COVID-19 Pandemic in Bergamo outbreak: a call to war. Implementation of a “COVID-Hospital” model in ASST Bergamo-Est Trust as a disaster-response strategy.

Abstract

Background: COVID-19 is a strikingly emerging disease caused by a new coronavirus (SARS-CoV-2) that has rapidly spread across all continents and affecting virtually every country. From a clinical, epidemiological, political and financial perspective, COVID-19 pandemic is now recognized as one of the worst disasters in modern era. In the North of Italy, Bergamo has been the European equal to Chinese City of Wuhan in terms of epidemiological impact of COVID-19. The first case of SARS-Cov-2 infection in Bergamo has been reported in Alzano District General Hospital (DGH), part of ASST Bergamo-Est Multi Hospitals Network. ASST Bergamo-Est comprises four Hospitals serving more than 50% of Bergamo Province and with a patient catchment of 387000 inhabitants. Methods: We retrospectively analyze the challenges and actual impact of the SARS-CoV-2 pandemic on the hospital capacity and performance. Accordingly, we report the specific operational procedures and clinical governance implementation related to the transformation of our Institutions into “COVID-hospitals”. Results: From 1st of March to 20th of April, 4919 consecutive patients were assessed in ASST Bergamo-Est Hospitals as “COVID-Hospital” referral centre, of these 1412 patients were admitted with diagnosis of moderate to severe COVID-19 respiratory insufficiency. Most of patients were high-risk individuals with a median age of 69 years. In-hospital mortality rate was 33.1%. Specific performance improvements under the “COVID-19 Hospital model” capacity-expansion strategy were analysed. Conclusions: This paper informs on the experience of ASST Bergamo-Est Trust and the disaster-response strategy during the COVID-19 pandemic. The ASST Bergamo-Est data reported corroborates the recent call for action to Governments for promoting MCI improved management with focus on COVID-19 pandemic and its possible recurrence.

Patterns in the Pandemic: Disproportionate Patient Burdens Among Regional Hospitals

“… 6 This relationship has been studied in a variety of infectious diseases, including in H1N1, where 1% increases in acute respiratory infection admissions were associated with 0.25% increases in nonacute respiratory infection mortality, 4 and in COVID-19, where increased COVID-19 admissions are associated with unnecessarily high mortality rates. 27 …”

Application of Health-Care Networking in COVID-19: A Brief Report

“…Hospitals in urban Italy have been challenged by sudden surge of patients similar to Level 5 and 6 Mass Casualty Incidents (MCIs) and requiring state-wide resources aid as per definition (> 1000 patients). 2 Healthcare networking and liaison are essential component in disaster management and public health emergencies, especially in natural disasters, mass casualties, large scale industrial accidents and disease outbreaks. In general, aims of networking are to provide logistical support between hospitals, provide financial support through local or regional governmental & nongovernmental agencies for response, to provide a manpower & mechanism for coordination and to implement policies, procedures and technologies in the event of such crisis.…”

“…Likewise, hospital staff including the surgical teams were re-allocated to run the clinical operations. 2 The Emergency Medical Relief (EMR) division of Ministry of Health & Family Welfare (MOHFW), Directorate General of Health Services, Govt of India issued a Guidance document on appropriate management of suspected/confirmed cases of COVID-19 in April 2020 and assigned that for severe COVID 19 cases; Dedicated COVID Hospital (DCH) can be set up using the entire hospital or a separate block in a hospital. These facilities were designated as referral centres for COVID Care Centres and Dedicated COVID Health Care Centres which were treating mild and moderate patients.…”