Coronavirus (186) A message from Italy: We need help for decision-making

23 March, 2020

Italy is severely affected with more than 5000 deaths and, currently, some 600-800 deaths per day. This is despite a highly sophisticated health system in a high-income country. Other countries face the possibility of a similar situation in the coming weeks and months and everyone is working hard to reduce the impact, with WHO leading the global effort. I am forwarding below a message from the forum of the WHO Global Patient Safety Network, from a health professional on the front line:

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Subject [gpsn] WHO guidance and other useful resources for COVID-19 response

Dear Collegues and friends

Usually I am not used to reply preferring to learn from all your competency and professional abilities which I esteem and honoured to be part of.

I am speaking to all of you from the front line here in Italy, mainly in Florence Tuscany. As you all may remember I am a surgeon and emergency physician and also since 2002 Clinical Risk Manager of the Florence Healthcare trust. When COVID 19 outbreak occurred I felt the necessity to go back to front line and help my collegues,nurses and intensivits, and other specialties to treat the enormous amount of COVD 19 positive symptomatic patients in very severe conditions needing invasive ventilation and/or supported by NIV or CPAP procedures.

Believe me we are experiencing a very dramatic situation and need to be helped and supported. All of us professionals on the front line are exhausted and very tired because we are on the job , since many hours and days on a continuos basis. Some of my collegues haven't been able to leave the hospital since Feb 24th !!! They are on a continuos shift and dealing with a number of severe respiratory distress cases caused by coronovirus as severe interstitial pneumonia and deaths are an everyday issue.

Tuesday March 24 IsQua invited me on a Webinar scheduled from 11:00 a.m. italian time as a testimoy of what's happening in my country and specifically in Tuscany. I accepted and be very honoured to share my experience. IsQua and INSH (Italian Network for Safety in Healthcare - italian IsQua chapter) are about to release a paper of reccomendations to healthcare professionals dealing on the front line with COVID patients. This paper will list some general and specific reccomendations based on evidence based data and the experience of frontline workers who everyday give feedback of the situation.

I believe that we all need substantial reccomendations free of bureaucracy mainly because we don't have the time to read books or very long papers; we need substantial advices of what to do also in terms of self-protection; psychologically we are all near to burnout status and need also psychological support.

I felt the necessity of sharing with all you prestigious professionals of healthcare worldwide, some of you I had the honour of meeting personaly, these every day issues that are a grief on nurses, doctors and other healthcare workers besides of course patients,their families and friends and the entire italian healthcare system which is close to a breakdown.

Now I am aware it has become a global issue and this means we are farther obliged to support healthcare systems worldwide with practical and concrete suggestions to help decision-making on the front line.

What I have observed in the recent 2 months is a failure in situation awareness and communication leading to a consequent unsuccess of leadership and teamwork. We are now aware of this and trying to struggle up with solutions. Our regional government and the patient safety center of Tuscany are trying to support us with organizational strategies which now are very hard to realize and we appreciate all the efforts being myself part of this system; but we experienced a very severe and unjustifiable lack of protection devices for nurses and doctors: a severe lack of masks (all of them), a severe lack of vital supporting devices and many other criticalities and this means that none of the leaders in healthcare institutions dealing with preventive strategies ever took into consideration.

We also need to reinforce our personell: we need more doctors and nurses on the front line and this will be the need within shortly in other countries.

A such severe pandemic episode should have been forseen and many data prove this. We are now working under very severe conditions and are exposed to contamination ourselves. Is this a strategic way of dealing with such mass casuality? As Dr.Dhingra says in her mail" this is an unprecedented situation", correct and I fully agree, I also would like to share with you all a personal consideration: could we have done better? and, as a risk manger may I say: after all this is over and life comes back to routine, what lessons have we learned from this and where should we address improvement strategies.

I apologize for having occupied your time with my considerations but I have been working since 8 days continuously, I am tired need a rest, but I needed to share with all of you my personal experience in this heatlh catastrophy.

My best to all of you and thank you for allowing me to be part of your prestigious organization.

Francesco Venneri, M.D.

Florence Italy

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Best wishes, Neil

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org