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MANTOVA. The virus runs fast and hospitals have to press the accelerator to keep track of it. And they can only do so by changing the structure again through the progressive increase of Covid beds, especially intensive care, and by remodeling the non-Covid hospitalization and surgery activity.
A cold, icy shower for patients, just as they were rescheduling medical care after the first wave ended.
The coronavirus emergency levels defined by the Lombardy region are currently four and Mantua has reached level two. And probably also for this reason, and not only, in recent days the crisis unit of the Asst de Mantua, made up of some thirty specialists, has come together in full.
The first maxi summit, after the pause in early August when the spread of Covid-19 had shown a slowdown, immediately welcomed – we are organizing – the provisions issued by the Region: at least 50-55 acute Covid hospital beds, 20 -25 Covid semi-intensive hospital beds and increase in Covid acute diving beds. In anticipation of a general situation that tends to worsen, the invitation to all services is to reintroduce actions to reduce programmed hospitalization activities, with special reference to those that affect the availability of intensive physicians.
Here is the detail of Asst’s reorganization plan to deal with the second wave.
LEVEL TWO UNIT AND CRISIS
To date, the emergency phase of Mantua Asst is at level 2, a stage that the Mantua socio-sanitary company wants to maintain as long as possible so as not to affect the ordinary activity that has been restored in the meantime but is now running risk to suffer a new contraction. Currently, the convocation of the Covid-19 crisis unit will be held weekly.
BEDS
The reorganization of the Covid beds goes through five phases of the pandemic and currently the Poma has installed beds that already pass phase 2. Here are the five phases. Phase 1: total 24 beds, of which 19 in Infectious Diseases, 4 in Intensive Care and 1 in Neonatal Intensive Care (Tin). Phase 2: total 29 beds, of which 19 in Infectious Diseases, 4 in Intensive Care, 1 in Tin and 5 in Utir (subintensive respiratory therapy unit). Phase 3: total 38 beds, of which 24 in Infectious Diseases, 8 in Intensive Care, 1 in Tin and 5 in Utir. Phase 4: total 64 beds, of which 24 in Infectious Diseases, 13 in Intensive Care, 1 in Tin, 5 in Utir, 21 in Ex Thoraco-Vascular Surgery. Phase 5: total 101 beds, of which 24 for Infectious, 21 in Intensive Care, 1 in Tin, 10 in Utir, 21 in Ex Thoraco-Vascular Surgery, 21 in Medicine A. The beds currently available in Carlo Poma in all departments are 446.
Thanks to the collaboration with Ats Val Padana, the availability of the “Maugeri” clinic in Castel Goffredo has emerged to activate up to 46 beds for acute divers from an initial allocation of 7. Availability of another 20 Covid beds for acute patients also from Castiglione delle Stiviere hospital.
NOW COCOON
In light of the new wave of infections, Asst has decided to immediately activate 28 acute Covid sub-beds at Bozzolo hospital in the neuromotor rehabilitation department with the transfer of patients to the closed wing of the Covid-free acute sub-operative unit .
ASOLA
The provision of Covid beds in the Asola hospital has also been defined: 6 gray Covid beds in Pediatrics; 12 Covid beds in the old Surgery; maintenance of 13 medical beds without Covid.
SEMINTENSIVE
The allocation of semi-intensive places as established by regional indicators is shown below: 5 Utir Covid beds (semi-intensive respiratory therapy unit); 4 free Utir beds; 6 beds in semi-intensive pulmonology free of Covid; 10 hospital beds in Covid Free ordinary hospitalization; 2 semi-intensive technical positions of Covid in emergencies. If necessary, it is possible to transform 13 ordinary Covid-free pneumological hospital beds into Covid semi-intensive hospitalization to comply with the indications that have come from regional organizations
PIEVE DI CORIANO
In phase 3, 4 Covid resuscitation beds will be inserted in Pieve di Coriano with an additional Covid-free bed (isolated individual place). A choice that will allow the hospitals of Mantua and Pieve di Coriano to maintain surgical activity for as long as possible.
Swabs
The Poma Analysis Laboratory has extended the hourly slots for swabs from 8 a.m. to 8 p.m., Monday through Sunday, processing around 50/60 swabs per day. But a new machine is on the way that will allow 300 tampons per day. Swabs for schools cost around 500 per day and are processed at the Zooprophylactic Institute of Brescia and Modena. Suzzara’s lab processes 100 swabs Monday through Friday, 80 on Saturday for pre-admissions only.
ACTIVATION OF THE DRIVE
In building 10 of Ats in via dei Toscani, the transmission channel will be activated with infrared heating and with a hot chamber that can be accessed by car only for reserved patients. The installation of clinics always for tampons is also planned.
PPE SITUATION
Currently, the personal protective equipment in hospitals is sufficient until December.
HEALTH PERSONNEL
To meet the needs of the staff, psychological support will be activated with Clinical Psychology with the Frailty department for those who request it.
RECOVERY ACTIVITIES
The resumption of ordinary hospitalization activities will have to be progressive up to a maximum of 60-70% of the activity provided before the pandemic and will affect patients who need services that cannot be postponed beyond the 60-day waiting period.
ONCOLOGY SURGERY AND PRIORITIES
Up to different indications, the increase in surgical activity can be programmed up to a maximum of 60-70% of ordinary pre-Covid activity. For oncological surgery, 4 priority classes have been defined depending on the pathology: urgent due to the presence of complications, relative urgency due to tumor reasons, non-urgent, deferred.
NON-ONCOLOGICAL SURGERY
The criteria have been defined for the types of services that must be reactivated up to “medium priority” and in any case for the services that cannot be deferred beyond 60 days due to risk.
SURVEILLANCE BED
At Viadana hospital, 30 general geriatric rehabilitation beds have been temporarily transformed into a surveillance hospital for Covid patients requiring a low level of care. Sixteen are already active, while six of the remaining 14 have been activated for low-risk subacute positive Covid care.
