Rapid response to crisis: Health system lessons from the active period of COVID-19

Abstract

Highlights COVID-19 has become the epitome of complex health problems where evidence-based medicine should be completed with other scientific approaches to facilitate informed planning. Rapid response prioritisation should incorporate systems thinking and healthcare ecosystem approaches as well as new methods to collect expert knowledge using new technologies. Digital conferencing has proven feasible and usable to get a quick and transparent appraisal of the evolution of the active period of COVID-19 worldwide. The current international typology for staging pandemics could be adapted to three phases: preparatory, active (including initiation, acceleration and deceleration) and recovery. This facilitates international comparisons in complex areas such as mental health. The severity of the outbreak, the containment measures and the societal response varied greatly across sites and countries. Using a “glocal” approach for understanding this variation is vital to assess the impact of COVID-19 in health care.

The impact of Covid-19 pandemic on community-oriented mental health services: The experience of Friuli Venezia Giulia region, Italy

“…Major challenges included the initial provision of PPEs for professionals and users as well as a rapid technological predisposition for a broader use of remote devices. These issues were similar for the general healthcare sector, especially in countries which experienced an explosive acceleration of the pandemic, such as Italy [ 2 , 13 , 14 ], although research from Catalonia (Spain), which has been facing a situation similar to Italy, showed an exponential increase in teleconsultations from the March 2020 [33] . In spite of these challenges, regional MHDs complied quickly with the operative recommendations, and monitoring indicators were mostly achieved after one month from their delivery.…”

“…In FVG, however, psychiatric patients, even with severe conditions, had the possibility of being discharged discharged from hospital and being hosted in outpatient services. This could have led to choose CMHCs for managing patients with psychopathological difficulties, and decrease pressure on hospitals, more engaged in crisis response [ 2 , 5 ].…”

“…Although in FVG almost 40% of suspected cases were in GHPUs, none was found positive to infection. This may have to do with a different regional epidemiological situation compared to Lombardy, but is likely also linked to FVG's different MHD organisation, where a strong community system allowed a more rapid response to pandemic emergency [ 2 , 5 ] and permitted the identification of positive cases prior to hospitalisation, for example during home visits. This consequently might have had a role in preventing the spread of infection inside mental health services.…”

“…The FVG Regional Social and Health Information System (SISSR) was used to retrieve data on all subjects registered as patients of the regional MHDs from the 1st of January 2020 to the 30th of April 2020 (pandemic period) and from the 1st of January 2019 to the 30th of April 2019 (control period). The pandemic period involved the recognition, initiation and the subsequent acceleration interval of the initial wave of Covid-19 [2] . SISSR is an administrative database wherein a unique anonymous identifier is provided for each individual resident in the Region.…”

“…The first patient in Italy was found positive the 29 th of January 2020, although the pandemic had been probably spreading months before. Nonetheless, from February the incidence of contagion dramatically increased, with 1000 deaths reported by the 28 th of March [2] .…”