Triage decision-making at the time of COVID-19 infection: the Piacenza strategy

Excerpt

Since its detection in China in December 2019, coronavirus disease 2019 (COVID-19) rapidly spread throughout the world becoming a Public Health Emergency of International Concern. In January 2020, the WHO Emergency Committee decided to declare a global health emergency. On February 21, 2020, the first case of COVID-19 had been reported in Northern Italy (Codogno, Lombardy), becoming the beginning of the COVID-19 pandemic and humanitarian crises in Italy. The COVID-19 outbreak in Northern Italy has been the cause of the healthcare system crisis with a massive influx of patients to the Emergency Departments, particularly in Piacenza due to its proximity to Codogno. In few days, the COVID-19 epidemic paralysed our public health system and hospital organization, becoming a challenge for our Emergency Department. At the beginning of the Italian COVID-19 outbreak, we based the suspicion of COVID-19 infection upon the epidemiological risk: the exposure to confirmed COVID-19 case or prolonged contact with people in the geographical area with confirmed COVID-19 cases in the past 14 days. Unfortunately, with the global and severe spread of COVID-19 and the dramatically increased number of infected patients in Piacenza, despite being a relatively small city, our hospital became one of the epicentres of the Italian epidemic with 2276 cases and 447 deaths at this moment. The situation quickly turned critically with overcrowded Emergency Department and Intensive Care Unit, nearing collapse. As consequence, our own hospital became a quite totally dedicated COVID-19 hospital with 80% of beds reserved for ill COVID-19 patients. We felt deeply concerned both by the alarming levels of spread and severity, and by the number of critically ill patients who required an immediate hospitalization in the Intensive Care Unit. To avoid the complete collapse of our healthcare system because of the lack of expertise in epidemics and the presence of limited human resources, we needed to change our perspectives and develop a long-term plan against catastrophic consequences to warrant a “COVID-19-free way” in the Emergency Room and prevent COVID-19 spread in “COVID-19-free wards” in our hospital. …