Non-critical asymptomatic patients the new emergency
These days the whole country is facing a new wave of the SARS.CoV.2 pandemic. The pandemic impact today more than in the past puts under pressure not only the vaccination processes, but also a series of territorial choices, protocols and organizational situations on which SIAARTI intends to draw the attention of health institutions.
The intervention of SIAARTI
“We have three phenomena that cause our concern,” he says Antonino Giarratano, president of SIAARTI, “The first is naturally linked to the direct needs linked to the COVID.19 pandemic, those of sepsis and severe respiratory insufficiency that absorb hundreds of beds and numerous human resources, including in the first place those of the Anesthesiologists. The second one: non-Covid healthcare. 19 in many regions it is overwhelmed by the needs of the pandemic and perhaps even – in some situations – by the need to reserve beds in order to remain in ‘lighter and less-emergency’ colors. We know that this criticality generates worrying delays, reaffirmed in particular by the world of surgery and already presented with a question to the XII Commission of the Chamber. And then there is the third overlooked phenomenon: health care for asymptomatic non-critical COVID.19 patients. There are hundreds of patients who are detected as positive and who will have to be operated on, transplanted, and assisted in the intensive postoperative. We need to plan today what in a few weeks – after the last wave of the pandemic emergency is over – will in all likelihood become a new health emergency “.
The SIAARTI message is based on the concrete experiences of the coordinators of the various scientific areas of the company. As it observes Nicola Latronico (SIAARTI resuscitation and intensive care manager): “The COVID.19 Intensive Therapies are traveling towards saturation, with the very close need to open other places stolen from non-COVID.19 ICUs. The latter, reduced in their capacity for beds and staff, are under pressure to cope with time-dependent pathologies (trauma, stroke), acute non-COVID 19 pathologies (sepsis, acute respiratory failure) and to take care of patients complex and severe post-operative “.
Angelo Gratarola (responsible for SIAARTI anesthesia and perioperative medicine) also underlines other problems: “we experience a sort of color blindness of the risk bands, in fact there is a risk of territorial orange for patients hospitalized not because of COVID.19, but only for the incidental positivity discovered at Emergency room. This represents a concrete problem: the Ministry should in fact – after hearing the scientific societies, primarily SIAARTI – offer indications and operational guidelines to be able to undergo surgery for patients who are simply positive for the virus “.
Analysis confirmed by Roberto Balagna (responsible for SIAARTI emergency critical medicine), who stresses that “Every day we are forced not to operate on patients who would need surgery of a certain importance and necessity, for example cancer patients. I am referring to an increasingly large population of vaccinated patients, often with three doses, asymptomatic and who test positive for the swab performed at the time of pre-hospitalization. This population is becoming more and more numerous both in the context of emergency urgency and as regards patients who need life-saving transplants. Clinical, logistical and organizational management of the pathways is becoming increasingly critical. If dynamic solutions are not found soon, by reviewing the current procedures – concludes Balagna – the entire surgical system will soon be in chaos ”.
Within the obstetrics area, Maria Grazia Frigo (responsible for SIAARTI maternal and child care) offers an unprecedented clarification: “the obstetric population is still too exposed to contagion because it is still largely unvaccinated against SARS.CoV.2, despite the recommendations of the ISS and the main scientific societies in the sector . The event of labor in childbirth or in general the obstetric emergency cannot be postponed and this entails pressure on the structures that can compromise the safety of the birth path if it is not carried out safely and with the utmost organizational prudence “.
Extreme pressures on intensive care and anesthesia, surgical procedures at risk of continuous referral, asymptomatic patients, guarantee of safe births, lack of clear protocols in situations that were not foreseeable only two or three months ago: SIAARTI asks that these areas not be silenced or undervalued due to the current global pressure.
In light of these data and considerations, Antonino Giarratano, on behalf of all of SIAARTI, invites the Ministry of Health and the Regions to “focus on these critical issues and plan actions and methods of intervention, so that the NHS, currently engaged on two such hot fronts (fight against COVID.19 and planning of the interventions foreseen in the PNRR) know how to give a clear direction on the management of these problems in order to avoid the collapse of the Health System in the coming months “.