Clare Gerada: Some good must come out of covid-19BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m2043 (Published 26 May 2020) Cite this as: BMJ 2020;369:m2043
All rapid responses
According to the article of Clare Gerada, we can confirm that some good must come out of covid-19.
Covid-19 has infested Italy (1) and taken thoughts and life of people submitted to lockdown. Media, information, news and experts' declarations, contributed to raise awareness on the overwhelming expansion of the epidemic and on the potential consequences of the viral infection. At the same time, people have realized that the healthcare system and healthcare professionals play a key role in the defense of the common good, our health. Varese Hospital, in Lombardy, as well as many other hospitals in the whole Country, has made extraordinary efforts to increase Intensive Care Unit (ICU) and Emergency beds, to receive a growing number of patients in need of advanced medical and technologic support. Between March and April 2020, 50 ICU beds, including three operating rooms, were converted to care for covid-19 patients under mechanical ventilation, whereas a large Emergency/Triage area, and about 200 beds of the Departments of Medicine, Pulmonology, and Infectious Diseases admitted critically ill subjects, many treated with oxygen therapy, continuous positive pressure ventilation (CPAP), or non-invasive ventilation.
While the viral shedding in thousands of people caused the exponential increase in the daily count of new cases and deaths, we noticed people’s gratitude to support hospital personnel and purchase clinical furniture and technological equipment. According to the general management of the Hospital and with the advice of expert ICU physicians, donor citizens could use simplified administrative procedures to quickly acquire medical equipment needed to guarantee medical staff protection and properly care for patients in need of care. New mechanical ventilators were provided by the Italian Civil Protection, whereas crowdfunded and individual donations allowed an increase in the number of existing devices or the introduction of new items, all aimed at better managing covid-19 patients. Regular public procurement policies would have required weeks, if not months, in order to receive the materials, while donations were key to receive a quick and effective response to the growing hospital needs. The long list of devices, whose total amount is estimated to be over one million euros, includes the following:
• Personal protective equipment: N95/FFP2 and N99/FFP3 facemasks, eye protection, aprons, gloves.
• Video-guided laryngoscopy systems, to optimize the procedure of intubation and to minimize the proximity between operator and patient (2).
• Single-use bronchoscopes, with portable high-resolution monitor and specimen collection system, to allow bedside diagnostic procedures, not only in ICU, but also in high level care departments.
• Additional bronchoscopy system, increasing the number of equipment of the ICU area, to obtain bronchoalveolar lavage fluid, to perform interventional procedures, or to guide percutaneous tracheostomy.
• Real time PCR system, to enhance the laboratory response in human viruses and other infectious disease research.
• Infusion pumps, to deliver fluid and medications in controlled amount and to reduce workload of operators outside ICUs.
• Stand-alone monitors, located outside the ICUs, to control ECG, non-invasive blood pressure, pulse oximetry, body temperature, respiratory rate. Pulse oximeters and infrared thermal scanners.
• Simplified multiparametric monitoring systems with telemetry, also provided to a long-term care facility.
• Echographs, for bedside examination, including lung ultrasounds (3).
• Biohazard stretcher for patient transport.
• Helmet CPAP systems.
• Telephones cordless and tablets pc for patient-family communication.
• Furniture for healthcare staff in a new covid-19 area of the Hospital.
Moreover, day by day single citizens provided food, pastry, and other goods, and broadcast thankful messages to hospital doctors, nurses, medical staff, and volunteers fighting covid-19.
Our recent experience shows that daily information about a hospital’s activities and needs can play an important part in triggering people’s generosity: crowdfunding contributions were key to increase in a timely and effective way the availability of medical equipment for a safe and adequate response to the outbreak. For this reason, we have to thank Fondazione Il Circolo della Bontà, Il Ponte del Sorriso Onlus, Trust Bassani Valcavi, Agusta Westland, Unione Industriali, Rotary Club, Lions Club, Lindt, Italian Military Forces, and every single citizen who has provided support to our hospital and to covid-19 frontline workers.
We declare no competing interests.
1) Remuzzi A., Remuzzi G. COVID-19 and Italy: what next? The Lancet, Published Online March 12, 2020 https://doi.org/10.1016/ S0140-6736(20)30627-9
2) European Society of Intensive Care Medicine and the Society of Critical Care Medicine 2020. Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19) https://doi.org/10.1007/s00134-020-06022-5
3) Poggiali E, Dacrema A, et al. Can Lung US Help Critical Care Clinicians in the Early Diagnosis of Novel Coronavirus (COVID-19) Pneumonia? Radiology, Published Online:Mar 13 2020 https://doi.org/10.1148/radiol.2020200847
Competing interests: No competing interests
Clare Gerada claims that some good must come out of COVID-19, which she says unlike previous epidemics affects the whole world, negatively and positively (1).
This pandemic is like a global tsunami causing widespread chaos, out of which has come a lot of devastation and suffering, affecting almost everyone, and some good.
After the tsunami of 2004 came a lot of suffering, but a global heart of support and good emerged and an opportunity to advocate for a complexity thinking in a book “Tsunami Chaos Global Heart,” made available free online, subtitled, “using complexity science to rethink and make a better world,” with chaos science part of complexity (2).
This pandemic reinforces our interdependence, interconnectedness and shared humanity, with a global heart emerging in the support for healthcare staff described, the concern and advocacy for everyone, in particular the vulnerable globally, and more.
It offers an opportunity to rethink everything, in interdependent/interconnected complexity science terms, and what we can do with this new thinking for complex global issues like climate change, poverty, health and global health, social, racial/ethnic and economic equity and justice, etc.
Some good must come out of covid-19, some already has, but we must work harder to make it much more. We are all in this together and we should work to come out of it better. We should use the lessons of the past, and the present, to make a better world.
1 Gerada C, Some good must come out of covid-19. BMJ 2020; 369:m2043
doi https://doi.org/10.1136/bmj.m2043 (Published 26 May 2020) (accessed May 30, 2020)
2 Rambihar VS, Rambihar SP, Rambihar VS Jr. Tsunami Chaos and Global Heart: using complexity science to rethink and make a better world. 2005. Vashna Publications. Toronto, Canada. http://femmefractal.com/FinalwebTsunamiBK12207.pdf (accessed May 30, 2020).
Competing interests: No competing interests
There have been some other god that has come out of cOVID19 and these points were emphasized during two recent Health Excellence Through Technology (HETT) webinars that I was pleased to join:
HETT webinar - The Seismic Shifts in Management of Patient Data - best practice for right now and planning for the 'new normal'
Three presenters explained that digital transformation had accelerated progress - one said "We have achieved three years advance in 3 weeks" another said "we have achieved four years advance in 4 months.
"Since under Health Service Control of Patient Information Regulations, Matt Hancock issued four emergency notifications a quicker digital and mobile transformation of services has occurred which presenters felt should happen across other areas of provision."
GPs were finding it useful to work in a viryal mode and even to talk about “Care without a waiting room”
Hospital administrators were making less use of the word “outpatients” in care planning
“Coming together over one problem seems to have produced potential solutions for many other problems.”
The changes that have accelerated have been cultural more than technical. The changes have to be seen to serves a public benefit and public interest not just the benefit of the organization responsible for the changes. There is a question of how to measure and define public benefit and interest
London had achieved data goals in March 2020 rather than in November 2020 in response to COVID19.
London had produced successful working multidisciplinary sharing aims and systems
The COVID19 pandemic had created new cultures and systems of integrated care and were reducing the barriers between primary and secondary care
The speakers strongly recommended consolidating the recent changes in culture into regular and standard practice
A point was made that there will be a legacy/consequence of the changes in health data processing that have taken place and “should there be Sunset Clauses to reverse some of the changes”
The obstacles in the past to these behavioural/cultural changes have been made in risk averse environments. A risk narrative has changed during the COVID19 pandemic. The changes seem to have been positive for public and professionals and a continued positive change dialogue with public and patients will be preferred to a risk averse dialogue.
The health system should learn from, evaluate, improve or reject the changes that have taken place.
Competing interests: No competing interests