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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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Italian Doctors Call for Protecting Healthcare Workers and Boosting Community Surveillance during Covid-19 Outbreak

Italian Doctors Call for Protecting Healthcare Workers and Boosting Community Surveillance during Covid-19 Outbreak

While Italy is experiencing a dramatic situation due to the spreading of Covid-19 infection, it seems that we can do more to protect medical doctors and all the hospital workers, including nurses, therapists, technicians, and support staff. Beyond the personal risks that doctors and healthcare workers are facing directly – highlighted by the death of the first general practitioner and national delegate for continuous medical education Dr. Roberto Stella in Varese – hospitals and medical personnel represent a possible vehicle of diffusion for the Covid-19 infection.[1] The New England Journal of Medicine has addressed the issue of the huge proportion of infected subjects that remain asymptomatic and their role in the spreading of the epidemics.[1] At the same time, as pointed out by the WHO director-general Tedros Ghebreyesus, it has been shown that in China about 41% of Covid-19 cases confirmed in Wuhan resulted from hospital-related transmission.[2]

A hospital-centric model has been shown to be inadequate in coping with the coronavirus outbreak. Actually, epidemics must be counteracted through well-planned community surveillance at local level by identifying and isolating at home suspect or symptomatic cases. This has become evident as entire hospitals in Italy were closed because of the infection diffusion among a number of doctors and nurses. By March 22nd, 4824 healthcare workers had been infected by the new coronavirus (9% of total cases) with 24 doctors dead: these figures are worse than those observed in China (3300 healthcare workers infected and 23 doctors dead). It comes up that protecting healthcare workers is a crucial factor both for the control of the outbreak and for continuing to provide all the necessary cares to people with Covid-19 infection as well as to all the other patients who need treatments at home or in hospital setting.[3]

Along with adequate urgent supply of respiratory protective devices and disposable gowns, which are unacceptably still lacking in the middle of the epidemics, we propose providing at least all symptomatic healthcare workers with validated rapid-response tests – registered at the Italian Ministry of Health – that present a 100% ability to detect negative cases (very high specificity) and makes the result available between 15 and 45 minutes, according to the different products. These rapid-response tests should be systematically provided at least to healthcare workers displaying any possible symptom of Covid-19 infection (even mild and in absence of fever), as well as to those known to have been in contact with suspect or confirmed cases. In this way, healthcare services will be sure that personnel with negative results can start working in hospital, ambulatories, or home-based and long-term care facilities for elderly people and critical patients. Rapid-response tests performed on healthcare workers should be confirmed by pharyngeal swabs (twice in the same week) and tested with the most reliable PCR-based methodologies, whose results are usually delivered within 48 hours.

Filippo Anelli 1, Cosimo Nume 2, Prisco Piscitelli 3,4, Alessandro Miani 3,5, Roberto Carlo Rossi 5, Ernesto Burgio 6, Donato De Giorgi 4, Luigi Peccarisi 4, Ivan Gentile 3,7, Maria Triassi 3,8 , Annamaria Colao 3

1. President of the Italian Federation of Medical Professional Associations (FNOMCEO), Rome, Italy
2. Medical Professional Association (OMCEO) of Taranto, Italy
3. UNESCO Chair on Health Education and Sustainable Development, Federico II University, Naples, Italy
4. Medical Professional Association (OMCEO) of Lecce, Italy
5. Medical Professional Association (OMCEO) of Milan, Italy
6. Medical Professional Association (OMCEO) of Palermo, Italy
7. Division of Infectious Diseases, University Federico II, Naples, Italy
8. Director of Public Health Department, University Federico II, Naples, Italy


1. Rosenbaum L. Facing Covid-19 in Italy—Ethics, Logistics, and Therapeutics on the Epidemic’s Front Line. New England Journal of Medicine. 2020 Mar 18.
2. 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 February 24
3. Chang D, Xu H, Rebaza A, Sharma L, Dela Cruz CS. Protecting health-care workers from subclinical coronavirus infection. Lancet Respir Med 2020;8(3):e13-e13.

Competing interests: No competing interests

25 March 2020
Filippo Anelli
President of the Italian Federation of Medical Professional Associations (FNOMCEO), Rome, Italy
Cosimo Nume, Prisco Piscitelli, Alessandro Miani, Roberto Carlo Rossi, Ernesto Burgio, Donato De Giorgi, Luigi Peccarisi, Ivan Gentile, Maria Triassi , Annamaria Colao
Rome, Italy