doctors were treating patients as best they could, trying different approaches. And one of the most significant causes of death was the presence of comorbidities, that is, of preexisting conditions, including heart conditions, in patients alongside pulmonary problems.” Moreover, scientists are now studying whether COVID-19 can cause myocarditis, an inflammation of the heart.[2]

“At some point, the use of hydroxychloroquine became very popular as a treatment, and that has a well-known effect on the ECG curve.[3] If it deviates by a certain percentage with a certain consistency, this can lead to cardiac problems,” Liprino continues. “And, of course, the heart is the most important for a patient’s immediate survival. It’s a very sensitive organ, and so being able to monitor it is crucial to recognize potential deviations from standard ECG patterns in time to treat patients.”

By way of analogy, Liprino described the heart as a pump and its muscular fibers as a motor. ECGs help evaluate the functioning of that motor by charting out its electric signals. “We do this by placing electrodes on the patient’s chest and arms and watching how the electric signals are distributed throughout the body. From this we can understand if the heart is working properly,” he says. “These days, an ECG can detect very particular anomalies and heart conditions.”

“If diagnoses depend on the mapping out of electric signals, then having the most precise graphing improves our ability to analyze and provide correct diagnoses.”

ECG technology has evolved substantially over the years, and GE has invested heavily in improving the quality of the devices’ graphing capabilities. “If diagnoses depend on the mapping out of electric signals, then having the most precise graphing improves our ability to analyze and provide correct diagnoses,” Liprino says. “In addition, GE has been using algorithms for some time now, which allow for the automatic detection of certain heart conditions. We’ve grouped these conditions according to their deviation ranges on an ECG to help doctors in their diagnoses.”

The next generation of algorithms for ECGs will incorporate artificial intelligence to analyze data, he added, allowing doctors to forecast how many patients within a given population are likely to need care for a heart attack within a specific time frame.

The Red Cross provides a range of social services. It receives regular visits from elderly patients who have come to know staffers and rely on them for preventive care, as well as from homeless people and immigrants who are fearful of approaching state-run entities. The organization aims to ensure medical assistance is available to all who need it, but providing quality care requires having the right equipment. The Red Cross had an out-of-date ECG model, Simeone says, noting that the new machines from GE Healthcare “allow us to guarantee a certain level of care.”

“The Croce Rossa is a big family,” Simeone says of the organization. “It’s like a mother with many children. One speaks Neapolitan, another Roman, another the Milanese dialect, but we’re all under the same flag.”  Italy and the world, she says, need to stay strong and look to the future.

“Early on we received a series of donations of masks and other gear, including from China,” she adds. A sticker on one of the boxes with a quote from the final canto of Dante’s Inferno caught her attention. “It said, ‘e quindi uscimmo a riveder le stelle.’ ”

In other words: “Thence we came forth to rebehold the stars.”[4]



[1] The Financial Times, ‘Pasta and Beans’- Italy’s Shadow Workers Are Out of the Safety Net – https://www.ft.com/content/08847c08-9582-4c48-9d2d-319f8593da19

[2]  American College of Cardiology, COVID-19 as a Possible Cause of Myocarditis and Pericarditis – https://www.acc.org/latest-in-cardiology/articles/2021/02/05/19/37/covid-19-as-a-possible-cause-of-myocarditis-and-pericarditis

[3] U.S. Food and Drug Administration, FDA Cautions Against Use of Hydroxychloroquine or Chloroquine for COVID-19 Outside of the Hospital Setting or a Clinical Trial Due to Risk of Heart Rhythm Problems –

 https://www.fda.gov/drugs/drug-safety-and-availability/fda-cautions-against-use-hydroxychloroquine-or-chloroquine-covid-19-outside-hospital-setting-or

[4] Poets.org, Inferno, Canto XXXIV, Translation by Henry Wadsworth Longfellow –https://poets.org/poem/inferno-canto-xxxiv