Is it really possible, on the basis of the little information available at the time, to ascertain whether there was inexperience, negligence or willful misconduct on the part of those responsible for deciding how to deal with the pandemic?
We are the only country where a judicial investigation has been launched into possible responsibilities in the management of the Covid-19 pandemic. It can certainly be useful to examine what worked and what could instead be done to reduce the dramatic cost of human lives that occurred first of all to avoid the same mistakes in the future. This is what happens, for example, after a plane crash by national bodies – in Italy we have the National Agency for Flight Safety – which examine the causes that led to it in order to prevent the recurrence of similar episodes in the future. In health care we do not have a similar body.
I wonder how the judiciary can ascertain whether, on the part of those responsible for deciding how to deal with the pandemic, there has been inexperience, negligence or willful misconduct. We know that an expert report was commissioned to shed light on what happened, a“logical map” per “quantify what could be the consequences of certain choices”.
I have not read the report and what I am about to express is the result of my reflections on the little information I have managed to gather. I imagine that the calculation of the victims that could have been avoided is based on estimates made with the numbers that occurred after the events took place. In other words, with data not available at the time the decisions were taken and with a wealth of knowledge resulting from experience that had not been gained at the time of the disputed facts: hindsight.
Returning to the example of the plane crash – I use this comparison because it is the sector in which the culture of safety is extremely high – the investigators examine the training of the pilots, the flight manuals and the information at their disposal to understand whether the choices they accomplished were or were not consistent with what they knew. To make this reconstruction, they use flight simulators that are set up with the same operating conditions (weather, equipment operation, etc.) and act according to what the pilots knew (training, controls, experience).
Unfortunately we don’t have a similar simulator in healthcare. Medicine is not an exact science but a practice that is based on knowledge and that proceeds in an empirical way; that’s why I’m puzzled by the decision to launch a criminal investigation into a tragedy that was being tackled with what little knowledge was available at the time.
In air accidents there are normally two investigations: that of the judiciary, aimed at establishing legal responsibilities and that of the aviation safety agency which identifies the causes and defines the corrective measures that must be adopted. The former is almost always based on the evidence of the latter.
I am therefore even more amazed to note that no health organization has done any reasoning on how to prevent or at least contain the damage of a pandemic in the future. In organizational terms, the reform of the DM77 relating to territorial assistance does not represent an appropriate response. It is a model born before Covid-19, aimed at creating local healthcare and focused on the management of chronicity and fragility, nothing to do with managing a lethal virus. Not even on the digital health front have ad hoc infrastructures been set up for the management of a pandemic. We continue to rely on the usual information flows of the NSIS except, if necessary, conceive new ones in a hurry. The new Electronic Health Record and the Health Data Ecosystem are, despite the proclamations, firm and will be really operational in several years.
Will we be able, leaving aside useless controversies, to start a path to seriously reflect on what we could do to avoid similar tragedies in the future? After all, the progress of humanity and that of medicine are based precisely on this ability.