In our "International" newsletter section, we venture a look beyond national borders. This time, Prof. Giuseppe Banfi, Scientific Director of the Galeazzi Clinic in Milan and Managing Director of the San Raffaele Clinic Foundation, which is part of the private San Donato Clinic Group, one of the largest healthcare groups in Europe, reports. Both clinics are located in Milan and therefore in the Italian region that has been hardest hit by the coronavirus. After China, northern Italy was the area that was hit particularly suddenly and unexpectedly by the crisis.
Prof. Banfi, how have you experienced the last few months of the state of emergency?
Our hospital played a key role in Covid management. First of all, the organization of the operations of the teaching and research hospital specializing in orthopaedics was completely turned upside down: Regular surgical activity and the outpatient clinic were suspended. Only emergency cases were admitted and the regional government concentrated orthopaedically urgent patients from the Milan region (4 million inhabitants) in two specialized hospitals. In addition, some patients with Covid symptoms without orthopaedic problems were admitted to our clinic. The doctors and nurses have made enormous efforts to cope with the state of emergency, to help patients and relatives and to prevent the spread of viruses. The aggressiveness of the epidemic has been terrible and the organization has to face absolutely new and unprecedented problems.
The organization of healthcare services should be changed in the near future, especially the link between hospitals and general practitioners. Technology is essential for the treatment of patients, especially in severe cases, but the prevention and care of less symptomatic patients should be done in private practice and via telemedicine and web-based contacts to avoid the crowding of hospital services and the associated crisis.
How was your day-to-day work as director and managing director affected?
The changes in the hospital organization were manifold and related not only to patients, but also to the routes for patients and doctors (we changed the use of some rooms to new areas, for example, to isolate those doctors who had contact with patients), the shift work of doctors and nurses (due to sick professionals and the length of the illness, even if it was not serious, was long), the provision of protective devices and materials, the restrictions on access to hospitals, the continuation of research and clinics, especially for oncology patients, to provide web-based support to professionals and patients.
You were also confronted with a variety of ethical issues - as well as a lot of human suffering. How did you deal with this?
Ethical issues were very important. The limited availability of beds and ventilators or intensive care units caused serious problems for specialists in all hospitals. For example, the National Ethics Committee recommended that the age of the patient should not be a decisive factor in the decision (editor's note: for or against a ventilator). We used some drugs liberally, others more cautiously for patients with severe courses of disease. We always sought the opinion of the ethics committee for the use of experimental drugs and for research that we carried out on patients and their biological material.
What are your feelings about the uncertain future?
We are now starting the "new normal" and have reopened elective surgery and outpatient services for selected patients. We have also developed a web-based tele-assistance for rehabilitation and medical assessment after hospitalization. Length of stay has been further reduced and pre-hospital assessment, including all virological investigations, has been further extended. We have to be optimistic...