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In recent days, the coronavirus data in Milan has become increasingly worrying. Both on Wednesday and Thursday the number of new daily infections in the municipality of Milan exceeded 500, while in the first week of October there was an average of 84: the province of Milan has reached half of the infections in all the Lombardy region, the region today the most affected by the epidemic, and the city of Milan half of the infections of the entire province. In the city there is also increasing pressure on hospitals and hospital activities. contact tracking carried out by the health authorities go very slowly.
As noted by Mayor Giuseppe Sala, the transmission rate (Rt) has exceeded 2, a fairly high value and well above the threshold of 1, considering the level of alert and equal to the national average value calculated by the Istituto Superiore di Sanità in its latest report. To this end, Sala is considering the introduction of new restrictions.
The situation in Milan is considered very serious by both the local administration and the regional government, because even during the peak of the epidemic the city had not registered such a high number of new cases per day (the record was 480, 22 April of a remitted blockade). However, no one is talking about a real emergency yet, because, as much has been specified in recent months, today’s figures are hardly comparable to last spring, especially data on new infections: today we do much more testing, We tested entire categories of people beyond hospitals, including students, and found many more asymptomatic. However, there are a few things to keep in mind to understand the situation in the city.
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The first refers to the difficulties encountered by the Milan ATS when making contact tracking, which is the tracing of the contacts of the positives, a fundamental activity to contain the epidemic (ATS is the acronym for the Health Protection Agencies, public bodies that manage the Lombard regional health system, and which in other regions are called ASL).
As Vittorio Demicheli, director of the ATS in Milan, said, the tracking system has gone into crisis: the ATS has recruited for traditional tracking – therefore, what is done by calling each contact of each person who tested positive by phone – 150 health assistants, which however seem to be insufficient. Having improved the ability to make swabs and, therefore, to identify positives even among asymptomatic patients, and finding ourselves in a non-blocking situation, the number of contacts to call health workers is increasing. Therefore, the risk is not being able to interrupt the chains of contagion in time, allowing potentially contagious people to continue going to work and having social contacts.
A family doctor who has the practice in Milan told al Send have learned directly from the ATS that training activities contact tracking “I’m twenty days late”: an enormous amount, and a period of time that makes it practically useless to trace the contacts of the positives.
According to the doctor, in recent weeks a great work overload had been created in the ATS, first by the tampons that were made to people who returned from abroad, at the end of the holidays, and then by the reopening of schools, and the large number of tests performed on children. In this regard, on Thursday the mayor of Milan, Giuseppe Sala, said: “We must know where infections arise. More where they are born than where they are detected. For example, in schools a great contagion does not arise, perhaps it is detected, they are more monitored places, and when the infection is detected there is the possibility of an immediate trace ”.
– Read also: The difficult months that await pediatricians
To understand the progress of the epidemic in Milan and assess its severity, we must look above all at the situation in the city’s hospitals, which during the so-called “first wave” had evolved quite well, also thanks to a much more contained spread of viruses than in other Lombard cities and provinces. In fact, between March and April, the Milanese hospitals were able to accommodate intensive care patients transferred from other structures in the region, such as the Bergamo and Cremona hospitals, which were much more in difficulty. Today, this is no longer the case.
In recent days, some hospitals in Milan have shown their first serious difficulties: at the moment, intensive care is not so under pressure, that they still have several free beds and can have a certain number of “plans b”, so on. say – but the other departments.
San Carlo and San Paolo said that they had run out of beds in sub-intensive therapies, and the general manager of the Asst referral, Matteo Stocco, said that the hospitalization of all patients who came to the emergency room was only possible thanks to the opening of additional departments and the conversion of a specific area of the structure. The situation is also getting worse in Niguarda, in the north of Milan, where in recent days there has been a significant increase in the number of patients arriving at the emergency room with respiratory symptoms: in the vast majority of cases, said Andrea Bellone , Head of the Service. These patients do not need resuscitation, but rather low-flow oxygen, cortisone, and anticoagulant. In the Polyclinic, the pressure began to be felt in the last week, during which hospitalizations have tended to double both in intensive care and in the wards: the situation, however, is defined as “under control”.
The Sacco hospital emergency service has decided to accept only COVID-19 patients in the pulmonology rooms and one of internal medicine, diverting patients with other illnesses not related to the coronavirus to other Milanese hospitals. The decision was made to protect patients not affected by COVID-19 and still guarantee them medical care. Il Sacco also seems to have difficulties with regard to intensive care places: an anesthetist from a large hospital in the province of Milan told the Send that Sacco has stopped accepting intensive care patients transferred from other facilities due to a lack of available beds.
At present, about half of the COVID-19 patients admitted to intensive care in Lombardy are in hospitals in Milan and, in particular, in Niguarda, Policlinico, Sacco and San Carlo. We speak of more than thirty people, a figure that is not very worrying considering that there are still places available. In fact, only places should not be considered currently available, but also those that will be when the number of admissions to intensive care exceeds the thresholds established in June by the Lombardy region, and that will lead hospitals to allocate more and more space to coronavirus positive patients (we are now at the level 1 of 4: When level 3 is reached, for example, the hospital will reopen at the Fair).
In recent days, Milan has been discussing the introduction of new restrictions, which could also be adopted in other areas of Lombardy where worrying figures are registered, such as the provinces of Monza and Brianza and Varese. For example, we are talking about distance learning for high schools, hourly restrictions on takeout, and additional restrictions on public gatherings and events. A decision could already be made in the next few hours.
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