Coronavirus, Covid-19 will remain an endemic disease: “It will be treated like a flu”

“In Lombardy, every doctor conducted has an average of 30 potentially Covid patients in isolation waiting for a buffer, waiting for the result to last up to 7 days, but if the symptomatic remains in isolation, in the meantime, family members can go shopping, or at work. The estimate is that there are 700 thousand positive potentials for a walk. ” The numbers it entrusts to Today doctor Silvestro Scotti, National Secretary General of the Italian federation of family doctors, throw a new light on an iceberg that the usual civil protection bulletin would only be able to detect in a small part.

Coronavirus, waiting even 7 days for swabs: denucia

The crack of the protocols with which the coronavirus emergency has been managed since January 31st emerges day by day in all its worrying complexity. Over the past few months the Italians have learned that the new virus that arrived from Wuhan (probably via Munich) is highly contagious and that only a part of the infected people show symptoms, a large part so lightly that it does not catch the attention , being invisible to official statistics but ending up becoming carriers of the virus. Then there are the over 80 thousand registered Covid patients positive from nasopharyngeal swabs who to date have guaranteed the basis for discussions on the lethality of the disease. The figure of the victims out of the total number of infected people appears so apparently out of scale compared to the data of China, but as the mayors of the province of Bergamo are pointing out, it captures only by default the deaths caused by the coronavirus epidemic.

TO #Bergamo, from 1 to 24 March, the deaths of the residents were 446: 348 more than the average in recent years (98).
Deaths officially due to # Covid19 there are 136 in the period. There are 212 more.
With a mortality of 1.5-2%, the infected in the city would be between 17 and 23 thousand pic.twitter.com/wnDYE1IVl3

– Giorgio Gori (@giorgio_gori) March 26, 2020

Let’s start from here to understand the complaint that the union of family doctors reiterates to Today. “We need to change the paradigms with which our country is facing this emergency,” he explains Silvestro Scotti.

Coronavirus, a paradigm shift

On September 23, 2019 the manager of the League Giancarlo Giorgetti and then Undersecretary to the Prime Minister, responding to a request on the greater funds necessary for the health of the then leader of Article One, Roberto Speranza, today Minister of Health, said “Dear Hope, it is true, there will be 45 thousand GPs in the next five years. But who goes to the general practitioner more? Without offense for general practitioners also present in the room. In my small country they obviously go to make medical prescriptions, but those who are less than fifty go on the internet, have self-prescriptions made on the internet, look for the specialist. All this world here, that of the doctor who was trusted too, that stuff is over there too“.

Mr. Secretary, let’s start from here: it is clear that Italy is finding itself at the center of an emergency that could perhaps have been managed in a different way. Did we find ourselves unprepared? Is there anything wrong with the Lombard health model as denounced by the mayor of Bergamo Giorgio Gori?

“In normal conditions it is a highly efficient model, but when it moves on the public hygiene level the knots are blown away. In 2015 the Region has chosen to dismantle the system of territorial districts to adopt that of the ATS, the health protection agencies. Model (born with the Maroni administration, already heir to that of Formigoni, ed) ends up centralizing some of the forms of garrison of the territory on hospitals that were previously the duty of the doctors conducted. A model that had to take charge of managing an epidemic. ”

Can you explain better …

“The default and the bureaucratic process that has been put in place. I ask you a question: who is in charge of the quarantined persons? If a patient calls his doctor accusing symptoms of coronavirus infection, the family doctor asks him to As he is not a health police officer, he can only draw up a card if the patient reveals that he is in close contact with a Covid patient. The card is then sent to the public hygiene department of the competent health company in the area. The department then activates your own doctor who as a medical officer contacts the suspected Covid patient again (that it is worth remembering, has not yet made the buffer, ed) to submit it once again to the symptom evaluation form. The health authority discharged the symptoms activates health surveillance for 14 days. At this point, contact the family doctor who contacts the patient and draws up the medical certificate to be presented to INPS (quarantine counts as illness period, ed.). At this point the INPS doctor activates and must certify the disease “.

A Byzantinism worthy of Italy …

“But it’s not over. Let’s assume, fortunately for the majority, that the patient can heal in home isolation without the family doctor having to request a transfer to the hospital for breathing support (currently there is no treatment protocol, and it is essentially the immune system that defeats the infection. Experimental drugs are used only in the most critical cases. Editor’s note). Who can certify that patient’s recovery? What if he returns to work and risks infecting his colleagues? And in the meantime, family members living with a Covid suspect – but not certified – can continue to go to the supermarket? Or at work? “.

What are the possible solutions?

“The Chinese solution: equipped hospices in which to transfer positive Covid patients, and the quarantine of family members who will be able to receive home support of basic necessities. You see well that this is not a system that can hold up if it only refers to hospitals: family doctors must go back to being health officers in order to manage support for the sick at the forefront, and not just by providing palliative care as it is now “.

And make more tampons?

“The tampons are now useless, now they only serve to protect the sanitary ware, which obviously had to be done before to prevent us from having to attend this Spoon River of white coats involving largely family doctors (Here is the list of doctors who are victims of the coronavirus epidemic). Even today, the ASLs do not provide us who are at the forefront with suitable protective instruments, surgical devices. We had to buy protective glasses and masks ourselves when we find them. We have to realize that the Covid will remain as an endemic disease. For this reason, our health system must be equipped to lighten hospital management which, unfortunately, must also take on all the other diseases that have not disappeared overnight. Home treatment must be implemented, and the blockage of administrative management which, as we have seen before, is considerably cumbersome must be avoided. It is therefore necessary to define new protocols and adopt a clinical diagnostic criterion: already today most of the symptoms found are attributable to Covid patients, and will have to be treated as a flu, pending a cure and a vaccine. ”

𝐀𝐢𝐮𝐭𝐚𝐜𝐢 𝐚 𝐩𝐫𝐨𝐭𝐞𝐠𝐠𝐞𝐫𝐞 𝐢𝐥 𝐭𝐮𝐨 𝐦𝐞𝐝𝐢𝐜𝐨 𝐝𝐢 𝐟𝐚𝐦𝐢𝐠𝐥𝐢𝐚! 𝑫𝑶𝑵𝑨 𝑶𝑹𝑨 https://t.co/VtKATmrev9

With only 1 Euro you can help us purchase PPE to be distributed to all the family doctors involved in the area # COVID19 # FIMMGcè @Cittadinanzatti pic.twitter.com/Vr1L7Hw59E

– FimmgNazionale (@FimmgNazionale) March 16, 2020

Coronavirus, the latest news

Side note: today antimalarial drugs have been authorized in Italy based on chloroquine and hydroxychloroquine. As stated in the Official Gazette, they are fully charged to the National Health Service for the treatment of patients with Sars-CoV2 infection.

A virtual reality fly-through showing the extent of COVID-19 lung damage (yellow) in a 55 year old patient. Source Dr. Keith Mortman, George Washington University Hospital.