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The Relaunch Decree had foreseen 3,500 new beds in intensive care, which would have guaranteed the presence of 14 beds for every 100,000 inhabitants in a homogeneous way throughout the national territory. However, to date there are only 1279 additional units, less than half of the stated goal. In addition, the new positions are distributed unevenly throughout the territory. The reasons for the delay lie in the planned planning procedure and, in general, in an action by the Public Administration that has not been able to achieve the objectives even in the presence of adequate financial resources.
Beds in intensive care
Article 2 of the Relaunch Decree had foreseen an increase in the number of beds in intensive care by 3,500 units, which would be added to the 5,179 existing pre-Covid units, for a total of 8,679 units. The resources allocated were important: about 606 million. The new places would be distributed to the regions in such a way as to guarantee 14 places for every 100,000 inhabitants in a homogeneous way throughout the territory. However, as of October 9, there were 6,458 beds, an increase of just 1,279 units.
The regional distribution of the increases is uneven. Veneto, Valle d’Aosta, Friuli-Venezia Giulia and Basilicata obtained particularly good results with a high degree of completion of the beds. The first three regions achieved an increase in beds even above the target (the completion rate is greater than 100%). Among the regions with the lowest degree of completion are Umbria, Calabria, Marche, Piedmont and Abruzzo. Lombardy also had a low degree of completion, around 20 percent. You might think that the regions that performed best in terms of degree of completion were those that had a less difficult goal to achieve. Indeed, there is a negative relationship between the degree of achievement of the goal and the difficulty of reaching it (the latter measured by the expected increase in the number of beds per 100,000 inhabitants; Figure 1). However, the difficulty of the objective explains only a small part of the differences between regions. In Figure 2, Veneto, Valle d’Aosta, Friuli-Venezia Giulia, and Basilicata are all above the regression line, indicating that they did well even with regard to goal difficulty.
“Younger and less serious”, here is the identikit of the new patients in intensive care
by Michele Bocci
In addition, the Decree provided for the provision of 4 mobile structures with a total of 300 beds to be assigned to the areas with the greatest need. For the acquisition of the four facilities, on August 11 a preliminary study of market consultation was published for the acquisition of technical documentation. The bid submission date was set for September 2. The procedure is still ongoing.
Beds in Semi-Intensive Care
Semi-intensive therapy is intermediate between intensive and ordinary and is intended for patients undergoing continuous monitoring. The Relaunch Decree also ordered the requalification of 4,225 semi-intensive therapy beds. 50 percent of these beds (2,112 beds) had to be easily convertible into intensive care.
The increase in semi-intensive care places exceeded the goal: 7,670 places were created (compared to the 4,225 planned) which, added to the pre-existing places, give a total of 14,195 units. However, it is unclear to what extent the goal of rapidly transforming around 2,000 of these beds into intensive care beds has been achieved.
The reasons for the delays
The procedure for assigning beds envisaged the presentation by the regions of a plan to the Ministry of Health before July 17, a plan that the Ministry had to approve within 30 days. After that, the Extraordinary Commissioner for the Covid emergency should have provided the operational indications for the implementation of the plans. According to the regions, and the Commissioner confirmed, the presentation of the plans and the approval was carried out within the established deadline. However, according to the commissioner, the plans presented and approved “often lacked the technical, operational and logistical details necessary to start the races.” It would take more weeks to complete. Consequently, the relative announcement was published only at the beginning of October, with the deadline for participation in the contest set for October 12. This would have been the cause of the delays. The fact is that the procedural process has not proven adequate to handle an emergency situation. Was it necessary, for example, that the programs submitted by the regions had to be approved by the Ministry within 30 days? The early fall date was known. Couldn’t we have acted faster, perhaps leaving more room for autonomous action by the regions? On the other hand, there are also responsibilities at the regional level, as some regions have nevertheless managed to meet or exceed their goal of increasing the number of beds, while others have failed. In any event, if delays were mounting, shouldn’t the Commissioner have energetically signaled the emergence of a serious problem, especially in certain regions, even publicly?
