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First sent with a lot of protocol and then withdrawn with another official communication in which it is asked not to take it into account as it was sent “for mere material error”. The circular lists some objectives such as the completion of the vaccination campaign against Covid and the use, in the event of a worsening of the epidemiological situation, of masks inside closed places, as well as the temporary adoption of other measures such as working from home or limiting the size of events involving gatherings. There are also indications for the health services in order to be ready to face a possible increase in cases of Sars-CoV-2 infection. THE WITHDRAWAL CIRCULAR.
03 NOV –
The Ministry of Health has ready the circular for the Regions with the new indications on the management of the pandemic. But around the text developed by the Directorates General for Prevention and Programming a little has been staged that for which due to the fact that it was sent to the Regions “for a mere clerical error” before the final examination by the minister.
However, the text has now circulated among the Regions – which were in any case notified by the same ministry of the sending error and therefore urged not to take it into account – and we are therefore able to anticipate its contents pending the launch of the final circular.
Within the circular we find a whole series of detailed indications on the completion of the vaccination campaign against Covid to “continue to make the elderly and frail safe as a priority, protecting them from serious illness and hospitalization”, also filling the gaps for primary and combining vaccination campaigns for Covid and influenza and indications on what to do in case of worsening of the epidemiological situation, from the possible use of masks inside closed places, to the temporary adoption of other measures such as working from home o limiting the size of events involving gatherings.
There are also indications for health services in order to be ready to face a possible increase in the demand for assistance for cases of Sars-CoV-2 infection and recommendations on ventilation of the premises and home care.
But let’s see in detail all the indications that the ministry provided to the Regions.
Surveillance and monitoring activities
In the autumn-winter period 2022-2023, all surveillance activities will continue. Since it is likely an increase in pressure on laboratories both for diagnostics but also more generally, on virological surveillance networks due to a greater seasonal circulation of respiratory viruses, “it is necessary that there be mechanisms to strengthen the systems in place”. In fact, it will be essential to ensure a “volume of sequencing sufficient to monitor the viruses in circulation and the emergence of new viral variants and an adequate diagnostic capacity of the laboratories. Therefore, it is strongly recommended at least in elective contexts such as hospitals and emergency room, collect samples to be subjected to molecular tests, to ensure a minimum number of samples to be genotyped in each Region / PA “.
Covid vaccination
In the autumn-winter 2022-2023 season, it is explained that the objective of the vaccination campaign will be to continue to make the elderly and frail safe as a priority, protecting them from serious illness and hospitalization.
Priorities and factors to consider in preparing and implementing new vaccination strategies include:
– the continuation of the current vaccination campaign, filling the gaps in the vaccination coverage of the primary cycle and of the recommended boosters and maintaining a sufficient vaccination capacity;
– the possibility of combining vaccination campaigns against Covid and influenza;
– the development of vaccination programs with adapted vaccines, identifying priority population groups and ensuring that there is sufficient availability of doses;
– monitoring the efficacy and safety of adapted vaccines once large-scale deployment has begun;
– the implementation of effective communication strategies to promote the intake of booster doses, the completion of the primary series and the campaign on new and adapted vaccines and protein vaccines.
Non-pharmacological interventions
Non-pharmacological interventions have proved to be “critical in limiting the spread of the virus, protecting vulnerable groups and reducing pressure on health systems.”
Contact tracing and quarantine “should primarily be conducted and applied in individuals at risk of serious illness, high-risk settings (healthcare, nursing homes and long-term care facilities), and in situations of greater concern (e.g. example, an emerging variant of interest or concern). Furthermore, for the autumn-winter season 2022-2023 it will remain important to comply with any recommended precautions in closed environments where outbreaks of high transmission are more likely to occur “.
The use of masks, he explains, is “effective in reducing the transmission of respiratory viruses and in the event that an evident epidemiological worsening is documented with a serious clinical impact and / or on the functioning of the assistance services, their use could be indicated in closed spaces, aimed in particular at protecting people at high risk of serious illness. Similarly, in the event of a significant worsening of the epidemiological picture, the temporary adoption of other measures, such as work from home or the limitation of dimensions of events involving gatherings “.
Finally, ensuring adequate ventilation indoors is a key measure to reduce the risk of transmitting Sars-CoV-2 and other respiratory viruses.
Home care
The clinical management of patients affected by Covid allows an early management of the infection by limiting the overload of health care facilities. This management “has evolved over time, reflecting the evolution of knowledge relating to the pathogenesis, the symptoms presented by patients, the new evidence on therapies, and the availability of new antiviral drugs and monoclonal antibodies”.
Measures of organization of health services
For the autumn-winter 2022-2023 season, in the circular it is considered “indispensable” that the regional health services verify, and if necessary strengthen their state of preparation in order to face a possible increase in the demand for assistance for cases of infection by SARS-CoV-2.
In particular, the verification of:
– provision of beds in ordinary hospitalization (Covid medical area) and in intensive / sub-intensive therapy dedicated to and dedicated to Covid patients, to be identified and activated in a flexible manner based on demand;
– availability and correct application of formalized hospital protocols for the safe management of patients:
– hospitalized due to the clinical manifestations of Covid;
– hospitalized for other causes in wards with different nosological expertise and positive results in search of the Sars-CoV-2 virus;
– availability and correct application of formalized hospital protocols for the disinfection and sanitation of the living rooms of patients positive for the Sars-CoV-2 virus;
– procurement of consumables, instruments, devices, diagnostics, drugs, vaccines, etc .;
– availability of trained and continuously updated health personnel, who can support hospital departments and local services in the event of an increase in the number of cases such as to exceed the current capacity of the assistance systems and / or the Prevention Departments;
– equipment and procedures of RSA and long term facilities;
– methods and protocols of home care;
– effectiveness of external and internal communication, including the timely communication of data that feed the national information flows.
It is recommended to closely monitor the progress of the waiting lists for scheduled hospitalization, outpatient and cancer screening services and the careful updating of recovery plans based on the results of monitoring, according to the criteria identified in the Guidelines for the recovery of health services not provided due to the SARS-CoV-2 epidemic.
Finally, it should be emphasized that the organization of services must in any case take into account the need to safely manage visitors’ access to health facilities.
John Rodriguez
03 November 2022
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