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Feature Covid-19

On the front lines of coronavirus: the Italian response to covid-19

BMJ 2020; 368 doi: (Published 16 March 2020) Cite this as: BMJ 2020;368:m1065

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Re: On the front lines of coronavirus: the Italian response to covid-19

Dear Editor:

My heart goes to those affected by the COVID-19 outbreak in Italy. I think we are all impressed by Italian healthcare workers' courage and commitment to the affected patients on the frontline. However, I am not sure if it was bad luck. About 8.2% (2026/24747) infected by COVID-19 were Italian healthcare workers. These are most likely nosocomial transmissions that have nothing to do with "social distancing" and it should have been a "real-life outbreak surveillance" warning when many healthcare workers fell ill unexpectedly. This was an under-invested and ill-prepared public health /healthcare system in Italy. This chronic shortage of healthcare workforce snapped when facing an unprecedented outbreak which had started two months previously in Wuhan, China. In addition, with thousands of health workers infected, how many other COVID-19 cases in Italy were infected through nosocomial transmission?  It is important to distinguish between patients infected/co-infected with SARS-COVID-2 in these hospitals from those through other routes of transmission since it would determine which interventions are the priorities.
It should also not be a surprise that some patients with flu-like symptoms became freaked out by the daily scary news and the lockdown, flooded into the local hospitals and got infected with COVID-19 when searching for help. This was what happened in Wuhan, China: high nosocomial transmission and co-infection among panic patients due to public panic from the sudden draconian lockdown which resulted in 1,716 COVID-19 healthcare workers infected and 5 deaths (1), including the COVID-19 whistler blower Li Wenliang at the age of 34 (2).
If hospital infection control fails, we would expect to see an amplifying effect on the outbreak. Hospitals, instead of curing patients, became many small epicenters of the outbreak. Hospitals, clinics, nursing homes, and other medical institutions are the true frontline battlegrounds against the COVID-19 outbreak or any future outbreaks. Let's focus and support healthcare workers all over the world to fight against COVID-19 by strengthening infection prevention and control and systematic surveillance of nosocomial transmission associated infection.  


1.Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA 2020.
2. Hillary leung. An Eternal Hero.' Whistleblower Doctor Who Sounded Alarm on Coronavirus Dies in China. February 77, 2020, TIME.

Competing interests: No competing interests

17 March 2020
Wayne Gao
Taipei Medical University, Taiwan
250 WuXing Street, Taipei, Taiwan