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ROME – A 40 page document, three risk scenarios, graphs and tables to develop measures againstcoronavirus epidemic. Here it is National Health Plan for the response to a possible Covid-19 pandemic, which the government has classified and of which the Minister of Health Roberto Speranza He continued to deny its existence until two days ago, dismissing it as an ongoing study whose evaluations were hypothetical, random. The Plan was developed on February 19, the final draft on February 22, 2020. The stated objective:proper management of infection in a territorial and hospital context without compromising the continuity of care, rationalizing access to care, to ensure optimal use of resources. Providing appropriate care will reduce morbidity and mortality by mitigating the effects of the pandemic. The file establishes priorities: have adequate supply of masks, coveralls and gloves, but above all greater availability of intensive care places. Supplies that in the first weeks were not enough, neither for the health personnel nor for the sick.
The three scenarios
The existence of the National Pandemic Plan was presented by Corriere della Sera on April 21. The interview with the Director General of Health Planning of the Ministry of Health unleashes a political storm. Andrea Urbani He referred to three scenarios and explained that the plan had been classified do not scare the population with overly dramatic projections and numbers. By constructing the virus reproduction numbers in China based on the R0 infection rate, the plan simulates the possible course of the epidemic in Italy. Risk level 1, sustained but sporadic transmission and local spread of the infection, is indicated almost as a school case, because the attention of academics will focus on the most difficult scenarios to face. Risk level 2: widespread and sustained local transmission with increased pressure on the NHS that responds by activating pre-established extraordinary measures. Risk level 3: generalized and sustained local transmission with greater pressure on the SNS that responds by activating extraordinary measures that also involve non-health organizations and structures. The last two scenarios – with contagion rates of 1.15 and 1.25 respectively – are the ones that project the widest gap in intensive care settings. The document opens with some key messages, the first of which China has demonstrated the high epidemic potential of the SARS-CoV-2 virus. As a result, radical and timely containment measures are effective in reducing R0 below the threshold level and in keeping the epidemic under control. In bold, he underlined how, from the confirmation of the first case of local transmission, it is essential to quickly activate containment measures.
Gloves and masks
The experts had pointed out that the procedures applied in intensive facilities are highly invasive. And for this they planned to equip these operational units with adequate supplies of “overalls” suits, masks, shields (shields, ed), hoods, gloves and other aids in different sizes and sizes. Stocks must be adequate the expected volume of patients according to the level of activity expected by the organization.
Intensive terapie
The experts write: From the analysis of the hospital supply referred to intensive care, a total national endowment of beds equal to 5,324 emerged (of which 687 in simple isolation and negative pressure) emerged with an occupancy rate of 85%. Assuming that 15% of the available beds can be used with a 50% reduction in elective surgery activity (as expected in scenarios 2 and 3), up to 1,597 ICU beds could be progressively released, of which 103 in isolation.
The regions
The most political point concerns the coordination between State and Regions. The governors, especially in terms of closings and reopening – from the movement of people to discos – have made advances on too many occasions that have caused institutional friction. activated a National Coordination that operates according to well-defined central decision-making model and a strong and directive mandate that, while respecting individual regional organizations, defines the efficiency of the interventions to be implemented but above all the effectiveness of the planned actions. Then the invitation to adhere to the line of government: in a state of national emergency, the Regions and Autonomous Provinces must overcome the current norms, principles and programmatic differences that derive from the adoption of very different organizational models, especially for the activities of emergency. Words to reread in retrospect.
September 8, 2020 (change September 8, 2020 | 07:17)
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