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Swabs, doctors and hospitals: why the virus is out of control

Yellow, orange and red: these are the colors that today identify the Italian regions on the basis of three different risk bands that take into account the relationship between the speed of diffusion of Covid-19 and the risk linked to the health system of each Region.

The problem is that the circulation of the virus in Italy, at the moment, is outside control: the new cases of positivity have been steadily over 30 thousand for days and the number of patients who end up in intensive care increases exponentially. And deaths. Yet the summer had made us catch our breath, deluding us that the virus would disappear, as if by magic. And above all the Conte government was deceived (it should never have happened) that it did not know how to implement the right countermeasures for the second autumn wave that we are all experiencing on our skin. Now the situation is a lot grave, the national health system is saturated and every hour that passes under increasing pressure. But that’s not the only problem.

“Doctors are missing”

“The exponential curve needs a turnaround, we have to go back to lockdown generalized. We take a break, make a healthy reflection and reduce the infected. If we have not been able to dominate the situation as in the good months, at this point we must take a break otherwise the situation escapes us. Doctors and nurses are not infinite “, he exclusively told ilgiornale.it the vice-president of the National Federation of the Orders of Surgeons and Dentists (FNOMCeO) Giovanni Leoni.

“The Covid-19 infection curve has assumed exponential proportions, we need to be able to contain hospitalizations for therapy intensive because the places are limited, the battle must be conducted in the territory and not in the hospitals “, Leoni told us. Precisely the regional territorial realities, which are the responsibility of both the national government and the individual Regions, have not been strengthened in the summer they had allowed them to breathe.

The lack of sanitation. “The tragedy is that healthcare workers are always there same and the other problem is also the transfer of doctors from specialist functions to other Covid assistance functions, their preparation is in other fields. Right now we are suffering from a numerical and organizational gap. “As Prof. Leoni says, the problem of the objective lack of specialized doctors is only the tip of the iceberg of a health system that, in the short term, will not be able to withstand what is happening with this second wave. To tackle this problem, the words of the governor of Veneto Zaia have caused a stir and created controversy, who would also like to enlist veterinarians, who only treat animals, to help family doctors to carry out rapid swabs .

Insufficient family doctors. “The problem is that general practitioners have too many homework“, says Leoni, and they concern the flu vaccinations in progress, the numerous problems that do not concern Covid (which continue to exist) and all the patients who turn to them if positive for the virus. To all this we must add the fact that, many of them have clinics inside condominiums where the inhabitants are on a war footing fearing infection. “Doctors have a 20% chance of swabbing properly, all the others must equip themselves with the help of Local health authorities and the Municipality to make them in suitable structures “.

On the question, atAdnKronos, the National Secretary General of the Family Doctors Silvestro intervened Scotti: “We are working on starting the execution of the tampons rapid in the offices of family doctors, preparing what is necessary to guarantee a structured and safe service. We signed the agreement in record time, in one week, now we need the operational structure that the agreement provides, from the distribution of the tampons to the development of the platform for communicating the results. And all this does not depend on the doctors“. In any case, the previous question remains: there is a lack of adequate professionals and it could get worse in the near future when the retirement of 4-5 thousand doctors is expected, which would leave between 5 and 8 million Italians uncovered.”In recent years, a standard has been introduced that allows you to become mmg already during specialization in order to try to stem this problem – concludes Scotti. – However, we have been waiting for 6 months for the green light which depends on the Conference of Regions. Throughout Italy there are 2 thousand doctors who would be ready to go to the office, in Lombardy there are 200“.

The hospital network

But how is the hospital network? In recent months, each Region has had the freedom to organize itself in its own way, albeit with the obligation to submit a reorganization plan for approval by the Ministry of Health. And what has changed? Virtually nothing. “The big difference is that the infection is now also in the South, which is seriously involved. The beds in intensive care are obtained by transforming even the operating rooms at the expense of normal surgical activity”, the vice-president told us. Lions. And the initial problem arises again: the increase in the number of beds in intensive care does not coincide with the increase in doctors, or if it does, there is a risk of sending those who have another professional training to the fore. “The recruitment of doctors to assist patients with respiratory failure needs preparation, they cannot be sent to the field like this … They must also be protected from an insurance point of view because they go to do a job that is not theirs”, is the bitter Italian reality.

Problems in the ICU

“The places have increased but, in the face of the increase in ICU beds, health workers have increased by only 5%.” It is a situation of ‘magic’ … I did not invent the data, I amazed myself at these things here. A doctor is forced to follow several beds but it is the standards of care for the sick in intensive care that are not good: they are sick who need everything. “In short, the doctors are always the same, forced into grueling shifts and forced to follow many more patients than necessary. The battle, therefore, is to avoid arriving in intensive care, out of 100 Covid patients 3-4 end up in intensive care and 10-15% in normal wards. “Lower the number of infections” .

Just to manage the new beds in intensive care, almost two thousand anesthetists are needed in addition to the nurses and specialists necessary for the plan to strengthen sub-intensive therapies, said Carlo Palermo, secretary of the Anaao Assomed union, in an interview with Republic. “The increase, although not optimal, in intensive and sub-intensive beds, in fact, has made the blanket even shorter“. According to the analysis Altems on 15 October it was discovered that the number of anesthetists per bed has decreased: if before Covid in Italy there were on average 2.5 anesthetists per bed, today there are 1.6 with marked regional differences. “These are roles that must be regularized with fixed-term and open-ended contracts, otherwise the shortage of medical personnel will only worsen in the coming years, and we will find ourselves again unprepared when a new emergency arrives.”, Concludes Palermo.

The Continuity Care Units

In addition to the reorganization of the hospitals, the Government’s strategy also rests on the strengthening of territorial assistance with the creation of the Usca dedicated to taking charge and monitoring of patients in home isolation. But these Usca are a mirage in many and there is no monitoring system that tells exactly how many are actually in operation: according to the latest data available, there should be about 600 in 15 Regions, less than half of what was considered necessary by the Government to last March. “Again, the major problem is the preparation of newly graduated doctors who are made available. The Usca will be sufficient if the number of patients remains controllable”, says Prof. Leoni. “Usca insufficient? I can speak for the Veneto, in my region they work but all the Regions must reach this level of recruitment. There is no shortage of graduated doctors, there is no organization”.

In short, Covid runs and does not stop. But under these conditions here, it’s going to be really hard to resist until the much-relied on vaccine arrives.

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