Italian doctors call on world to change perspective on care

Doctors at the epicentre of the COVID-19 outbreak in Italy have made an urgent call on the rest of the world to change the way they treat pandemic patients. In a paper published in NEJM Catalyst (21 March 2020) they say patient-centred care is no longer feasible in a pandemic and that ‘community-centred’ care should be the new norm.
They say that hospitals might be the main COVID-19 carriers as they are rapidly filled with infected patients.
“This disaster could be averted only by massive deployment of outreach services,” they emphasize.
The doctors (Nacoti M, et al – At the Epicenter of the Covid-19 Pandemic and Humanitarian Crises in Italy: Changing Perspectives on Preparation and Mitigation) who work at Papa Giovanni XXIII Hospital in Bergamo, a brand-new state-of-the-art facility with 48 intensive-care beds, say: “Our own hospital is highly contaminated, and we are far beyond the tipping point: 300 beds out of 900 are occupied by Covid-19 patients. Fully 70% of ICU beds in our hospital are reserved for critically ill Covid-19 patients with a reasonable chance to survive. The situation here is dismal as we operate well below our normal standard of care. Wait times for an intensive care bed are hours long. Older patients are not being resuscitated and die alone without appropriate palliative care, while the family is notified over the phone, often by a well-intentioned, exhausted, and emotionally depleted physician with no prior contact.
“But the situation in the surrounding area is even worse. Most hospitals are overcrowded, nearing collapse while medications, mechanical ventilators, oxygen, and personal protective equipment are not available. Patients lay on floor mattresses. The health care system struggles to deliver regular services — even pregnancy care and child delivery — while cemeteries are overwhelmed, which will create another public health problem.
They say pandemic solutions are required for the entire population, not only for hospitals.

  1. Home care and mobile clinics avoid unnecessary movements and release pressure from hospitals.
  2. Early oxygen therapy, pulse oximeters, and nutrition can be delivered to the homes of mildly ill and convalescent patients, setting up a broad surveillance system with adequate isolation and leveraging innovative telemedicine instruments.