Three years have passed since the positive Covid swab of patient 1 of Italy was discovered in Codogno. Five days after “the first Covid case in Legnano. It was February 25, 2020, a medical colleague was the first to test positive for Sars-CoV-2 infection”. Antonino Mazzone, director of the Medical Area Department of the Asst Ovest Milanese and general secretary of Fism (Federation of Italian medical-scientific societies), recalls those days when his hospital, like various structures in the country, clashed with the pandemic and, looking at the past from where we are today, invites us to use “the experience of fighting the pandemic to address new needs, such as those of the emergency room”.
The expert defines his words as “free reflections of those who have fought against the virus, have fallen ill and are still fighting to improve the system”. In his opinion, “there is no doubt that the Covid emergency has found us unprepared, not only for what concerns the actual pandemic but for what the Covid ‘syndemic’ was, i.e. the global biological impact and social impact that it has had on the health care organization and on the general population”. Mazzone speaks of “a war” that the world community has had to face against an infection “that has affected and affects everyone, increasing mortality, especially in the setting of patients suffering from various pathologies, in polypharmacotherapy and the elderly”.
The focus of the specialist is concentrated on the internal medicine departments and on the role of the internist, who “a bit like the halfback in football: he doesn’t appear, but he wins the World Cup”. And he observes: “Now in this new emergency that sees emergency rooms and emergency medicines in difficulty, we need the same flexibility and spirit of collaboration to face together the new emerging health problems”. During the pandemic “we really witnessed the concept of ‘patient at the center’, until then it remained more of a theory than a fact”. In the same way, Mazzone insists, “now that there is an emergency room emergency, we need to recover that organizational capacity that has seen the patient at the center. In the serious shortage of medical personnel, we cannot keep emergency rooms open they are nothing more than clinics, which are of no use and create damage to the population as well as economic damage”.
Today, continues the internist, “we must overcome this feeling of abandonment and frustration that has affected post-Covid doctors and nurses. We must fight like in Spain, where 250,000 citizens took to the streets in defense of the Public Health Service. We cannot afford not to make effective and efficient decisions in defense of the National Health Service. We are risking losing a public heritage that must be defended, supported and improved”.
What has the pandemic taught us? “The importance of ventilators has rightly been highlighted – reflects Mazzone – but we must not forget how even bedside ultrasound (vascular, cardiological, thoracic, abdominal) of patients who are difficult to move has facilitated the diagnosis and consequently the treatment. This it must make us change the organization. In large medical areas there must be at least 20-30% of ‘High Care’ beds, i.e. beds equipped with technology for monitoring vital parameters with relative observation and control unit. necessary in complex patients, in patients requiring semi-intensive treatments or in patients suffering from a serious acute pathology, not only to guide the treatment, but also to intercept in advance situations of potential instability”.
And then there is the training chapter. “Administrations will have to understand that doctors must have time available for training and updating. Only in this way can what is routine in other parts of the world, namely the periodic re-evaluation of one’s skills, be better accepted”, says the expert. Finally, the concept of the patient at the center: during the pandemic “infectious disease specialists, pulmonologists, internists and specialists from other disciplines intervened on the individual patient, each according to his or her skills, going beyond what until yesterday was a single simple consultancy. We have seen experiences where all the specialists saw the patient every day, even several times a day, once the request for that patient had been acquired, taking charge entirely of the problem for which they had been called in. This – concludes the specialist – must happen today in the emergency room and in medicine emergency: the patient at the center and the specialists who take care of it for their part”.