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March 19, 2020

How coronavirus overwhelmed one of Italy's premier hospitals

Daily Briefing

    Even one of the "most advanced" hospitals in Italy is struggling to keep up with the volume of COVID-19 patients, but the harrowing experiences of the hospitals' staff can serve as lessons to providers in the United States as they treat more cases of the disease themselves, Marcus Walker and Mark Maremont report for the Wall Street Journal.

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    About the COVID-19 pandemic

    Reports of COVID-19, the disease caused by the new coronavirus, first surfaced in early December 2019 in Wuhan, China. While the number of new cases of COVID-19 reported in China has been dropping, newly reported cases of the disease have spiked in other countries, with COVID-19 reaching global pandemic status.

    Italy has been the country hit hardest by the disease after China, with 35,713 cases and 2,978 deaths from COVID-19, so far. As of Thursday morning, there have been 227,743 cases of COVID-19 reported globally with 9,115 deaths.

    COVID-19 overwhelms one of Italy's 'most advanced hospitals'

    One of the Italian cities hit hardest by the new coronavirus is Bergamo, which has a population of about 120,000 people and is located in one of the most affluent regions in the country, according to Walker and Maremont. Cases of COVID-19 have overwhelmed Papa Giovanni XXIII Hospital, a 950-bed hospital that opened in 2012 that's considered one of the "most advanced" in the country, Walker and Maremont report.

    Typically, the hospital can dispatch an ambulance within 60 to 90 seconds of a 112 call, the European equivalent of 911. Within 30 minutes, patients typically can reach an OR, according to Angelo Giupponi, who runs the emergency response operation at the hospital.

    But COVID-19 has changed that. Giupponi said patients now are waiting an hour on the phone to report a heart attack because all of the lines are busy, and Giupponi's team fields 2,500 calls and transports 1,500 people to the hospital daily.

    At the hospital, over 400 of the 950 beds are dedicated to confirmed or suspected COVID-19 patients, and the ICU is holding more than 100 patients, the majority of whom have COVID-19, Walker and Maremont report. Plus, three out of the hospital's four top managers are sick with the virus.

    And the hospital is short on medical equipment. It lacks enough ventilators to intubate every COVID-19 patient with breathing problems, and doctors said the ICU is extremely unlikely to see a patient over 70.

    Mirco Nacoti, an anesthesiologist and intensive care specialist at Papa Giovanni, said, "Until three weeks ago, we did everything for every patient. Now we have to choose which patients to put in intensive care. This is catastrophic.

    What US hospitals can learn from Papa Giovanni's experience

    Maurizio Cereda, an intensive care doctor and anesthesiologist at the Hospital of the University of Pennsylvania, who trained in Milan and has spoken to colleagues in Bergamo, said there are several lessons American hospitals can learn from Italy.

    Most of the lessons are about public health and ways to avoid overwhelming hospitals, Walker and Maremont report. "Mild-to-moderate cases should be managed at home, not in the hospital, and with massive deployment of outreach services and telemedicine," according to Cereda.

    He added that smaller hospitals "are unprepared to face the inflow of patients" and likely will collapse. He recommended admitting the sickest patients to larger hospitals and deploying specific ambulances for suspected coronavirus patients.

    Another takeaway from Bergamo's experience is that a large number of Italian emergency-medical technicians have caught the virus and are spreading it as they travel, Cereda.

    Brendan Carr, chair of emergency medicine for The Mount Sinai Health System, said studying the events in Italy can help American hospitals be prepared. "It's terrible to hear them talk, but it benefits us to learn from it," he said.

    One lesson Carr said he's learned is to make sure there is enough capacity for an influx of COVID-19 patients before the capacity is actually needed.

    Nacoti said hospitals in the United States and throughout Europe should get organized ahead of time, and governments need to implement community lockdowns sooner than later.

    "An epidemic doesn't let you proceed by trial and error," he said. "Every day you lose, the contagion gets worse" (Walker/Maremont, Wall Street Journal, 3/17; Johns Hopkins tracker, accessed 3/19).

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