Intended for healthcare professionals

Rapid response to:

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

Read our latest coverage of the coronavirus outbreak

Rapid Response:

COVID-19: leave no healthcare worker behind

Dear Editor

On March 09, 2020, the Italian Government passed the Prime Minister’s Decree n.14, which established urgent measures to support the Italian National Healthcare Service (Servizio Sanitario Nazionale (SSN) in response to the COVID-19 pandemic [1].

Article 7 of the Decree states that the 14 day quarantine order, mandatory for individuals who were in close contact with COVID-19 infected subjects, does not apply to healthcare workers under epidemiological surveillance. Medical staff are hence allowed to suspend their activity if they experience respiratory symptoms or test SARS-CoV-2 positively.

The Anaao Assomed, the biggest trade union for doctors of the country, reacted to the directive with an open letter to the Government, predicting the concrete risk of an intense COVID-19 spread across medical staff [2].

To date (25 March 2020), Italy recorded 6.205 SARS-CoV-2 infections and 39 related deaths amongst health-care professionals [3,4].

According to official data, the COVID-19 infection rate within medical staff is approximately 9%, almost three times the Chinese one (3.8%).

In Sardinia, about 50% of COVID-19 cases have been registered among medical doctors and registered nurses, while providers at high risk levels of severe COVID-19 illness continue to report to work [5].

Given this evidence, on March 24, 2020, the Italian Trade Unions signed an agreement with the Italian Ministry of Health on the “Prevention and safety of medical and other healthcare workers in response to COVID-19 emergency” [6].

Among others, the agreement includes strategic measures like: 1) prioritizing the protection of medical staff, according to the most updated international standards, including the timely availability of supplies of Personal Protective Equipment (PPE) and the rigorous adoption of further technical equipment; 2) ensuring that COVID-19 exposed personnel are promptly tested for SARS-CoV-2 laboratory confirmation; 3) harmonizing regional and national procedure for the surveillance of potentially infected healthcare workers; 4) ensuring the necessary sanitization operations in the workplace.

The COVID-19 pandemic imposes the need to guarantee all personnel working in health services and facilities to operate in maximum safety, ensuring that adequate additional training is provided when needed, all necessary measures to protect their health are adopted, as well as to avoid the spread of contagion in the services themselves and within their family. It is essential that policy makers demonstrate consistency with public health principles, emergency preparedness and with the implementation of the recommendations.


[1] Disposizioni urgenti per il potenziamento del Servizio sanitario nazionale in relazione all’emergenza COVID-19, DECRETO-LEGGE 9 marzo 2020, n. 14, GAZZETTA UFFICIALE DELLA REPUBBLICA ITALIANA Serie Generale n. 62
[2] Covid-19: senza protezioni l'ospedale diventa un pericolo. Lettera aperta dell’Anaao Assomed al Presidente Conte e al Ministro Speranza.
[3] GIMBE. Monitoraggio dell'epidemia da COVID-19 in Italia. Available at: (Accessed on 26 March 2020)
[4] Federazione Nazionale dell’ordine dei Medici Chirurghi e degli Odontoiatri FNOMCeO (Accessed on 26 March 2020)
[5] “Carenza Dpi, aperta inchiesta a Cagliari”, ANSA. Available at:
[6] Protocollo per la prevenzione e la sicurezza dei lavoratori della Sanità, dei Servizi Socio Sanitari e Socio Assistenziali in ordine all'emergenza sanitaria da «Covid-19»

Competing interests: No competing interests

26 March 2020
Beatrice Formenti
Silvia Ussai, Benedetta Armocida, Francesca Palestra, Eduardo Missoni Associazione di Promozione Sociale Via Collebeato 26, 25127, Brescia, Italy