“Enough with the ghetto wards dedicated to Covid patients. They are not needed and the other diseases are left out. Many serious ones too”. The warning issued by a university doctor does not allow for replies, but the premise is fundamental. Here she is. The Cardarelli of Naples is the largest hospital in the south. Two days ago the operations center of the 118 territorial received a note from the bed manager: “The emergency room closes its doors. Only patients in indelible urgency will be welcomed”. A drastic measure which, adopted several times, is revealing all the fragility of the health system.
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A fragility that, concerning many structures of the entire peninsula, is also the daughter of an error that is taking place everywhere in Italy and which risks precipitating the situation. To explain it, denouncing the harmful effects on assistance, is Ivan Gentile, the professor of Infectious Disease at Federico II who, in his ward, is paying the price for the concentration of Covid patients, hospitalized for other pathologies and not for complications from Sars-Cov-2. “The current pandemic situation shows a different scenario from previous waves, with a less aggressive virus for the vaccinated. Many of these patients do not actually have the usual Covid respiratory disease.”
Basic pathologies that still require hospitalization and specialist hospital assistance. Are you afraid that ad hoc departments for positives only represent a danger?
“In fact. I’ll give you an example. In my division, we also welcome a large number of cancer, haematological and surgical patients. All subjects who have a positive swab, but have not been hospitalized for pneumonia or respiratory failure. And therefore they should not have been hospitalized for Covid, in the strict sense. Among other things, I have found that all this happens in many hospitals scattered throughout the country “.
Are you saying that these are sick people who need other treatments?
“Their need, in the majority of cases, are other. Indelible chemotherapies, frequent transfusion support or pre- or post-operative surgical monitoring. It is irrational to concentrate them in one place now that the virus does not kill and that it will soon be able to be dealt with like any other. infectious agent. My God, no one underestimates it, but we can’t forget all the other diseases either. “
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Are you afraid of welfare “holes” for specific pathologies?
“There is a risk. Despite the availability of colleagues from the various specialties to come on call for individual consultations, a concrete difficulty is emerging in the management of subjects with primary disease not of infectious disease relevance. The end of the epidemic phase will reveal us in all its crudeness such a scenario. Dramatic “.
What should be done?
“I believe, but it is not just my personal point of view, that these patients should each be managed in the department of their own competence where rooms and areas dedicated to Covid should be set up, precisely to ensure the highest quality of care by the specialists of the sector”.
But the concomitant presence of the coronavirus remains.
“Exactly, and in the case of the development of symptoms typical of Sars-CoV-2 infection, they should be followed by the reference infectious disease team. It does not take long, I imagine ad hoc areas in the departments of Internal Medicine, Cardiology, Hematology, Gastroenterology, Surgery, Oncology “.
And are you structurally sure that such a solution is feasible?
“And why not? No particular spaces are needed, just a few structural changes would be enough with a room suitable for dressing staff. In short, a non-standard isolation room, as in the past”.
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Would this solve the situation and protect you from the risk of abandonment?
“The infectious disease specialist will have the task of managing and supervising the antiviral and immunomodulatory therapies for these patients. In the infectious disease wards, patients with pneumonia and respiratory insufficiency from Covid or concomitant bacterial or fungal superinfections, that is all those in whose framework an infectious pathology predominates. This, in addition to allowing a more efficient better management of the patients, will contribute to guaranteeing better quality care pathways “