As their hospital in Bergamo, Italy, is besieged with COVID-19 patients, 12 medical doctors and one engineer implored health systems around the world to treat coronavirus patients in the community with increased outreach services to avoid hospitals becoming epicenters of virus transmission. They chronicled their learnings in a piece last week in NEJM Catalyst Innovations in Care Delivery.
The doctors work at the Papa Giovanni XXIII Hospital, in a wealthy but densely populated region, which at the time of publication had 48 ICU beds to treat the critical patients who would emerge from the 4,305 COVID-19 cases they faced.
“Older patients are not being resuscitated and die alone without appropriate palliative care, while the family is notified over the phone, often by a well-intentioned, exhausted, and emotionally depleted physician with no prior contact,” they wrote in the piece.
Having COVID-19 patients flood to the hospital, or be transported by ambulances, is spreading the virus to uninfected patients and turning ambulances and their staffs into possible vectors as they try to care for COVID-19 patients under the current model for health delivery systems.
The answer, they wrote, is “massive deployment of outreach services,” pointing to home care and mobile clinics that would prevent unnecessary movement of patients and relieve pressure from hospitals.
“Early oxygen therapy, pulse oximeters, and nutrition can be delivered to the homes of mildly ill and convalescent patients, setting up a broad surveillance system with adequate isolation and leveraging innovative telemedicine instruments,” the doctors wrote.
“This approach would limit hospitalization to a focused target of disease severity, thereby decreasing contagion, protecting patients and health care workers, and minimizing consumption of protective equipment.”
As for the hospitals, the doctors called for equipment to be made available to protect medical personnel, so they don’t have to compromise protocols designed to protect them, and the involvement of a wider array of experts in developing solutions for the future: social scientists, epidemiologists, psychologists, social workers, logistics experts and humanitarian agencies.
The experience in Italy, shared through anguished social media posts, articles and videos, has served as a warning to the US healthcare system, and experts are watching closely to see how US cases compare.
In response, healthcare systems and state governors are making desperate pleas for proper equipment for their staffs, to avoid a similar fate of virus transmission to healthcare workers. An analysis published in JAMA of COVID-19 case data from Italy showed healthcare workers represented 8.9% of the cases in Italy.
As more data is available and healthcare systems identify the patients most at risk, providers may consider community partners that can help them treat and monitor high-risk groups in the home with nutrition services, counseling and virtual appointments, keeping them out of hospitals and doctor’s offices.
Telehealth could also be an important tool for providers wanting to protect vulnerable patients and keep symptomatic patients out of high-traffic healthcare spots where they may increase the transmission of the virus. Recognizing this need, US insurers and CMS have recently taken actions to free up access to telehealth services.