Changing Emergency Department and hospital organization in response to a changing epidemic

health systems, their structures and professionals in a crisis never experienced before. More than 500 articles on COVID-19 have already appeared in international medical literature, suggesting that the SARS-CoV-2 virus will be much more difficult to contain than those responsible for SARS and MERS,1,2 at least for two reasons. The first, its Reproductive Rate (RR) is 2-3 people per infected patient, the disease is therefore transmitted very efficiently and its incidence has an exponential trend. The second, it has a high mortality, between 1 and 3% (with a rate even 3-4 times higher in the elderly) and, according to Chinese estimates,3 an important amount of severe (14%) or critical cases (5%). The combination of these two aspects jeopardizes the tightness of health facilities and requires a reorganization of the Emergency Department (ED) and the hospital as a whole. In fact, the COVID19 epidemic requires the activation of an Internal Emergency Preparedness Plan which has a greater complexity than a usual one, as it is characterized by repeated waves of accesses for a period the end of which is not yet foreseeable. Figure 1 shows the data related to ED accesses and hospital admissions for COVID-19 in the first two weeks of March (from the 1st to 8th) at the University Hospital of Brescia, a large hub of Lombardy. Interestingly there is an accesses reduction but a constant admission of COVID-19 patients. Italy, and especially the districts of Lombardy, Veneto and Emilia Romagna, are the center of the second epidemiological outbreak in the world and, although only three weeks have passed since the first case appearance, the number of infected and severely ill patients is already so prominent that a significant experience has been accumulated in the management of the problem. We believe that sharing this knowledge and the open questions could help those who are operating in the initial epidemic stage, but could find themselves facing the critical issues within a short time. We will therefore examine the main clinical and organizational aspects of this epidemic, with particular attention to ED’s work. In any case, you will have to pursue the following objectives as a priority: i) Maintaining a response as efficient as possible to all patients with urgent conditions (e.g. acute myocardial infarction, stroke, trauma etc.) or with other serious pathologies. This includes the need for the hospital as a whole to be able to continue the surgical management of cancer, cardiovascular diseases and more in general patients needing short-term surgery; ii) an adequate clinical response to patients with COVID-19 respiratory problems, both in ED and in-hospital; iii) adequate logistical, administrative, technological and personnel support that allows professionals to follow protocols safely and in the best possible way. Emergency Care Journal 2020; volume 16:8969