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It is not so much, nor only, a problem of places, beds to find and respirators to ride. The main concern of intensive care and resuscitation departments is above all the lack of men and women capable of operating these machines. “We hired just one more anesthetist, a young apprentice – says Sebastiano Macheda, manager of the Reggio Calabria hospital – but in the meantime a colleague has retired and another has moved north.” There is no turnover, so it is useless to increase the number of jobs, which then “in Calabria only 6 more have been activated in the entire region, apart from doubling”, explains Macheda. Things are better at the Maggiore hospital in Bologna, where “we have built 34 more places – says Chief Medical Officer Nicola Cilloni -. The room is already half full. Two weeks ago we had no patients.
In addition, yesterday in Italy Covid patients in intensive care exceeded the one thousand mark. The same trend at the Niguarda in Milan: “We have already converted the general medicine departments into Covid departments – says chief physician Roberto Fumagalli – now that intensive care is filling up, we must increase the availability of places”. Lombardy, along with Emilia-Romagna, is among the 10 regions that, according to the Istituto Superiore di Sanità, could reach 30% saturation of resuscitation places dedicated to Covid patients in the next month. The threshold beyond which the system leak alarm is activated.
Campania is also on the list. “Here the beds have increased, but the force is not enough”, warns Professor Giuseppe Servillo, director of Anesthesia and Intensive Care and director of the graduate school of the Federico II University of Naples. “It is not enough to enter the fourth and fifth year postgraduate courses, you have to extend it to the third year and also call the ASL anesthesiologists,” he explains. New fans don’t work alone, you need the skills. We fear that we will not be able to handle the real emergency, which has not yet arrived.
Without interventions
To do this, it will be inevitable to postpone even more scheduled and non-urgent surgical interventions, to transfer the majority of anesthesiologists-resuscitators to intensive Covid care. “They can’t take it anymore,” explains Flavia Petrini, president of the Society for Intensive Care and Anesthesia Resuscitation, they continue to work double shifts to address the growth in hospitalizations for Covid. But if the trend does not change, it will be inevitable to reduce other activities.
Try to be optimistic Maurizio Berardino, director of the Department of Anesthesia and Resuscitation of the City of Health of Turin: “If we celebrate in March we will do so even now – he says – but it will be difficult not to overlook the other emergencies, from cardiology to oncology” . According to Luigi Tritapepe, chief doctor of San Camillo in Rome and a reference for intensive care in the Lazio Region, the problem is that “we are not and perhaps we will not return to the confinement, so we will have to manage all traumatic surgery, that of the traffic accidents to understand each other “. which represents 60% of the work. At the moment, resuscitation places in Lazio have only increased “by 10-15%” and for Tritapepe “around a thousand more nurses and another 150 anesthetists would be needed.” It is useless, however, to bring other specialists to lend a hand in resuscitation, at least according to Alessandro Vergallo, president of the Association of anesthetists and hospital resuscitators: “It would be confusing, a better specialist than a dermatologist.”
The need
At the national level, 3,000 more intensive care places are needed, compared to 5,000 in the pre-Covid era, but for now “about 1,500 have been created,” explains Vergallo. And to ensure full performance, 4,000 anesthetists would have to be hired, but there are none. “We fear that hospitalizations in intensive care will double in 15 days – he warns – the staff will not be enough”.
