The response of Milan's Emergency Medical System to the COVID-19 outbreak in Italy

Abstract

The number of people infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus causing coronavirus disease 2019 (COVID-19), is dramatically increasing worldwide.1Wu Z McGoogan JM Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China.JAMA. 2020; 2019: 25-28Google Scholar The first person-to-person transmission in Italy was reported on Feb 21, 2020, and led to an infection chain that represents the largest COVID-19 outbreak outside Asia to date. Here we document the response of the Emergency Medical System (EMS) of the metropolitan area of Milan, Italy, to the COVID-19 outbreak. On Jan 30, 2020, WHO declared the COVID-19 outbreak a public health emergency of international concern.2WHOStatement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV).https://www.who.int/news-room/detail/30-01-2020-statement-on-the-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov)Date: Jan 30, 2020Date accessed: February 24, 2020Google Scholar Since then, the Italian Government has implemented extraordinary measures to restrict viral spread, including interruptions of air traffic from China, organised repatriation flights and quarantines for Italian travellers in China, and strict controls at international airports' arrival terminals. Local medical authorities adopted specific WHO recommendations to identify and isolate suspected cases of COVID-19.3WHOGlobal surveillance for human infection with coronavirus disease (COVID-2019).https://www.who.int/publications-detail/global-surveillance-for-human-infection-with-novel-coronavirus-(2019-ncov)Date: Jan 31, 2020Date accessed: February 24, 2020Google Scholar, 4US Centers for Disease Control and PreventionCoronavirus disease 2019 (COVID-19). Prevention & treatment.https://www.cdc.gov/coronavirus/2019-ncov/about/prevention-treatment.htmlDate accessed: February 24, 2020Google Scholar Such recommendations were addressed to patients presenting with respiratory symptoms and who had travelled to an endemic area in the previous 14 days or who had worked in the health-care sector, having been in close contact with patients with severe respiratory disease with unknown aetiology. Suspected cases were transferred to preselected hospital facilities where the SARS-CoV-2 test was available and infectious disease units were ready for isolation of confirmed cases. Since the first case of SARS-CoV-2 local transmission was confirmed, the EMS in the Lombardy region (reached by dialling 112, the European emergency number) represented the first response to handling suspected symptomatic patients, to adopting containment measures, and to addressing population concerns. The EMS of the metropolitan area of Milan instituted a COVID-19 Response Team of dedicated and highly qualified personnel, with the ultimate goal of tackling the viral outbreak without burdening ordinary EMS activity (figure). The team is active at all times and consists of ten health-care professionals supported by two technicians. The COVID-19 Response Team collaborated with regional medical authorities to design a procedural algorithm for the detection of suspected cases of COVID-19 (figure). Patients were screened for: (1) domicile or prolonged stay in the hot zone (ie, where COVID-19 cases first appeared), or both; (2) close contact with suspected or confirmed cases of COVID-19; and (3) close contact with patients with respiratory symptoms from the hot zone or China. The COVID-19 Response Team assessed the clinical condition of screened individuals to determine the need for hospital admission or for home testing for SARS-CoV-2 and subsequent isolation. Finally, recommendations to limit viral spread were provided to the other family members, especially when isolation was indicated.4US Centers for Disease Control and PreventionCoronavirus disease 2019 (COVID-19). Prevention & treatment.https://www.cdc.gov/coronavirus/2019-ncov/about/prevention-treatment.htmlDate accessed: February 24, 2020Google Scholar The COVID-19 Response Team handles patient flow to local hospitals and addresses specific issues about bed resources, emergency department overcrowding, and the need for patient transfer to other specialised facilities. The algorithm is constantly updated to meet regional directives about hot zone extension and modalities for SARS-CoV-2 testing. Recent literature suggests that viral spread is still expected to grow, and the preparedness of public health systems will be challenged worldwide.5Sun K Chen J Viboud C Early epidemiological analysis of the coronavirus disease 2019 outbreak based on crowdsourced data: a population-level observational study.Lancet Digit Health. 2020; (published online Feb 20.)https://doi.org/10.1016/S2589-7500(20)30026-1Summary Full Text Full Text PDF Scopus (288) Google Scholar In this context, the EMS is inevitably involved in facing the consequences of the SARS-CoV-2 outbreak. Specific algorithms, detailed protocols, and specialised teams must be fostered within each EMS department to allocate the right resources to the right individuals when cases of COVID-19 present. The Italian EMS, along with public health authorities, has just started to fight a battle that must be won. We declare no competing interests.