SARS-CoV-2 pandemic in Italy: ethical and organizational considerations

  • Stefano G. Nardini | snardini.pneumologo@gmail.com Italian Respiratory Society Research Centre, Milan, Italy.
  • Claudio Maria Sanguinetti Italian Respiratory Society Research Centre, Milan, Italy.
  • Fernando De Benedetto Italian Respiratory Society Research Centre, Milan, Italy.
  • Claudio Baccarani Business Management, University of Verona, Italy.
  • Mario Del Donno Italian Respiratory Society Research Centre, Milan; Pneumology Unit, A.O.R.N. “San Pio” – P.O. “G. Rummo”, Benevento, Italy.
  • Mario Polverino Italian Respiratory Society Research Centre, Milan; Endoscopic Unit, Pulmonary Division, Hospital M. Scarlato, Scafati (SA), Italy.
  • Isabella Annesi-Maesano INSERM and Epidemiology of Allergic and Respiratory Diseases Department, Sorbonne University, IPLESP, Paris, France.

Abstract

The current SARS-CoV-2 pandemic is still raging in Italy. The country is currently plagued by a huge burden of virus relatedcases and deaths. So far, the disease has highlighted a number of problems, some in common with other Countries and others peculiar to Italy which has suffered from a mortality rate higher than that observed in China and in most Countries in the world. The causes must be sought not only in the average age of the population (one of the oldest in the world), but also in the inconsistencies of the regional health systems (into which the National Health System is divided) and their delayed response, at least in some areas. Ethical issues emerged from the beginning, ranging from restrictions on freedom of movements and restrictions on personal privacy due to the lockdown, further to the dilemma for healthcare professionals to select people for ICU hospitalization in a shortage of beds in Intensive Care Unit (ICU). Organizational problems also emerged, although an official 2007 document from the Ministry of Health had planned not only what measures had to be taken during an epidemic caused by respiratory viruses, but also what had to be done in the inter-epidemic period (including the establishment of DPIs stocks and ventilators), vast areas of Italy were totally unprepared to cope with the disease, as a line of that document was not implemented. Since organizational problems can worsen (and even cause) ethical dilemmas, every effort should be made in the near future to prepare the health system to respond to a similar emergency in a joint, coherent, and homogeneous way across the Country, as planned in the 2007 document. In this perspective, Pulmonary Units and specialists can play a fundamental role in coping with the disease not only in hospitals, as intermediate care units, but also at a territorial level in an integrated network with GPs.

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Published
2020-05-25
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Reviews
Keywords:
SARS-CoV-2, mortality rate, ICU beds, ethical and organizational issues, intermediate respiratory care
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How to Cite
Nardini, S. G., Sanguinetti, C. M., De Benedetto, F., Baccarani, C., Del Donno, M., Polverino, M., & Annesi-Maesano, I. (2020). SARS-CoV-2 pandemic in Italy: ethical and organizational considerations. Multidisciplinary Respiratory Medicine, 15. https://doi.org/10.4081/mrm.2020.672