A very sobering piece published in NEJM Catalyst Innovations in Care Delivery (a new digital journal in the NEJM group) describes a catastrophic situation in a hospital in Bergamo, Italy, which has been overrun by COVID-19. We all have much to learn from this experience: about pandemic preparedness, response, and the key role of IPC at all stages of this pandemic.
Bergamo is a city in Lombardy, Italy, with a population of a little of 120,000 people. The group of clinicians who have written this article work in a modern hospital with 900 beds, and almost 50 ICU beds. The article describes how the hospital has rapidly become overwhelmed with COVID-19. One third of the hospital beds are being occupied by patients with COVID-19, standards of care have slipped badly, and staff are exhausted, emotionally depleted, and largely unprotected. The article describes an even worse situation in surrounding hospitals and healthcare services.
We have much to learn from this experience:
- IPC is key to mitigating the impact of COVID-19 on an acute healthcare provider – and the wider healthcare sector. Wherever you are on the epi curve (awaiting your first case, or with 1/3 of inpatient beds full of patients suffering from COVID-19), reinforcing the key IPC principles of surveillance, patient segregation, hand & environmental hygiene, staff protection, and optimal patient therapy will make a bad situation better.
- The healthcare sector needs to respond in a co-ordinated way to COVID-19. An isolated response by acute healthcare providers will not be enough unless there is a co-ordinated approach to release pressure on acute hospitals (e.g. different and enhanced home care arrangements).
- Extensive social distancing is the short-term solution, and the rapid development of a vaccine is the long-term solution.
Thanks to this group of clinicians who somehow found time to put pen to paper to share their experience. My sincere hope is that the extensive social distancing that has been implemented in the UK will prevent us getting to this sort of scenario.