In these troubled times, our Paper of the Month for April is: Grasselli G, Pesenti A, Cecconi M. Critical care utilization for the Covid-19 outbreak in Lombardy, Italy: Early experience and forecast during an emergency response. JAMA On-line publication March 13 2020.
The Covid-19 global pandemic is a public health crisis of unprecedented magnitude in the modern era and EAN Pages will be focussing on this issue above all others until it is resolved. The speed of evolution of the pandemic makes it difficult to keep up, both in the clinical and research arenas. At the time of writing, Italy is the worst affected European nation, with numbers of cases rapidly approaching those in China, where the pandemic began. Our paper of the month is the first report of the consequences of the Covid-19 outbreak on critical care capacity outside China, and describes the experience of clinicians in Milan dealing with the early stages of the outbreak. They note ITU admission rates much higher than previous Chinese reports, 12% of total cases and 16% of hospitalised patients and report on steps taken as the crisis unfolded. Early measures taken were to: 1. Create separate cohort intensive care units for Covid-19 patients; 2. Organise triage areas both for patients with respiratory symptoms and for patients requiring ventilation pending results of diagnostic tests; 3. Ensure adequate provision of personal protective equipment; 4. Report all cases centrally. Their key advice to other countries at earlier stages in terms of caseload can be summarised as follows: 1. Increase laboratory testing facilities early and rapidly; 2. Create the large dedicated Covid-19 treatment facilities that will be needed early; 3. Quarantine and containment measures should be imposed early; 4. Make provision for a huge surge in demand for intensive care beds. We need to heed these warnings across Europe as this fast-moving crisis unfolds.