“You Do Everything You Can To Try And Stay Safe”: Q&A On Filming On the Front Lines of COVID-19
FRONTLINE producer Sasha Joelle Achilli films at a hospital that's treating an influx of COVID-19 patients in hard-hit Cremona, Italy. (Arianna Pagani)
Just days before the coronavirus outbreak was declared a global pandemic, Italy imposed one of the first lockdowns outside of China to combat the spread of COVID-19. Sasha Joelle Achilli, an award-winning filmmaker who had experience making documentaries about infectious diseases, was keeping a close eye on the country where she was born and raised.
Achilli landed in Italy on March 18, just as the country was turning into one of the early hotspots of the pandemic. For the next few weeks, she would work to document the harrowing and intense moments at the front lines of the battle against COVID-19 inside a hospital in northern Italy. The gripping footage Achilli captured for Inside Italy’s COVID War follows an ER doctor and her team as they treat rooms and hallways full of people infected by the virus, grapple with difficult decisions of how to save people as beds run out, and cope with the fear of falling sick themselves.
“What I wanted to do was tell the story, from the beginning, of the psychological impact this was having on the healthcare workers and on the psyche of the Italian people in general,” Achilli told FRONTLINE.
She spoke to FRONTLINE about the challenges of safely filming a documentary about an infectious disease, getting to know the doctors and nurses leading the fight, and how her experience making a film about Ebola helped prepare her for COVID-19.
Can you walk me through how this documentary went from a kernel of an idea to you getting on a plane to Italy to start filming?
It was a Tuesday morning and I’d sent [FRONTLINE Senior Producer] Dan Edge a message, because he and I had made a film in West Africa about the Ebola outbreak in 2014. I sent him a random message being like, “It’s so weird to see things that we had seen in Sierra Leone and Liberia and Guinea play out in Italy.”
I’m Italian, so my whole family lives in Italy. And my dad lives in Milan. He has a gym, and he had to close his gym in mid [February]. So he was one of the first businesses that needed to shut down. And then the whole country kind of went into lockdown. My sister lives in the countryside in central Italy. She’s a farmer. And all of a sudden, she wasn’t selling her produce to restaurants because they all shut down. I was talking to them a lot and it was affecting me a lot to hear what was happening in Italy. And so I said that to Dan: “It’s so strange to hear stories from my family. It’s just surreal.” And then … that afternoon he sent me a message being like, “Do you fancy making a film?” …
So then the next day I started thinking and I was like, “If we can get access to a hospital … we could tell a really good story.”
Those days, [Dr.] Francesca [Mangiatordi]’s photo, the one of the nurse completely exhausted, went viral. I looked her up, I wrote to her on Facebook. And then within a few hours, I was on the phone with her. And then she was like, “My doors are open. Come.”
And so within five days I was out there. How I got out there was unbelievable, it was surreal. Because to get to Milan it’s like an hour and a half on a plane. To get to Rome, it’s two hours and 20 minutes direct from London. To get to Cremona, which is in Lombardy, you’d think you travel to Milan.
All the airports were shut. Europe was shutting down. The only flights we could find were flights through Germany to Rome. So I had to get on three different planes to get to Rome, to then get a train from Rome to go back up north. So it took me like two days to get there. …
What was it like to meet Dr. Francesca Mangiatordi and her team? Did it take a lot to convince them to film inside their hospital?
So Francesca, obviously, already on the phone was really open. I asked her to send me a video diary before I got there, which is the first video diary in the whole film. When she sent me that video diary, I sent it to Dan and I was like, “She’s incredible. She’s unbelievable.”
I went there and right away, she was very warm and welcoming. Because I was following her, and her colleagues, the nurses and the doctors, they really respect her, she kind of vouched for us. There were a couple of people who were like, “I don’t want to be filmed. I don’t like these things.” But I would say out of the whole hospital, there were three people who reacted like that. Everybody was super open, really warm. I guess they really wanted to document what they were going through. I think for them, it’s kind of like a catharsis.
I remember one night just chatting in the hallway with two of the nurses and they just started talking to me about what had happened in “the early days.” I got there two weeks into the crisis and already “the early days” seemed like a memory that was quite different. I could tell they just wanted to tell someone, “This is what we had to do. This what we had to go through.” …
They now say to me, “We feel like you lived it with us now. So you’re one of us.” That’s how they say it, which is nice. I mean, I’m not saving lives, but I think they felt like I was part of it with them, and in the trenches with them. I remember when I did the first 12-hour night shift. They were totally shocked about the fact that I kept staying and I wasn’t going home, that I was going to do the whole 12-hour shift. “How long have you been here? The whole time? How long are you staying?” I was like, “I want to experience what you guys experienced.” I think that that got me quite a bit of respect.
What kinds of safety precautions did you have to take while filming around patients who might be infected with COVID-19?
Most of the masks and gloves and stuff we brought ourselves. And then we were given from the hospital, which is super generous, the same PPE that the doctors and nurses were wearing. So we wore that and then in a shift in the hospital, you change your gloves continuously, change your mask. And then at the end of the shift, we would disinfect all of the gear, which probably wasn’t very good for the equipment.
I was using a zoom lens. I was in the place, and it’s everywhere, right? And all you can do is do the best you can.
I think doing Ebola really helped me prepare, because I was in West Africa for five months continuously. And I got used to not touching my face. I got used to that barrier, you just never lift your hands above your waist essentially. It was the constant washing of hands and just being really cautious. So I kind of automatically went back into that mode.
Was it difficult filming while being fully suited up and masked? I would imagine it’s difficult trying to form a connection with the people you are filming when you’re obscured like that.
Yeah. Same for the doctors, right, connecting with the patient, and even with each other. This isn’t in the film, but because half of [Dr. Mandiatordi’s] staff, her colleagues were sick, they had volunteers come from different parts of Italy. Every day she’d show up and there’d be someone she didn’t know. And even people she knew she’d be like, “Who are you?” And then she’d be like, “You’re so and so,” because she could recognize the eyes. But it took a while for them to recognize each other through just their eyes.
It was physically intense, because it’s just very hot. It’s plastic, right? But the most depressing aspect of it is the mask. When you’re wearing your mask for that long, it’s just very suffocating. You’re breathing your own air which isn’t nice, actually. And it hurts. My nose and my cheeks are completely marked. Some of the doctors, they have scabs here.
And it becomes really oppressive. You get used to it, but I remember those first couple of days and especially the night shift. I did that first night shift, it was pretty suffocating.
You’ve worked on documentaries about highly infectious diseases before, including a film for FRONTLINE about the worst Ebola outbreak in history. What knowledge and tools were you bringing to this pandemic? What was different?
During the Ebola outbreak, I didn’t touch anyone for five months. And I remember when I came back, and I landed at Heathrow and I saw people touching it was the weirdest feeling.
Despite making films in other parts of the world where things go wrong, and there are disastrous situations like outbreaks, like conflicts, like honor killings — you feel affected by it, but it’s not your home country. It doesn’t feel as personal. It always feels further away, despite the fact that Ebola showed us that the world is connected and we need to pay more attention to what’s happening far away.
When China broke out with COVID, in the early days, I bet you 90 percent of people thought, “Oh, it’s over there. It’s never going to reach us.” And that was the attitude. So we have to pay more attention. But it didn’t emotionally prepare me. I was more emotionally fragile going into Italy than I’d been going anywhere I’ve ever been. …
You were also able to film at the homes of some of the doctors, like Dr. Mangiatordi. Why did you feel that was an important part of this story to show? And did that pose any additional challenges to filming?
I, from the outset, thought there wouldn’t be a film if I wasn’t going to be able to at least film Francesca outside of her work environment. What I wanted to do was tell the story, from the beginning, of the psychological impact this was having on the healthcare workers and on the psyche of the Italian people in general. So I wanted to try and tell the story of Italy through the microcosm of Cremona and that hospital and the people I was meeting, as a kind of metaphor for everybody else, and now the rest of the world, because I’m sure her story is one of so many that are probably really similar.
So I knew that I needed to do that. And Francesca opened her door to me right away, no questions. She’d even offered for me to stay with her. In order to keep safe, we took all the precautions possible. Obviously, she’s a doctor, so she had her judgments and she risked bringing me into her home as well. She didn’t know me, or where I came from. And then when I started living her life with her, it was as if we were this unit.
But you do everything you can to try and stay safe. … I haven’t hugged Francesca. It’s the weirdest thing, especially as an Italian, to not go in and hug and give a kiss.