9/1/2023 0 Comments Italy lockdown end dateHospital overcrowding may also explain the high infection rate of medical personnel. Apparently, many patients with relatively modest symptoms were admitted by the time more patients with severe cases started to arrive, there were limited reserves. In the winter, hospitals tend to run close to full capacity, with 87% average occupancy in Italy during the flu season. Given the little experience in dealing with the new virus, it is unavoidable that some strategic mistakes were made about which patients should be hospitalized. Overall, 5090 ICU beds (8.4 per 100 000 population) are available in Italy, and 2601 beds in coronary care units (4.3 per 100 000 population), 5 as opposed to much higher numbers (36 ICU beds per 100 000 population) in the United States. Italy has a highly competent state-run health care system, but it has only a modest number of ICU beds and very few subintensive care beds. 4 Accordingly, a higher level of preparedness should be considered for areas where mass gatherings have occurred or where there is extensive social intermingling.Ī third set of factors pertains to the standard capacity of the health care system and decisions made during hospital management of the presenting cases. It is possible also that in early stages, there was not much adoption of standard hygienic measures, and instructions to stay at home proved difficult to accept, with many complaints registered with the police. Italian life is famous for its socialization and frequent congregations and clustering. For example, it is likely that the health care system was overwhelmed in Bergamo owing to massive viral transmission during the Champions League match on Febru(Atalanta vs Valencia), where a third of the population of Bergamo attended and continued celebrations overnight. However, elsewhere in Italy, it is likely that the prevalence of infection was several times higher in the absence of effective public health intervention. 3 Following aggressive testing, the epidemic was extinguished. In the town of Vò, all 3300 residents were tested the day the first case was detected in the third week of February, and 3% were found to be infected. The proportion of people infected must have been very high in specific areas that were highly affected. For example, the proportion of the population older than 65 years is 9.5% in Alaska as compared with 19.1% in Florida and 23.1% in Italy.Ī second set of factors in Italy is the increased burden of cases that presented themselves to the health care system. Taking this adjustment into account, burden of disease may be expected to be much less in most areas in the United States, with variability across states and hospital catchment areas. 2 The corollary is that preparedness for needs of intensive care unit (ICU) beds and estimates of expected deaths should consider the age structure and chronic diseases of the population served by each health care system. Moreover, COVID-19 morbidity and mortality is strongly dependent on the presence of concomitant serious diseases, and Italy has a high proportion of patients with history of smoking and high rates of chronic obstructive pulmonary disease and ischemic heart disease. The median age of people infected with SARS-CoV-2 who are dying in Italy has been 80 years, and the average age of patients requiring critical care support has been 67 years. COVID-19 has a strong age dependence for the severity of the infection and the risk of death. Italy has the most elderly population in Europe and the second most elderly population in the world after Japan. Some factors pertain to demographics and background disease in the population. Some other contributing factors are potentially modifiable. Some contributing factors may be immutable (eg, age structure of the population), but even these need to be laid out carefully in preparedness assessments. It is important to understand why death rates were so high in Italy to learn how to best prepare and how to plan for optimal actions in other countries. The number of cases and deaths cannot be explained simply because of the epidemic starting in Italy earlier compared with other countries besides China. In the coronavirus disease 2019 (COVID-19) pandemic, Italy has been hit very hard, 1 with 110 574 documented cases and 13 155 documented deaths related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection as of April 1, 2020. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.
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