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For several weeks now, the uncertainty about the number of beds available in Campania hospitals, and in particular in intensive care wards, has led to a political case that has drawn great criticism and serious accusations against the regional government, hinting at doubts about how much the real pressure on the local health system caused by the coronavirus epidemic.
Knowing the updated number of beds available in intensive care, and how many of them are occupied by patients with Covid-19, has been difficult since the beginning of the epidemic almost everywhere. This despite being the most important data to understand if hospitals are under pressure or not, and one of the indicators that influence the choice of the Ministry of Health on the restrictions to adopt. In Campania, however, in recent weeks the figure has been even more uncertain than normal.
On 11 November, in correspondence with the first doubts about the figures provided by Campania, some ministerial inspectors had carried out inspections in the main regional health centers. The president of the region Vincenzo De Luca had defined the inspection as a “hoax”: there are no official reports of what was discovered and, therefore, if it influenced and how much it influenced subsequent decisions: but a few days later the Ministry of Salud had included Campania, along with Tuscany, in the “red zone” (previously it was “yellow”). The growth of infections and that of pressure on hospitals had already been reported for a couple of weeks, especially in Naples.
To understand what has happened in recent months, the starting point is the data of the available places before the epidemic. According to a report signed by the extraordinary commissioner Domenico Arcuri, the number of beds in intensive care “pre-Covid” was 335. The report, published on October 13 by Quotidiano Sanità, also shows the beds added in recent months: there are 92 , for a total of 427 places available in mid-October.
But the ICU places in a region are not a fixed monolithic number. They increase every day in the different hospitals that manage to equip one or two more thanks to a new ventilator or a new equipment, for example. Therefore, the counts are aggregations of data from individual hospitals, which can change with some frequency. And sometimes the counts also improperly include those that can be activated, that is, those for which the resources and space potentially exist and that can be available in a short time, should the need arise. For this reason, it is normal to see slightly different estimates circulating in places in different regions.
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The most reliable source is the portal of Agenas, the national agency for regional health services. For about a month, after the attention raised about the occupation of beds in intensive care units, the site has published the percentage of occupation in each region. Every day the data of the beds available and those occupied by Covid-19 patients are updated. The update of November 24 says that the available places are a total of 590, those occupied by Covid-19 201, so the occupancy is at 34%, four percentage points above the alert threshold indicated by the Higher Institute of Health.
When observing the graph that shows the evolution of the employment percentage, it can be seen that on November 19 and 20 there was a sharp fall and then an increase on November 21.
The trend in the occupation of beds in intensive care in Campania (Agenas)
Thanks to the data extracted from the Ondata association, it is possible to try to understand what happened. In those two days, the number of beds available in intensive care units in Campania rose to 925, reducing the percentage of occupancy. On November 21, 590 beds returned, it is not clear if this anomaly is due to a communication error in the region or an incorrect transcription of Agenas. It is not possible to know this also because the graph only gives the explanation “Agen Processing”, without clarifying the flow that feeds these important tables.
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Another source to try to understand the situation of intensive care in Campania is the bulletin that the region publishes every day, which however does not help to clarify. In fact, in the first week of November, the elements presented in the bulletin have changed: until November 5, the figure was divided between “total”, “activatable” and “occupied” places available. The seats that could be activated until November 5 were 243. Since November 6, this distinction has disappeared and only the 590 total available seats have been communicated. To complicate matters, there are 66 “activated” beds on the Agenas site.
According to a reconstruction of Fan pageThere were also other impromptu communications that did not help clarify. On October 10, the Minister for Regional Affairs, Francesco Boccia, had said that the total of seats was 433. On October 28, the extraordinary commissioner Domenico Arcuri had counted 505.
During a live broadcast on Facebook on November 6, De Luca explained that “in Campania yesterday we had 175 intensive care hospitalizations, compared to a number of beds of 600. We have doubled the intensive care places compared to January, obviously We did not activate the 600 immediately so as not to hire staff unnecessarily. In two months we will have 800 intensive care places “.
At the moment, according to the latest regional update, the beds are 656. In a press release on November 9, entitled “Covid-19, clarification on beds,” the region had said that the figure refers to all beds. , public and private, and that “this is the same number of beds that can be found in the flow of ministerial platforms.” The note specifies that until February there were 335 active beds in intensive care and that “in recent months another 255 have been created and activated.”
Pierino Di Silverio, regional undersecretary of the Anaao Assomed medical union, says the only reliable data refers to the 335 intensive care places active before the emergency. In recent days, the union has tried to rebuild the availability of beds in Campania hospitals, but the picture is not clear. “We cannot understand if the 590 reported by the region also include those that can be activated,” he explained.
The mayor of Naples, Luigi de Magistris, has long accused the regional government of not providing clear information about the beds, and over the weekend he told the broadcast. It’s not the sand that «even in today’s bulletin the intensive therapies that are given as operative are” activatable “,” programmable “, where, however, or in some cases the instruments or doctors and nurses are missing». According to de Magistris, these beds “do not exist” and “are used to change color.”
According to Di Silverio, the real problem is not the beds, but the lack of health personnel, especially rescuers and nurses. The union has requested several times to hire apprentices who attend the last two years of training in Campania. «The apprentices are 42 per year. By hiring them, we would have 84 more intensive care anesthetists in ICUs in the region, “he explained. “But they must be hired with all the guarantees, otherwise there is a risk that young doctors prefer not to interrupt the training course.”
To find new doctors, on November 15, Civil Protection had published an expression of interest with places for 150 anesthetists, 100 infectious diseases, 100 pulmonologists and 100 doctors specializing in emergencies and emergencies. However, as soon as it was published, several doubts were raised about the effectiveness of the call, which remained open for a few days and excluded participants. Yesterday the region published the results. Of the 156 responses received, there were 97 exemptions and 7 exclusions due to lack of requirements. 25 responses are waiting for comments. In total, 27 doctors and 3 anesthetists entered service, of the 450 initially sought.
The table with the new employees in Campania (Campania Region)
The numbers are far from initial expectations. In the press release published by the region there are also two notes. The first refers to the requests for reinforcements submitted in recent months: “For months Campania has requested the dispatch of doctors (600), in particular anesthesiologists, and nurses (800)”.
The second note, instead, says that “many candidates, after a call, gave up, others, after verifications, did not meet the admission requirements (lack of specialization), others were non-existent or gave names, incorrect telephone or email communications. “
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