There was never any time to waste. But now the delay in vaccinating ultra-fragile people against Covid, which continues to cause so many avoidable deaths, is incomprehensible. Among these people there are 160,000 cardiac patients, 150,000 patients and 70,000 oncohematological patients undergoing active treatment or treated in the last 6 months, who should have already received the vaccines. But as of March 20, only 7.3 percent of eligible cancer patients had actually been vaccinated. This is not the only problem: in recent weeks a film that has already been seen is being shown in hospitals: postponed interventions, delays in treatments, checks and screening. To make an analysis of the situation that 11 million Italians are experiencing is the document “Status of the management of oncohematological and cardiological diseases during the Covid pandemic in Italy”, Which Salute received from MOUTH (Confederation of Oncologists, Cardiologists and Hematologists) and which was sent to the Presidency of the Council of Ministers. A document that reports precise data on the critical issues encountered so far and, above all, proposes concrete actions for a “Marshall Plan” of the health system. Below are the main points in the report, which can be read here in the full version.
STATUS OF THE MANAGEMENT OF ONCOHEMATOLOGICAL AND CARDIOLOGICAL DISORDERS DURING THE COVID PANDEMIC IN ITALY
Non-Covid deaths, the lack of assistance weighs heavily
Between March and December 2020 – the report reads – there were 108,178 deaths in excess of previous years. If 69% is attributable to Covid, at least 31% is represented by deaths related to non-Covid diseases, especially time-dependent, due to lack of assistance. Suffice it to say that mortality has doubled for cardiological diseases. The reasons had already been analyzed in a previous document sent last November to the then Prime Minister Conte and to Minister Speranza: delays or cancellations of cardiological and tumor surgeries due to the crowding of intensive care units; decrease in access to the emergency room and intensive care units for patients with heart attack; 20-30% of cancer treatments delayed, if not canceled; stopping or sharply slowing down cancer screening; almost zeroing of follow-up patient checks.
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Today like a year ago
“It must be noted that no structural or organizational intervention was made on these aspects after a year of emergency to reduce these critical issues”, the experts write. And again, for cancer patients: “Alarming data are being disseminated on the late diagnosis and therefore the observation of increasingly advanced tumors. In addition, the cancellation of more than 2 million screening exams and above all the absence of recent data on the recovery status of these exams, which seems absolutely lacking on almost the entire national territory, remains ”.
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The causes of high mortality
The summary is that the National Health Service recorded a very poor overall performance, above all due to “indiscriminate and unjustified horizontal cuts to Healthcare Structures as regards the medical and nursing staff, the number of beds and services and the adequacy of hospitals ”, suffered over many years. Cuts that have not spared the IRCCS. The count of ordinary beds per hundred thousand inhabitants is enough, much lower than the European average (314 vs 500), which places us in twenty-second place in the ranking among European countries. It is not much better if we consider health expenditure, which in 2017 placed us in fifteenth place in terms of percentage of GDP (European average 9.9% vs 8.8% for Italy). “It should also be noted – we read – that within this percentage there are at least three points that refer to the share borne by patients, so in reality public spending on health is about 6% in our country ” […] for which Italy is “ahead only of the countries of Eastern Europe”.
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The mess of vaccination priorities
Another cause of the high mortality should then be sought in the vaccination campaign for Covid. A month ago, on 10 March, the interim recommendations on the “target groups of anti-SARS-CoVID-2 / COVID-19 vaccinations” of the Ministry of Health and the Extraordinary Commissioner for the emergency were finally issued, welcoming the FOCE request for the definition of the categories most at risk. Also on this front, there is a debacle: “The current data – reports the document – show that up to now as many as 35% of citizens already vaccinated did not belong to the category with the greatest risk of lethality, and above all of the approximately 16 million citizens with the greatest risk only 38% have received the vaccination so far ”. The same has not happened in other countries that have benefited from vaccination volumes similar to ours in the last three months: “It should therefore be stigmatized how the vaccination campaign has favored some broad categories with many people who did not have the urgency requirements, not so much for initiative of some ‘crafty’, as for some wrong or unclear choices by the institutions in charge, which moreover did not exercise any control during the making of these serious choices “. According to FOCE, to reduce COVID mortality, it would be necessary to vaccinate only those over 70 and fragile patients for serious diseases, and only then gradually pass to other citizens, based on age. To date, with the exception of a survey conducted by FOCE, there are no precise data on the state of vaccinations of fragile patients in official communications.
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The 8 priority actions
Previously, FOCE had identified 8 actions to be carried out quickly (the document was published on the Agenas website). Among these: “All medical oncology, cardiology and hematology facilities must remain fully operational even on an outpatient basis. The cardiological emergency network must be preserved. The activities of oncological surgery must be guaranteed and must have absolute priority “. Furthermore, “Hospitals must be considerably strengthened in terms of medical, nursing and technical personnel and in the structural endowment of beds and services in order to fill the existing gaps between Italy and other countries. In the meantime, at least the original supply of beds in the medical and surgical departments to cope with the assistance of patients suffering from non-Covid pathologies must be restored “.
The “Marshall Plan” for health
The intervention proposals for a radical reform of the Italian health care of the confederation include actions in the short and medium term. In the short term, the priorities of primary prevention, early diagnosis and treatment must be addressed. We need: a campaign aimed at citizens to raise awareness on the need to resume treatment, so as not to abandon treatment plans and return safely to hospitals, and another campaign aimed at national and regional institutions, to resume screening and recover the delays. In the medium term, however, structural actions are needed in terms of funding and the organization of territorial medicine: “As FOCE – the experts conclude – we are convinced that only clinicians, those who live the wards every day, have relationships with patients and their families, they can have an overall vision and propose concrete, effective, measurable solutions over time, involving the various actors involved in the supply chain. Unfortunately, no clinician is currently included in the official advisory bodies that make decisions or that determine choices even at a central level “.
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