Abstract
The novel coronavirus, SARS-CoV-2, continues to spread rapidly. Here we discuss the dramatic situation created by COVID-19 in Italy, particularly in the province of Bergamo (the most severely affected in the first wave), as an example of how, in the face of an unprecedented tragedy, acting (albeit belatedly)—including imposing a very strict lockdown—can largely resolve the situation within approximately 2 months. The measures taken here ensured that Bergamo hospital, which was confronted with rapidly rising numbers of severely ill COVID-19 patients requiring hospitalization, was able to meet the initial challenges of the pandemic. We also report that local organization and, more important, the large natural immunity against SARS-CoV-2 of the Bergamo population developed during the first wave of the epidemic, can explain the limited number of new COVID-19 cases during the more recent second wave compared to the numbers in other areas of Lombardy. Furthermore, we highlight the importance of coordinating the easing of containment measures to avoid what is currently observed in other countries, especially in the United States, Latin American and India, where this approach has not been adopted, and a dramatic resurgence of COVID-19 cases and an increase in the number of hospitalisations and deaths have been reported.
Highlights
The novel SARS-CoV-2 coronavirus continues to spread rapidly
The most immediate is the lockdown imposed in Lombardy, including in the Bergamo area, after March 8th, and the activation of viral infection containment measures, such as home isolation for symptomatic individuals and their relatives, physical distancing and the use of face masks for apparently healthy asymptomatic subjects when they began to move around their own locked-down areas for specific reasons, or when they were subsequently allowed to circulate more freely in the community after restrictions began to be eased (May 4th, 2020)
This hypothesis is supported by findings from a recent systematic review and meta-analysis of 44 relevant, comparative non-randomized studies involving patients with COVID-19 or affected by the other betacoronaviruses that cause SARS and MERS [20]
Summary
The novel SARS-CoV-2 coronavirus continues to spread rapidly. On January 30, 2020 the WHO labeled it a public health emergency [1] and on July 21, 2020 the total number of laboratory-confirmed COVID-19 cases stood at over 14.7 million, having spread all over the world and caused over 611,000 deaths [2]. SARS-CoV-2 infection spread swiftly through other areas in Lombardy, in the province of Bergamo, where the first cases were reported on February 23, 2020 in two small villages (Nembro and Alzano Lombardo) (Appendix Figure 1). Several training meetings (small groups working faceto-face, on-line lessons and a dedicated video tutorial hosted on the hospital’s intranet) were held every day that covered the use and need for personal protective equipment (PPE) and how to approach and manage COVID-19 patients, with a special focus on the management of respiratory insufficiency and the use of non-invasive ventilation support [12] These peer educational courses were provided to all personnel in the hospital, with over 1,500 people trained in 1 week. During the second wave, hospitals in Bergamo were taking in patients from other parts of Lombardy
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