Tuesday, 14 April 2020

Information about the COVID-19 pandemic in northern Italy: the experience of the A&E in Alessandria, Piedmont.

T.Bolgeo1  M-Bertolotti2 M.Betti3  A.Roveta4 A.Maconi5

1. Head of the Research Unit of the Health Professions RN, MSc, PhD ( stud) Infrastructure Research, Training and Innovation Hospital A.O. SS Antonio and Biagio Alessandria, Italy, EU.
2. Epidemiology biologist Clinical Trial Centre Infrastructure Research, Training and Innovation A.O. SS Antonio and Biagio Alessandria – Italy, EU.
3. PhD Clinical Study Coordinator Clinical Trial Centre Infrastructure Research, Training and Innovation AO SS. Antonio and Biagio Alessandria – Italy, EU.
4. Biologist Infrastructure Research, Training and Innovation A.O. SS Antonio and Biagio of Alessandria – Italy, EU.
5. Responsible manager Infrastructure Research, Training and Innovation A.O. SS Antonio and Biagio of Alessandria – Italy, EU.

On 22 February, the first COVID-19 case was diagnosed in Piedmont. The total number of deaths involving COVID-19 in Piedmont as of 7 April 2020 was 1417 (267 Alessandria; 72 Asti, 96 Biella, 100 Cuneo, 145 Novara, 572 Turin, 73 Vercelli, 68 Verbano-Cusio-Ossola, 24 resident from other regions but died in Piedmont).

COVID-19 recovery trend in Piedmont: in recovery 834, recovered 732. There are currently 423 patients in intensive care. The number of diagnostic swabs performed so far are 51,311 of which 28,236 gave negative results. The Italian crude mortality average is 4 per 10,000. In Piedmont it is lower (3 per 10,000).

On 27 February 2020, the Ministry of Health issued a document prepared by the Superior Council of Health which gave guidance on the criteria for subjecting people to examination for the SARS-CoV-2 infection (Shah & Farrow, 2020). The document indicated the use of swaps only for symptomatic cases, stating that the test in the absence of symptoms does not appear to be supported by scientific rationality, and does not provide indicative information for clinical purposes, indeed it can be misleading. According to the Superior Council of Health, the literature data reports a share of false negatives in the first phase of the disease in excess of 15%.

Since the beginning of the epidemic, public health measures put in place to contain infection (suspected patient isolation, contact tracing) have been instigated on ‘suspicion of infection’, before testing and the availability of the results to prevent the timing of diagnostic analysis and false results from impacting on the spread of the infection data.

The Hospital Company "SS. Antonio and Biagio and Cesare Arrigo" of Alessandria, part of the Health System of the Piedmont Region, has been recognized as a reference Hub Hospital, home to the II level DEA, within the hospital network related to the South East Piedmont Area that includes the provinces of Asti and Alessandria, with a reference population of about 650,000 inhabitants.

Alessandria hospital works in close contact with the Piedmont Region Crisis Unit, to promptly reorganise the users services and rapidly adapt them to the evolving situation. A COVID-19 emergency management business crisis unit has been set up to meet twice a day to take operational decisions that are important to contain and manage the COVID-19 emergency in both the short and long term.(Remuzzi & Remuzzi, 2020)

Reception places have been created for suspected COVID-19 cases where triage is carried out. Inpatient wards have been redefined into COVID-19 and non COVID-19 wards. All scheduled non-urgent outpatient services have been suspended. For non-deferable visits, patients are pre-triaged in front of each clinic. Pre-triage involves a short interview and in cases of cough, cold or fever the patient is handed a surgical mask.

Oncology and haematological therapies, including clinics, remained active. These include: Blood and biopsy testing at the Gardella Testing Point, TAO testing, Post-surgical medications, Check-ups and post-discharge evaluation, Scheduled visits and check-ups for pregnant women, Dialysis, Direct distribution of drugs in hospitals and dedicated clinics. Blood donations; Visits for expiring driving licence renewal and visits and administration of drugs for various disciplines.

In addition, on the recommendation of the DPCM of 8 March 2020, patient carers are prohibited from staying in the waiting rooms of emergency departments (DEA/A&E). Only one person per patient is permitted to visit at a time - who does not have respiratory symptoms (cold, cough, etc.) or fever. Before entering the room, they are asked to use the gel placed at the entrance of the inpatient rooms. Visitors are advised to avoid contact with potentially contaminated surfaces and furnishings (furniture, handles, bed straps, etc.).

Following the guidance provided by the Crisis Unit, the Directorate General regulates the way relatives, visitors and carers enter as follows:

· Two check points managed by the nursing service have been set up, where body temperature is detected for both employees and visitors and patients and antiseptic hand gel is provided.

· In order to cope with the emergency, doctors (11), nurses (30), other professional operators (32).

· Emergency facilities have been implemented and training courses have been activated for their proper use (Figure 1).

· The Psychology professionals of Alessandria Hospital have activated a psychological emergency service for citizens and health professionals subjected to extraordinary stress due to coronavirus and its consequences on the individual and on relations with the community.

· In addition, within Alessandria Hospital we operate an Innovation Training Research Infrastructure (IRFI) that promotes, organises and coordinates the research and training activities of operators, according to the models highlighted by publications.

· The IRFI consists of the following areas: Clinical Trial Centre - Grant Office, Documentation Centre - Biomedical Library, Communication and Scientific Disclosure, Administrative Coordination, Training, UVT-HTA Units, Research Unit for Health Professions.

· Each sector works with professionals on a daily basis to manage the COVID-19 emergency in collaboration with the crisis unit.

· Hospitals have been identified for COVID patients and other hospitals that accept patients discharged from other centres, but not yet fully recovered.

Figure 1



https://www.coronavirus.gov .

Remuzzi, A., & Remuzzi, G. (2020). COVID-19 and Italy: what next? Lancet, 395(10231), 1225-1228. doi: 10.1016/s0140-6736(20)30627-9

Shah, S. G. S., & Farrow, A. (2020). A commentary on "World Health Organization declares global emergency: A review of the 2019 novel Coronavirus (COVID-19)". Int J Surg, 76, 128-129. doi: 10.1016/j.ijsu.2020.03.001

National Institute for the Infectious Diseases “L. Spallanzani”, IRCCS. Recommendations for COVID-19 clinical management

Emanuele Nicastri, Nicola Petrosillo, Tommaso Ascoli Bartoli, Luciana Lepore, Annalisa Mondi, Fabrizio Palmieri, Gianpiero D'Offizi, Luisa Marchioni, Silvia Murachelli, Giuseppe Ippolito, Andrea Antinori, for the INMI COVID-19 Treatment Group (ICOTREG) Infect Dis Rep. 2020 Feb 25; 12(1): 8543. Published online 2020 Mar 16. doi: 10.4081/idr. 2020.8543

Rapid response to COVID-19 outbreak in Northern Italy: how to convert a classic infectious disease ward into a COVID-19 response centre E. Asperges, S. Novati, A. Muzzi, S. Biscarini, M. Sciarra, M. Lupi, M. Sambo, I. Gallazzi, M. Peverini, P. Lago, F. Mojoli, S. Perlini, R. Bruno, COVID-19 IRCCS San Matteo Pavia Task Force J Hosp Infect. 2020 Mar 20 doi: 10.1016/j.jhin. 2020.03.020 [Epub ahead of print]

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