Infectious Disease

Italian hospitals are grappling with the surge in COVID-19 as the vaccination campaign picks up

April 02, 2021

5 min read

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Healio interviews

Ciappa, Fumagalli, Laurenti and Tascini do not report any relevant financial information.


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ASOLO, Italy – Italy, which spearheaded the COVID-19 pandemic a year ago, is still struggling. Hospitals are under pressure, although there are signs of a decline in reported cases.

The number of patients with COVID-19 admitted to intensive care units is growing, and bed occupancy in intensive care units is 39% nationally – above the critical threshold, according to the Ministry of Health. The bed occupancy is 43%.

Laurenti laboratory team

Patrizia Laurenti, MD, and staff at the COVID-19 Vaccination Center at Gemelli University Hospital in Rome.
Courtesy of Patrizia Laurenti

Meanwhile, the vaccination campaign is picking up speed after a slow and uneven start. The goal is to vaccinate 500,000 people a day. About 250,000 doses are currently administered per day. The total number of people in the country who received a dose is more than 10 million, of whom more than 3 million received both shots.

Intensive care units under pressure

Roberto Fumagalli

Roberto Fumagalli, MD, A professor at Bicocca University in Milan and head of the department of anesthesia and intensive care medicine at Niguarda Metropolitan Hospital, one of the largest hospitals in Milan, said only one of the 35 COVID-19 beds available in the hospital’s intensive care unit.

“Across the region, there are 830 intensive care beds in about 1,300 total occupied by COVID-19 patients,” he told Healio.

Lombardy, a populous region of northern Italy, has been the hardest hit region from the start.

“During these second and third waves, we never had fewer than 350 to 380 COVID-19 patients in the intensive care unit. The median age has now dropped to 62 years, and [the] The death rate is between 30% and 40%, ”said Fumagalli.

Variant B.1.1.7, first identified in the UK, is spreading rapidly and accounts for more than 50% of infections in the region.

“This virus always caught us off guard. We didn’t expect variants to have such an impact and trigger a new surge in infections that is even more difficult to control, ”said Fumagalli.

Since the pandemic began, the intensive care unit has admitted more than 10,000 patients, and the experience gained over a year has provided important insights into how to respond. Even so, the pressure is still high.

“One positive thing I can feel is that now that we have been vaccinated, we are less afraid. In the first phase, in addition to the incredible situation we suddenly had to struggle with, we were afraid of becoming infected and infecting our families. We took all precautions, but the fear was with us all day, ”said Fumagalli.

The pandemic has taken a heavy toll on healthcare workers. 348 doctors and 48 nurses died. In addition, six took their lives out of exhaustion and despair.

Resilience and collaboration

Since the first national lockdown last year, containment measures have been differentiated to take account of regional heterogeneity. Based on the prevalence of SARS-CoV-2 on site and the response from local hospitals, the regions are divided into white, yellow, orange and red zones, indicating increasingly higher risk scenarios and increasingly strict restrictive measures.

As of March 15, most regions have been classified as red zones due to the surge in cases, some as orange, and none are currently yellow or white. On the Easter weekend, the whole country will be placed under a national ban.

Friuli Venezia Giulia, another region in the north of the country, had a small number of infections during the first wave but has recently seen a significant increase.

Carlo Tascini

“Thanks to the enormous efforts of our regional health system and the high number of COVID tests carried out, we were never classified as a red zone until two weeks ago.” Carlo Tascini, MD, said Healio, head of the Infectious Disease Department at Udine University Hospital. “This created a misconception among the population that the situation was under control and many dropped their vigilance. As a result, the province of Udine, capital of the region, [now ranks] Fifth in Italy for the number of cases. In addition, variant B.1.1.7 led to an exponential increase in the numbers and is now responsible for 70% of our cases. “

Before the pandemic, Tascini’s department had 13 beds on the second floor of a building that has now been completely converted into a COVID-19 tower, including special units for COVID-19 pulmonology, COVID-19 neurology and COVID-19 medicine intensive and sub-intensive care. The negative pressure ensures high-flow oxygen ventilation, which minimizes the risk of transmission to hospital staff.

“This pandemic tragedy has underscored the value, strength and resilience of our healthcare system across Italy,” said Tascini. “If every cloud has a silver lining, this was the opportunity for us doctors and all health workers to work together across disciplines. In our department we have worked closely with anesthetists, surgeons, internists and laboratory staff. As a team, we were able to organize our hospitals efficiently to respond to the pandemic crisis. We have worked synergistically and cooperatively in ways we never thought we would be able to. “

Active monitoring and contact tracking

Giampaolo Weather in Ciappa

In the past year Giampaolo Weather in Ciappa, MD, The medical director of a major local health department in the Naples metropolitan area has coordinated activities related to COVID-19 testing and contact tracing.

“We’re seeing a slight improvement, likely the impact of the containment efforts of the past two weeks, but also the impact of a more efficient contact tracing system across the region,” he told Healio.

For each person who tests positive, they keep close contact with family, friends, and colleagues up to at least 2 weeks prior and are asked to self-quarantine 14 days after their last exposure, or 10 days if they test negative on that day 10.

“We have actively monitored 3,000 people since March 2020 and the hospitalization rate has been very low, with only seven deaths,” Ciappa said.

Active surveillance includes home care by general practitioners. If patients need oxygen therapy, it is also provided at home until patients recover or until they need to be hospitalized.

“This home care model has worked very well and has shown that it reduces hospital stays and costs,” said Ciappa. “Family doctors, the backbone of our healthcare system, should be commended for the vital role they have played in every phase of the pandemic.”

Vaccination advances and hurdles

Gemelli University Hospital, the largest hospital in Rome, is home to a COVID-19 vaccine hub that has already given more than 26,000 vaccine doses.

“We work at a constant pace of 350 to 400 recordings per day, up to 430 on peak days.” Patrizia Laurenti, MD, said Healio, professor of hygiene and preventive medicine and now in charge of the COVID-19 vaccine hub. “First we vaccinated our medical staff and gradually opened up to other categories, starting with patients over 80 and those at risk.”

The Italian government has issued guidelines on how to prioritize vaccines, starting with healthcare workers, people aged 80 and over, vulnerable and severely disabled citizens, teachers and military personnel, followed by the other age groups in descending order. However, the regions have developed independent plans that have sparked controversy and delayed vaccine rollouts.

“Some regions have prioritized other categories like lawyers and judges, while other regions have suggested vaccination of working people first,” Laurenti said. “There has been heated discussion, but the government has made a strong commitment that priority should be given to the most vulnerable categories.”

Italy was among the countries that temporarily stopped the use of the AstraZeneca vaccine because of reports of thrombotic complications. After the European Medicines Agency (EMA) gave the go-ahead, administration resumed, but many people canceled their appointment for safety reasons. In some regions, the rejection rate was up to 20%.

“Vaccine rejection is a very worrying topic that reflects poor understanding and misinformation that is often fueled by the media and social media,” said Laurenti. “The EMA clearly and consistently stated the safety of the AstraZeneca vaccine and then reaffirmed it. Governments may be right to seek further clarification, but the suspension of vaccination created fear and confusion. Now people come up and ask, “What vaccine do I get?” and we must use this as an opportunity to clear them up and clear up any misunderstandings. “


Italian Ministry of Health. Weekly report on monitoring phase 2. Accessed April 1, 2021.


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