SARS-CoV-2 pandemic in Italy: ethical and organizational considerations
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.
Pisano GP, Sadun R, Zanini M [Internet]. Lessons from Italy's response to Coronavirus. Harvard Business Review 2020 Mar 27. Available from: https://hbr.org/2020/03/lessons-from-italys-response-to-coronavirus
Centro nazionale per la Prevenzione e il Controllo delle Malattie del Ministero della Salute (CCM). Piano nazionale di preparazione e risposta a una pandemia influenzale. 2007. Available from: https://www.epicentro.iss.it/focus/flu_aviaria/pdf/pianopandemico.pdf
Nardini S, De Benedetto F, Donner CF, Sanguinetti CM, Conte S, Marino L, et al. [AIMAR protocol for the management of pandemia influenza A(H1N1)-2009 in respiratory divisions. Role and competence of the Pneumo(phtysio)logy department].[Article in Italian]. Multidiscip Respir Med 2009;4:434-43.
LaRussa P. 2009 pandemic novel H1N1 flu: what have we learned? Semin Respir Crit Care Med 2011;32:393-9. DOI: https://doi.org/10.1055/s-0031-1283279
WHO. Rolling updates on coronavirus disease (COVID-19). Accessed on March 2020. Available from: https://www.who.in/emergence/diseases novelcoronavirus-2019 .
Task force COVID-19 del Dipartimento Malattie Infettive e Servizio di Informatica Istituto Superiore di Sanità. Infografica. Accessed on: 5 April 2020.
WHO. Coronavirus disease 2019 (COVID-19). Situation Report – 77. Accessed on: 6 April 2020.
Atluri S, Manchikanti L, Hirsch JA. Expanded umbilical cord mesenchymal stem cells (UC-MSC) as a therapeutic strategy in managing critically III COVID-19 patients: The case for compassionate use. Pain Physician 2020;23:E71-83.
Li R, Pei S, Chen B, Song Y, Zhang T, Yang W, et al. Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV-2). Science 2020; pii: eabb3221. doi: 10.1126/science.abb3221. [Epub ahead of print]. DOI: https://doi.org/10.1126/science.abb3221
Day M. Covid-19: four fifths of cases are asymptomatic, China figures indicate. BMJ 2020;369:m1375. doi: 10.1136/bmj.m1375. [Response available from: https://www.bmj.com/content/369/bmj.m1375/rr-5]. DOI: https://doi.org/10.1136/bmj.m1375
Zhu L, Li C, Ning SS, Chen S, Cao L, Yang GJ, et al. [Epidemiological characteristics of COVID-19 in Shaanxi province].[Article in Chinese with English Abstract]. Zhonghua Liu Xing Bing Xue Za Zhi 2020 41:E034. doi: 10.3760/cma.j.cn112338-20200225-00172. [Epub ahead of print].
Singhal T. A review of Coronavirus Disease-2019 (COVID-19). Indian J Pediatr 2020;87:281-6. DOI: https://doi.org/10.1007/s12098-020-03263-6
Senior Italia FederAnziani. Proceedings Eighth National Congress. 21-22 Novembre 2019. Rimini, Italy.
Ferguson N, Laydon D, Nedjati-Gilani G, Imai N, Ainslie K, Baguelin M, et al. Imperial College COVID-19 Response Team. Report 9: Impact of non-pharmaceutical interventions (NPIs) to reduce COVID19 mortality and healthcare demand, 2020 Mar 16. Available from: https://spiral.imperial.ac.uk:8443/handle/10044/1/77482
[Internet]. Corona Virus - Covid19 - Covid Trends. Accessed on: 17 April 2020. Available from: https://covidtrends.com/
Langmuir AD. The surveillance of communicable diseases of national importance. N Engl J Med 1963;268:182-92. DOI: https://doi.org/10.1056/NEJM196301242680405
Langmuir AD. Evolution of the concept of surveillance in the United States. Proc R Soc Med 1971;6:681-4.
Selgelid MJ. Ethics of infectious disease control. In: S.R. Quah, editor. International Encyclopedia of Public Health 2nd ed. Academic Press; 2017; p. 11-16. DOI: https://doi.org/10.1016/B978-0-12-803678-5.00145-4
Gostin LO. Public health surveillance and research. Personal privacy and the "right to know". In: Public health law. Power, duty, restraint. California University Pres; 2008; p. 287-330.
Ministero dell’Interno. Coronavirus, i dati dei servizi di controllo. Accessed on: 6 April 2020. Available from: https://www.interno.gov.it/it/coronavirus-i-dati-dei-servizi-controllo
Petrini C. Ethics in public health surveillance. Ann Ist Sup Sanità 2013;49:347-53.
Lee LM, Heilig CM, White A. Ethical justification for conducting health surveillance publishes without patient consent. Am J Public Health 2012;102:38-44. DOI: https://doi.org/10.2105/AJPH.2011.300297
Rosenbaum L. Facing Covid-19 in Italy - Ethics, logistics and therapeutics on the epidemic's front line. New Engl J Med 2020. doi: 10.1056/NEJMp2005492. DOI: https://doi.org/10.1056/NEJMp2005492
Gardner-Thorpe J, Love N, Wrightson J, Walsh S, Keeling N. The value of Modified Early Warning Score (MEWS) in surgical in-patients: a prospective observational study. Ann R Coll Surg Engl 2006;88:571-5. DOI: https://doi.org/10.1308/003588406X130615
WHO. Assistance at home for patients with suspected new coronavirus infection (COVID-19) who exhibits mild symptoms and management of their contact. Intermediate guide. 4 February 2020.
Waydhas C, Herting E, Kluge S, Markewitz A, Marx G, Muhl E, et al. Intermediate care units: Recommendations on facilities and structure. Med Klin Intensivmed Notfmed 2018;113:33-44. DOI: https://doi.org/10.1007/s00063-017-0369-7
Christian MD, Hamielec C, Lazar NM, Wax RS, Griffith L, Herridge MS, et al. A retrospective cohort pilot study to evaluate a triage tool for use in a pandemic. Crit Care 2009,13:R170. DOI: https://doi.org/10.1186/cc8146
Khan Z, Hulme J, Sherwood N. An assessment of the validity of SOFA score based triage in H1N1 critically ill patients during an influenza pandemic. Anaesthesia 2009;64:1283-8. DOI: https://doi.org/10.1111/j.1365-2044.2009.06135.x
Fink SL. Worst case: rethinking tertiary triage protocols in pandemics and other health emergencies. Crit Care 2010;14:103. DOI: https://doi.org/10.1186/cc8216
Loddenkemper R, Séverin T, Mitchell S, Belevskiy A, Chuchalin A, de Hosson S, et al. Adult HERMES: criteria for accreditation of ERS European training centres in adult respiratory medicine. Breathe 2010;7:170-88. doi: 10.1183/20734735.020910. DOI: https://doi.org/10.1183/20734735.020910
Li JY, You Z, Wang Q, Zhou ZJ, Qui Y, Luo R, et al. The epidemic of 2019-novel- coronavirus (2019- nCoV) pneumonia and insights for emerging infectious diseases in the future. Microbes Infect 2020;22:80-5. DOI: https://doi.org/10.1016/j.micinf.2020.02.002
Del Donno M, Di Sorbo A, Micco A. Overcrowding in hospital emergency departments in winter and increase in beds in Respiratory disease units. Rass Patol App Resp 2018;33:206-14.
British Lung Foundation. Out in the cold: lung disease, the hidden driver of NHS winter pressure. December 2017. Available from: https://www.blf.org.uk/policy/out-in-the-cold
Leung CC, Lam TH, Cheng KK. Mass masking in the COVID-19 epidemic: people need guidance. Lancet 2020;395:945. DOI: https://doi.org/10.1016/S0140-6736(20)30520-1
Matricardi PM, Dal Negro RW, Nisini R. The first, holistic immunological model of COVID-19. Implications for prevention, diagnosis, and public health measures. Pediatr Allergy Immunol 2020. doi: 10.1111/pai.13271. DOI: https://doi.org/10.1111/pai.13271
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