12 physicians of an upscale hospital operating at the epicenter of Italy’s Covid-19 outbreak have jointly issued a plea that medical practice during a pandemic need to be turned towards delivering care to more patients at home , Statnews reported.

The physicians work at the Papa Giovanni XXIII Hospital in Bergamo, a brand-new state-of-the-art facility with 48 intensive-care beds. Despite being a relatively small city, Bergamois the epicenter of the Italian epidemic, is currently listing 4,305 cases at this moment — more than Milan or anywhere else in the country.

“Western health care systems have been built around the concept of patient-centered care, but an epidemic requires a change of perspective toward a concept of community-centered care.” the physicians jointly wrote in a paper published on Saturday in NEJM Catalyst, a new peer-reviewed journal from the New England Journal of Medicine.

“We are far beyond the tipping point,” Nacoti and his colleagues write. With 70% of ICU beds reserved for critically ill Covid-19 patients, those beds are being allocated only to those “with a reasonable chance to survive,” as physicians make wrenching triage choices to try to keep alive those who have a chance. “Older patients are not being resuscitated and die alone without appropriate palliative care, while the family is notified over the phone, often by a well-intentioned, exhausted, and emotionally depleted physician with no prior contact,” they write.

The physicians also note that hospitals might be the main Covid-19 carriers, as they are rapidly populated by infected patients, facilitating transmission to uninfected patients.

“Patients are transported by our regional system, which also contributes to spreading the disease as its ambulances and personnel rapidly become vectors. Health workers are asymptomatic carriers or sick without surveillance; some might die, including young people, which increases the stress of those on the front line.” they write

The physicians noted that Covid-19 type disaster can be averted only by massive deployment of outreach services.

“Pandemic solutions are required for the entire population, not only for hospitals. Home care and mobile clinics avoid unnecessary movements and release pressure from hospitals” the plea read.

The physicians advocated that early oxygen therapy, pulse oximeters, and nutrition can be delivered to the homes of mildly ill and convalescent patients, setting up a broad surveillance system with adequate isolation and leveraging innovative telemedicine instruments.

Pointing out this approach would limit hospitalization to a focused target of disease severity, the physicians said that it will decrease contagion, protect patients and health care workers, and minimise consumption of protective equipment.

“In hospitals, protection of medical personnel should be prioritized. No compromise should be made on protocols; equipment must be available. Measures to prevent infection must be implemented massively, in all locations and including vehicles. We need dedicated Covid-19 hospital pavilions and operators, separated from virus-free areas.” they added

Cellnex Telecom Papa Giovanni XXIII Hospital. Bergamo

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