COVID-19: Lessons learned from Italy
Anticipation, flexibility, standard of care, lasting implications and global networking are the five critical areas of COVID-19 care, according to an orthopedic specialist at the epicenter of the European outbreak in Bergamo, Italy.
Nicola Guindani, MD, presented his advice for orthopedic and trauma surgeons amid the COVID-19 pandemic at the EFORT Special Edition Webinar. Guindani said he hopes other countries will learn from the “catastrophe” experienced in northern Italy due to the novel coronavirus.
“It's surprising that some European countries seem not to have learned such lesson[s] till now,” Guindani said in the webinar.
The importance of early anticipation is Guindani’s initial piece of guidance for health care systems.
“The first, most important thing to anticipate is the lockdown of the population and public health measures to avoid the propagation of the infection,” Guindani said.
His hospital, a first-level hospital and academic medical center with more than 900 beds and 88 intensive care units, serves a city with a population of 120,000 people.
“You may think it's enough for such a city, but the rapid spread of the infection overwhelmed our system,” he said.
The next strategy of COVID-19 care is flexibility, according to Guindani.
“You have to recognize, as an orthopedic and trauma surgeon, regional major trauma network reorganization,” he said. “Your department has to be flexible. We have less orthopedic patients, from 48 to nine patients. Our wards were fused together with other specialties.”
Guindani said orthopedic and trauma surgeons should be ready to work in the wards, educating caregivers to do what is needed for COVID-19 emergencies. Every day, 25% to 33% of every department went to work in a COVID-19 unit, he said.
Standard of care
The problem with flexibility is that it can have an impact on standard of care, Guindani said.
“In our trauma department, what happened was that we had one-third of the normal operation,” he said.
With the city on lockdown and with consequently less trauma, this was an acceptable measure to take, he said, but noted that accepting compromise on protocol could result in a diminished standard of care.
“You need a careful selection of the elective surgery because your waiting list is growing,” he said. He added that fast-track surgery can be beneficial during such times and that telemedicine can help with patient follow-up.
Guindani also stressed the importance of reducing transmission of the virus and its lasting impact on the hospital system and community. He said one way to reduce the spread of the virus through the wards is to treat all patients as if they have COVID-19.
In orthopedics and trauma, he said that means taking the precautions to not admit or discharge patients without certainty that they have not contracted the virus and to limit the number of patients sent to rehabilitation.
“What's also important is a global strategy instead of a hospital or regional national strategy,” Guindani said. “You may need temporary hospitals to anticipate the problem to another hospital ... and to help other regions when the infection goes farther in other countries.”
Passing along strategies, knowledge, experiences and even mistakes will go a long way to get out in front of the virus, he said.
“What we are doing now with the EFORT community is really paramount because if you let the knowledge run faster than the fears, then we have a chance to fight and defeat it,” Guindani said. – by Max R. Wursta
Guindani N. Lesson learned in one of the most critical areas. Presented at: EFORT Webinar Special Edition: Orthopaedic & trauma surgeons in the time of COVID-19; April 6, 2020.
Disclosure: Guindani reports no relevant financial disclosures.