Germ Warfare

Drawings by Suzanne Dunaway

One day late in 1969, in a back office of Creedmoor psychiatric hospital in Queens, I hiked up my skirt and pulled down my tights. My boss Dr. Gideon Seaman, knowing I would soon be taking off for eight months in Europe, had brought along a huge syringe of gamma globulin and shot that horse dose of protective antibodies into the front of my thigh as I stood in front of him. I fell back onto a chair, passed out from the pain.

What country was he protecting me against? Italy. Why? Because, he said, it’s crawling with hepatitis. The locals would pick up the “infectious” A variety from eating their beloved mussels and clams – they were harvested from polluted waters and cooked, if at all, too briefly to kill any lurking viruses. The “serum” B kind they picked up from mothers as mere tots, preparing them to pass it on as adults through needles and sex; any guy I might pick up would likely have been infected since he was four. (If medical science had known about the C kind of hepatitis at the time – it didn’t – it would have also known that too was big in Italy.)

Today the shoe is on the other foot. Americans are much likelier than Italians to die of infections, mostly because of poor access to health care – not to speak of Italy’s conversion to farmed rather than wild shellfish. Former sins have left their mark on Italy, though, in that several key vaccines reached here decades after they became standard in the States. More cases of measles and congenital German measles are reported in Italy than in any other Western European country, with the number skyrocketing between 2016 and 2017 thanks to a know-nothing “No Vax” movement. And things may get worse: the measles vaccination rate for Italian toddlers fell steadily between 2010 and 2016.

My world-hopping clients often need to attend public travel clinics, which have a monopoly on vaccines against yellow fever and Japanese encephalitis. For decades this was a piece of cake: I wrote a prescription and an address, the patient showed up at the clinic any weekday between 9 and 12, and walked out a half hour later ten dollars poorer, with wisps of cotton taped to their arms. It was a poster child for public medicine. Now the party’s over – in 2013 my beloved vaccinators simultaneously started requiring appointments and stopped answering the phone.

Let me close with the strange case of tetanus. There are 400,000 horses in Italy and they are often healthy carriers of tetanus spores, including the ones you see roving the streets of Rome or Florence with police on their backs. Many of these healthy-looking animals gaily deposit manure laced with tetanus spores on the pavement, manure that then patiently waits for a passer-by to get injured so the spores can enter the body, wake up, and multiply. Italians now over fifty weren’t vaccinated as children, nor were most immigrants, so plenty of the people who show up in Italian Emergency Rooms with contaminated wounds should by rights receive not just a tetanus booster but also a shot of antiserum – a type of immune globulin hyper-packed with tetanus antibodies.

But as far as I know that antiserum has never once been administered, in any Rome hospital, to a single patient of mine. Emergency Room physicians go to great lengths to avoid giving it. They’ll tell patients that antiserum is no good two days after the injury (nope – it works even after three weeks). They’ll branish consent forms that claim it can transmit AIDS (possible in theory but nonexistent in practice). They’ll say tetanus was eradicated long ago (would that it were). Why those docs put up so much resistance is a mystery but it may be merely that the hospitals don’t keep the perishable antiserum in stock. An Italian team that studied tetanus prophylaxis in Naples’s public hospitals just a few years ago concluded, “Only 1.5% of the physicians correctly adhere to guidelines.” The upshot? More than a third of the cases of tetanus in the European Union occur in Italy, with 60 fatalities a year. So be forewarned: odd though it may sound for an otherwise proudly developed nation, Italy is one of those countries where you’ll want to make sure your tetanus vaccinations are up to date.

(This post is being published simultaneously as a Bedside Manners column in The American In Italia.)

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Scorecard: Booze

United States          Italy

Drank any alcohol during the past year          67%                 84%

Drink alcohol almost every day                      6%                   50%

Liters of pure alcohol per person per year     8.82                 7.56

Alcohol abuse

            Men                                                    10.7%              1.3%

            Women                                                4.2%                0.8%

Binge drinking in past month                          16.9%              4.2%

Yearly deaths from alcohol per 100,000         2.91                 0.37

What’s Their Secret?

By tradition Italians consider wine and beer to be foods, not drugs, knocked back to enhance a meal rather than to get soused. When I was first getting invited to dinner in Italian homes, in 1970, the children would be served acquavino, water laced with a few drops of wine. I’m convinced this non-medical homeopathy innoculated them against later dipsomania. Those old habits have by and large held up nicely, but very recently some young Italians have started to imitate the tourists in their midst by converting to the northern European cult of Saturday night drunkenness. Let’s hope it’s just a fad.

As with many American phenomena that favor the all-or-nothing (think Tesla vs. SUV), the United States is overloaded with problem drinkers on the one hand and teetotalers on the other. I sip my way through two glasses of wine every evening with supper, more alcohol than 95% of American women.

Alcoholic beverages are sold in every Rome supermarket and at every corner store, at all hours. The exception is before a soccer match if the Rome or Lazio team is playing against an adversary with notoriously hard-drinking fans, such as Manchester United, in which case City Hall has been known to institute temporary bans in the attempt to keep hordes of drunken Englishmen from taking over the streets.

(Curiously, a horde of drunken Italians is something of a contradiction in terms. Liquored up Romans get cheerful and friendly, not raucous and rowdy. Turns out the way people act when they’ve been imbibing is due at least as much to cultural expectation as to the pharmacological effect of alcohol.)

You’re supposed to be 18 to buy, but this being Italy nobody at the checkout counter is checking IDs. When American “abroad” college students catch on, they tend to go off the deep end and can land in deep trouble – since I’ve lived here a half dozen are known to have fallen to their deaths out of windows, from bridges, or off walls, and that’s not counting the cases that have been hushed up.

A small glass of wine every day throughout pregnancy doesn’t cause fetal alcohol syndrome or anthing else, by the way, contrary to the prohibitionist terror campaign in the United States. Every adult Italian you see on the street was exposed to it and survived.

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Take Some Bling And Call Me In The Morning

Italians have never been much for Calvinist-type frugality. The Catholic hierarchy’s response to Luther’s 16^th century revolt was a Counter-Reformation construction boom which aimed to woo back the faithful by dazzling them with ever more lavish churches. Rome’s Gesù is a prime example, with its dazzling colored marbles, swooping angels, and mouth-watering lapis lazuli columns. Same thing for clothes. Where my generation of American girls were taught to underdress – “look in the mirror before you go out, and remove one piece of jewelry” – Italian ragazze would toss on an extra necklace.

Public hospitals in Rome are shabby and General Practitioner offices run to the bare-bone, but in one medical niche the glitz principle holds: the vast private system. A ghostly for-profit shadow hovers alongside the National Health Service, complete with its own doctors (including me), laboratories, and hospitals. A private casa di cura or clinica will have an atrium decked out in Ficus benjamina, oil paintings, and design furniture, and rooms with disposable slippers and a comfy sleep-on couch for your spouse. A Italian patient of mine, exposed to the private system for the first time, cast his eyes around and said in wonder, “My God, this hospital’s so clean.”

Once you get past the glitter, Rome cliniche usually offer a narrow range of medical services. One may concentrate on childbirth, another on cancer, a third on cardiac catheterization, none covering all the bases and most preferring elective rather than emergency procedures – think hotels with operating suites. Here and there you’ll find a small intensive care unit, but they never have a real Emergency Room. A couple claim to cover emergencies 24/7, but the one time a patient of mine tested that boast the hospital flunked: she showed up with an asthma attack, something anyone with a medical degree should be able to handle, and was sent home without being examined much less treated because they “didn’t have the right specialist.” As the locals say with ironic intent, Tanto siamo in Italia, What can you do, we’re in Italy.

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