SPECIAL ARTICLE   Open access

Italian Journal of Emergency Medicine 2020 August;9(2):102-5

DOI: 10.23736/S2532-1285.20.00036-1

Copyright © 2020 THE AUTHORS

This is an open access article distributed under the terms of the CC BY-NC-ND 4.0 license which allows users to copy and distribute the manuscript, as long as this is not done for commercial purposes and further does not permit distribution of the manuscript if it is changed or edited in any way, and as long as the user gives appropriate credits to the original author(s) and the source (with a link to the formal publication through the relevant DOI) and provides a link to the license.

language: English

COVID-19. The Bergamo viral earthquake

Andrea DUCA, Ivan OPPEDISANO, Federico ZANARDI, Valentina ROSTI, Roberto COSENTINI ✉

Emergenza di Alta Specializzazione (EAS), Emergency Department, ASST Papa Giovanni XXIII, Bergamo, Italy

The first COVID-19 identified patient in ASST Papa Giovanni XXIII - Bergamo was on Feb 22, 2020. The paper describes the outbreak and our response, in terms of organization, mental reactions, and lessons learned. From Feb 22 to Apr 30, 2471 suspected COVID-19 patients were seen at our Emergency Department. We observed 3 different and worsening clinical presentations during the first week: 1) cough and core throat; 2) prolonged fever; 3) fever and pneumonia. During the first 3 weeks, over 30% of patients had a severe acute respiratory failure, and 48 patients died in the ED. 198/508 patients During the first 3 weeks, 198/508 patients were treated with Helmet CPAP: 52% survived (102/198), 28% with NIV alone and 24% with intubation and mechanical ventilation, suggesting that in limited resources, the treatment with Helmet CPAP and NIPPV may be a useful and feasible first line treatment for severe acute respiratory failure. Our ER has been completely redesigned and created a “clean” and “dirty” pathway according to a triage check-list. The entire ED was rearranged according to the severity of acute respiratory failure following the model developed by Stefano Paglia in Lodi, the first Italian hospital affected by the epidemic: 1) red area, for intubated patients; 2) yellow sub-intensive area (created ex novo), for patients treated with non-invasive mechanical ventilation; 3) green area, for patients on oxygen therapy. The rest of the hospital quickly converted the clean beds to COVID-19 beds. At the end of March, 102 patients were hospitalized in intensive care COVID-19, 160 patients were treated with NIV, both in the emergency room and in the wards, and 200 were in O2. In parallel, the health personnel had to be increased by 40% and the shifts were reorganized in terms of length (max 10 hours) and repetition (max 5 consecutive days). PPE protection was effective. As of April 30, 2020, only 10% have developed a mild acute infection and another 10% have IgG positive result. Other key factors are the supply of materials and logistics. Since we used high-flow CPAP with a helmet as the first line in the treatment of pneumonia, we had to add an additional O2 tank to meet the need for 160 simultaneous high flow CPAPs, bringing the maximum capacity to 11,000 L/min. If the team’s response is crucial, the epidemic is an immense mental and personal challenge. These are some personal lessons learned during the COVID-19 stress test: 1) stick to rituals; 2) share with family and friends; 3) go back to things you love. We had the privilege of being the first hard hit by the epidemic. And this was an opportunity to warn our colleagues in the emergency room around the world: 1) social media have also been a powerful catalyst for sharing data, solutions and hypotheses; 2) regularly evaluate the flow of patients and quickly change accordingly; 3) manage logistics and supply of materials in advance; 4) mentally prepare yourself, constantly share experience with colleagues. The final consideration is for our formidable staff, since the pandemic is an extraordinary stress test also for the health care personnel. If we managed such an apocalypse, it is thanks to them.

KEY WORDS: COVID-19; Italy; Pandemics