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– Each country has been facing the pandemic in different scenarios, with greater or lesser degrees of difficulty.
Minapim by Hernan Valenzuela: The experience of Italy, one of the most affected countries in Europe, shows that there is a similarity in different aspects, in relation to the measures adopted in the pandemic, the failures and the absurdities born of political decisions, or the so-called “ experts ”civil servants who make up a strong task in their countries and lead to a scenario of confusion due to the controversial and bizarre measures adopted to manage the crisis generated by the pandemic.
We have seen through the media the events that took place in Italy and in other countries, medical teams and nurses, working to exhaustion, isolated from families, giving their lives to save lives. But this is just a sample of an even more complex framework, because only by knowing the details can we assess the extent of the bravery of the health teams in several countries.
The University of Turin, in a technical note, reports on the experiences and suggests recommendations, in order to learn and be better prepared for a possible new pandemic, or even for application in the course of this year 2020.
The University of Turin is part of the health group that supports the government of Italy. Created in 1404, on the initiative of Prince Ludovico de Acaia, in the reign of Amadeu VIII of Savoie. It is one of the oldest and most prestigious Italian public institutions. With more than 74,000 students (undergraduate and graduate) it occupies the 5th place in the national ranking.
The Turin Academy of Medicine has been called several times in its secular history to act as a state health and public health consultant, and also in connection with the pandemic of the New Corona virus.
Academics were asked to freely demonstrate opinions, proposals, critical issues and projects, the summary of which is published on the Academy’s website (www.accademiadimedicina.unito.it) This document was created, divided into 10 points and designed to reach public opinion in the hope that it will help to combat the future in the most effective way unlikely pandemics, both to suggest measures to improve the level of the National Health System, which has shown obvious problems.
Experiences and recommendations: (document summaries)
1 Compliance with hygiene and behavior rules
Necessary to prevent the spread of infections (primary prevention), which consist of avoiding crowded places as much as possible, taking care of personal hygiene, frequent hand sanitation and social distance, but also scrupulously observing the indications of social isolation and quarantine (prevention secondary), remembering that the masks represent the necessary (and not accessory) integration useful to everyone (not just to the infected person but to not infect)
2 Virtuous lifestyles in a primary prevention context
Not only from Covid-19 infection, greater importance should be attached to the adoption of virtuous lifestyles and, in particular, the benefits of adequate nutrition, systematic physical activity and abstaining from smoking, which are the fundamental elements for maintaining health.
Forced domestic confinement generally results in less exposure to sunlight and a reduction in physical activity; the absolute ban on outdoor sports activities with park closures has created discomfort and confusion, while they, especially if done individually, represent a very low risk of contagion and therefore should be encouraged in order to protect the health of citizens, always with the warning to maintain the necessary distances.
During the pandemic’s access to the emergency room due to myocardial infarction and stroke, but the ones that occurred were more complicated for a late diagnosis: it may have affected the patients’ fear of going to the crowded ER with COVID patients, but it should be studied if, on the other hand, there was a reduction in cardiovascular accidents due to changes in lifestyle in these months: more regular meals, more sleep, less stress at work, less stress on transportation.
3 Vitamin D – The possible protective role of vitamin D
In the COVID-19 infection, advanced in the document released by the Academy of Medicine and the University of Turin and prepared with the aim of encouraging researchers to investigate this specific aspect of prevention, it received a wide international resonance and triggered a wide scientific debate: some works published later do not exclude the role of “guilt contest” of hypovitaminosis D in the pathogenesis of the infection, but there was no lack of criticism.
Anyway, the confinement of the elderly has contributed to the increase in hypovitaminosis D, widespread in Italy, with consequent damage to bone, muscle and perhaps also the level of the immune system.
Minapim Article “Possible preventive and therapeutic role of vitamin D in pandemic management of COVID-19 ”
4 The need for shared paths
The lack of clarity and formality has been clearly perceived in the indications on the diagnostic and therapeutic treatment of the pandemic: it would have been desirable for specific protocols to be issued, both of a general nature and in relation to particular conditions (pregnancy, dialysis, malnutrition, old age, dementia, thrombophilia, presence of neoplasms, gender of patients, considering the network prevalence of men, etc.), according to the above administered by scientific societies, aiming to protect citizens from the risks of infection; in particular, we must draw attention to:
- A) On the irrevocability of activating a network of qualified and efficient laboratories, capable of carrying out an adequate number of serological tests, especially in the risk categories (elderly, fragile, poly-pathological, immunosuppressed, RSA guests, obese, hypertensive, diabetic, health professionals etc.) also to obtain epidemiological information useful prevalence to assess the kinetics of the antibody response and to limit outbreaks of infection.
- B) About the extreme need to provide shared therapeutic indications, remembering that the complexity of the disease requires cultural and operational contribution, in addition to virologists, epidemiologists and pulmonologists, also other specialists (internists, geriatricians, coagulation specialists, cardiologists, nephrologists, rheumatologists, immunologists, psychologists, etc .: the speed with which the pandemic develops and the incomplete and late information from the countries in which they were initially manifested, they did not allow doctors to reach the front line with precise, limited therapeutic indications first ventilatory support and, subsequently, advise the use of drugs of poor or doubtful effectiveness.
5 The reassessment of territorial medicine
This point of extreme criticism is certainly that of territorial medicine management, which should have served as an effective filter in these dramatic circumstances, better coordinating the crucial role of general practitioners with hospital structures, which, moreover, have resisted well to the powerful shock wave; the territory, if better organized, could have been more quickly and effectively circumscribed and isolated infected patients, and even before those most at risk: above all, but not only, in RSA, where sometimes infected patients were transferred from hospitals.
Insufficient attention was paid to those with the weakest groups, in particular the elderly with cognitive impairment, forced to abandon routine practices that are so valuable in maintaining contact with reality.
Many of them were victims of the pandemic and were hurriedly buried without a last civil greeting, despite the good will of each operator, who, due to their homage in human life, were unduly called “Heroes”.
Doctors, nurses, social workers who fulfill the Hippocratic oath, working honestly and taking the risks associated with their difficult work, should be admired, supported, helped, gratified and sometimes even cared for, certainly not to be compared to figures rhetorical and archaic mythological.
6 Health policy and management beyond any single responsibility
In order for the competent bodies to have the opportunity to verify the mistakes that may have been made, certainly in good faith, we must wait for the policy and all health care managers in the public area to be assumed to raise awareness and outline strategies that go beyond emergency and that materialize in lasting acts of planning and management, with attention not only to individual pathologies, but to the patient in its complexity, abdicating the myth of saving resources.
In addition, the need for more adequate public control in health activities, even if carried out by private individuals, has never arisen on this occasion, in the priority logic of health protection.
7 Pandemic mismanagement in general
This fact has been noticed in many situations; approaching the pandemic:
Reminders were sent to operators not to wear masks in order not to alarm patients.
The primitive indication for patients not to be admitted.
The scarce availability of protection devices.
The unexpected rule of not performing autopsy checks,
Insufficient number of plugs for equipments.
These are just some of the factors that favored the spread of contagion, with morbidity and mortality that also affected an intolerable number of doctors, professionals and health professionals who were on the front lines without conscious precautions or special warnings.
Subsequently, upon becoming aware of the problem, a media phenomenon occurred that saw several “experts” as protagonists, often in mutual contradiction, without considering that participation in technical-scientific committees of promulgation Institutional governance must also involve the duty to maintain prudent discretion, without transmitting unshared messages to public opinion
8 De-bureaucratization
The critical point is the need to de-bureaucratize the system, abolishing anachronistic and often punitive rules for patients, often forced into tiresome and useless administrative paths, for example, for practices that can be easily performed online, or for release periodic treatment plans: systematically using modern technological supports (for example, telemedicine), harmful movements and encounters in waiting rooms could be avoided, keeping the patient more in their family and social environment and reviewing the models and routes of care for chronic diseases and degenerative, but with a clearer regulatory framework.
9 Information for citizens
A very important problem is that of managing information that institutions have provided to public opinion, often confused by contradictory, deficient, uncoordinated and without guarantee of sources.
The transparency of goals can allow citizens to consciously share or disagree without relying on improvised suggestions that often fuel false and dangerous illusions.
The numerous “force tasks” of specialists, established at different institutional levels, is cause for concern, because they were not notified of the criteria for the choices, nor of the weight of the decision, nor of the presence of conflicts of interest, nor the curricula of the published specialists, nor information about them in relation to policy makers.
It is necessary to provide correct information and not just aseptic numbers of infected, hospitalized or deceased people and to clearly explain the diagnostic criteria followed, also to provide the media and the public with true and motivated news
10 Many things must change
It is desirable that the dramatic experience of the COVID-19 pandemic radically changes social norms and behaviors, not only in the field of health, which leads to a general reflection on the limits of policies inspired by unlimited growth, uncontrolled use of environmental resources, an excessive transformation of agricultural land for residential or commercial use, the tendency to gather in narrow spaces; how much more in relation to the health sector, we only highlight that:
- a) The current crisis was triggered by an infectious disease, but it can be considered the consequence of the socio-health policies adopted in the last decades that do not have sufficiently improved territory. This could be an opportunity to transform the health system into a fair, efficient and universalist body, more effectively articulated in the interconnected and truly public sectors.
- b) Greater respect and more adequate control of the rules on unemployment insurance
- c) The predominant focus of health planning on expenditure containment has determined the need to invest large resources in the emergency now and has caused damage and enormous costs to the country’s general economy.
In Italy, before the pandemic, there were far fewer intensive care beds available than in Germany, an expression of a not always correct schedule for the hospital network, which sometimes has an irrational suppression of directors and specialized structures.
- d) The model of care for chronic diseases should be revised, placing the patient truly in the center of useful processes for the maintenance of his health, with greater attention to disease prevention, compliance with the criteria of equity and universality and not considering the object of a system that produced consumerism in health with performance diagnoses or therapies not always appropriate.
- e) It is necessary to reassess and support scientific research in the medical field, a real resource for the country: the hundreds of young doctors who leave Italy every year are cause for despair, in how evident is the expression of an incapable system to retain brilliant and lively researchers, providing them with interesting and transparent access to academic careers
References: Giancarlo Isaia President of the Academy of Medicine of Turin
Team: Paolo Arese, Giovanni Baduini, Alessandro Bargoni, Francesca Busa, Teresa Cammarota, Rossana Cavallo, Alessandro Comandone, Cristina Costa, Umberto Dianzani, Veronica Di Nardo, Giovanna Ferrarino, Dario Giulio Fornero Fontana, Enrico Fusaro, Gian Pasquale Ganzit, Guido Gasparri , Elena Gerardi, Guido Giustetto, Gianluca Isaia, Carla Lavarini, Simona Martinotti, Rosamaria Nebiolo, Luciano Peirone, Clara Lisa Peroni, Simonetta Piano, Patrizia Presbitero, Guido Regis, Francesco Scaroina, Maria Pia Schieroni, Patrizio Schinco, Piero Secreto, Piergiorgio Strata , Piero Stratta, Gabriella Tanturri, Vincenzo Villari, Elsa Viora,
Source: University of Turin
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