COVID Towers: low and medium intensity care for non ICU patients
References
1. Amit Arya, Sandy Buchman, Bruno Gagnon, et al. Pandemic palliative care: beyond ventilators and saving lives. CMAJ 2020;10.1503/cmaj.200465.
2. Grasselli G, Pesenti A, Cecconi M. Critical Care Utilization for the COVID-19 Outbreak in Lombardy, Italy: Early Experience and Forecast During an Emergency Response. JAMA. 2020 Mar 13. doi: 10.1001/jama.2020.4031.
In their paper Arya and colleagues mention the ways in which Italy has dealt with the COVID-19 epidemic; the authors state that “many older patients with comorbidities being denied access to critical care resources”.(1) This assertion does not correspond to reality. Indeed, next to the great effort to increase ICUs for the most critical patients, often younger, many hospital beds have been converted to offer a low-medium intensity of care to the great majority of patients, even older and frail, and we can affirm that no one was denied a cure because of age and comorbidity.(2) In Lombardy, a region of northern Italy, the COVID-19 outbreak has been catastrophic. In four weeks, the virus has overcrowded all hospitals and most wards have had to be converted into COVID-19 wards. Brescia, a city east of Milan and the capital of a Province with 1.2 million inhabitants, has had 6300 cases of COVID-19 between Feb 22 and Mar 26 and, of these, 1000 died. About 53% (2265 out of 4200) of hospital beds have been converted to the treatment of patients with Covid-19 related pneumonia, mainly in acute medical units and in ICUs (8.5% of dedicated beds). In the face of this challenge we radically reorganized traditional hospital departments (actually in our hospitals we manage 430 beds for COVID-19 patients): involving in the care doctors of various specialties, defining clear and shared guidelines, organize training program, daily meeting with team members and constant psychological support. In this way we faced an emergency of absolutely unexpected proportions, maintaining a high level of care and avoiding burnout of staff, offering to all patients, regardless of age and economic level, the comfort of a hospital bed. It is our hope that our experience will be of help to other hospitalist colleagues.
References
1. Arya A et al. Pandemic palliative care... CMAJ;2020:doi:10.1503/cmaj.200465.
2. Grasselli G et al. Critical Care Utilization for the COVID-19 Outbreak in Lombardy, Italy... JAMA;2020:doi:10.1001/jama.2020.4031.