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by Antonio Musella and Gaia Martignetti
From the yellow zone to the Covid red zone in a few days: this is how it was in Campania. The month of November was marked by the hardest phase of the Coronavirus pandemic. Everything happened between October and November: the president of the Region Vincenzo De Luca He went from invoking the red zone to claiming the yellow zone as a merit, to later capitulate under pressure from the national government that took charge of the delicate situation in Campania. In the center are the numbers provided by the region to the government.
The numbers, because decisions are made on numbers, and if the numbers are communicated incorrectly, there is a risk of making late or worse, ineffective decisions. While for the Campania region the situation was serious but controlled, we witnessed the lines of ambulances outside the emergency room, which in turn became veritable lazaretes. Something is wrong with the accounts.
On this basis, the Ministry of Health sent inspectors to the Campania hospitals to check the situation. A few days later, on November 12, the minister declared a red zone. Roberto Speranza who signed the ordinance for Campania and Tuscany. But what are the real numbers?
There are no “activatable” beds
To decide in which area a region should end (yellow, orange or red), the Istituto Superiore di Sanità has among the parameters the percentage of intensive care beds and busy ordinary hospitalization on all the availability of hospital beds in a single region.
If you exceed 30% intensive care and 40% hospital beds, the alarm goes off. The decisive number to make these proportions is, therefore, the number of intensive care and ordinary hospitalization places available for each individual region.
And it is precisely on this number that chaos has been generated between the Campania Region and the national government. The Campania region has transmitted a daily bulletin in which the beds were indicated as “activatable”. But what does “hover” mean?
The case of a patient, hospitalized in the Cto of Naples and tested positive for Coronavirus tells us: “They told me that there was a place available at the Cotugno hospital. – explains to Fanpage.it Elena Auricchio grandson of the patient – They couldn’t find ambulances for the transfer. The next day, Doctor 118 told me that the place had disappeared. Then a CTO doctor explained to me the difference between activatable beds and available beds. The places that can be activated, since there are no anesthetists, are places that do not really exist“. The number of “activatable” beds only exists on the card. This is confirmed by the doctors themselves.
“The numbers Campania has given are not real numbers. – Explain Pierino Di Silverio of the Anaoo Assomed – . The so-called “bed that can be activated” is a bed that is technically ready but without the necessary personnel to activate it.“The Campania numbers, therefore, represent an unrealistic situation.
The intensive care ballet
Intensive care is the last medical bulwark against Covid 19. This is where the possibility of saving the lives of the most serious patients is at stake. But how many intensive care beds are there in the Campania region?
Analyzing the statements of recent weeks, a truly impressive ballet of numbers emerges: for the Minister Francesco Boccia October 10th 433 intensive care facilities in the Campania region; for the special commissioner for the Covid 19 emergency, Domenico Arcuri, on October 28, after the State – Regions conference, are 505; by Enrico Coscioni, De Luca’s health consultant and president of Agenas are 590.
LThe Campania Region – as shown by the daily bulletins of recent months – has never declared more than 243. But since November 6, in a single day, they have gone from 243 to 590. As of November 14 they have gone to 656 .
“The Campania region has not created new beds, but has converted them – Di Silverio emphasizes -. In practice, it has closed entire rooms of Ordinary Medicine and has transformed them into Covid beds.“.
An Incredible Species Case It is the one of the intensive care places of the Covid Center of Ospedale del Mare. In a document dated October 17 from ASL Napoli 1, 72 intensive care places are indicated available in the prefabricated hospital sought by De Luca; in the same daily bulletins on occupied beds spread by ASL Napoli 1, the intensive care posts of the Covid Center in Naples become 16.
One wonders what is the number that the Campania Region sent to the national government: 72 or 16?
And it is in emblematic cases like this that the Minister of Health decides on November 10 to send the inspectors who have carried out this work, to verify the correspondence of the declared beds with the real ones in the Campania hospitals. So while De Luca declared: “Check everything you want, we have no problem“, exactly Two days after the arrival of the inspectors, on November 12, Campania was declared a red zone.
The agreement with private health
The leap forward in the number of beds available on November 6, as reported in the official newsletter of the Campania Region, is the result of a series of agreements made a few days before with the owners of the private clinics. On October 29, the Campania Region publishes a resolution in which those responsible for accredited private healthcare are invited to express their interest in making high, medium and low intensity beds available for the Covid emergency.
In the following days, Aiop, the trade association, meets in extraordinary session at the Hotel Continental in Naples. On that occasion, the agreement between the Campania Region and private healthcare is closed.
Explaining it in detail is Marco D’Acunto of the CGIL for private healthcare in Campania. To understand his speech you need to know what Drg, acronym for group related to diagnosis. It is the system that allows classifying all patients discharged from a hospital (hospitalized in ordinary or day hospital) into homogeneous groups by absorption of committed resources.
There are three bands. For the low intensity segment, you pay 180 euros per day for an unoccupied bed plus the Drg to 100%. For medium intensity it is pag 300 euros per day per unoccupied bed plus 100% Drg and finally 1,000 euros per day per unoccupied bed plus 100% Drg for high intensity positions“.
The number of beds available for private healthcare is not official. In short, it is not known how many places there are.
We asked Gianfranco Shirt, Vice President of Aioè Campania: “The Region has asked us to provide beds for the Covid emergency – he tells us by phone – I think we’ll get to 1200 seats“.
Beyond any consideration of merit, as D’Acunto of the CGIL points out: “It is a fact that the Campania Region found itself unprepared, so much so that it had to resort to the beds of the private structures accredited in the agreement“.
But how much did this deal cost us? The stated figures are also paid for beds that are not actually occupied at the moment. the DRG fee is added (ie the fee paid by the public to the private for services under the contract).
But that is not all.
The resolution of the Campania Region of October 29 establishes that these figures are only an advance of the total which will then be established by means of a decree of the Ministry of Health that has not yet been issued.
Still: to this money must be added the supplies for Dpi, medicines and other health aids that will be paid to the clinic owners separately. In short, an agreement whose figures are impossible to calculate to date and that represents a river of public money towards individuals.
It seems almost trivial to point out that this onerous arrangement was necessary because the public hospital system alone cannot cope with the pressure of the pandemicHowever, it arrived only in early November, just when the data provided by the Campania Region began to arouse some suspicions in the national control bodies, the Higher Institute of Health, the State-Regions conference and the Ministry of Health.
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