Increasing surge capacity in intensive care units and implementing containment measures were the two priorities Italian physicians identified as they worked to curb an outbreak at a hospital in Italy, according to a viewpoint article in the Journal of the American Medical Association.
On Feb. 20, a young, healthy person in his 30s was admitted to the intensive care unit at a hospital in Lombardy, Italy, with the new coronavirus. Within 24 hours, 36 more cases were identified without links to first patient or any other confirmed COVID-19 cases in the country.
The next day, the government of Lombardy and local health authorities created an emergency task to lead the response to the outbreak.
The task force, called the COVID-19 Lombardy ICU network, pinpointed two priorities: increasing surge ICU capacity and deploying containment strategies.
To help deal with the influx of patients requiring critical care, the network decided to admit COVID-19 patients to 15 first-responder hospitals, selected because they either had expertise in infectious disease or were part of a national referral network of selected ICUs able to provide advanced respiratory care.
The identified hospitals were asked to take several actions to increase surge capacity, including creating "cohort ICUs,' units that are separate from other ICU beds, and organize a triage area where patients could receive mechanical ventilation if necessary.
The hospitals also were asked to cancel nonurgent procedures.
"In total, over the first 18 days, the network created 482 ICU beds ready for patients," the article's authors wrote.
In terms of containment measures, local health officials implemented quarantine and self-isolation orders in the area.
"The goal is to ensure that an ICU bed is available for every patient who requires one" the authors wrote. "Other healthcare systems should prepare for a massive increase in ICU demand during an uncontained outbreak of COVID-19. This experience would suggest that only an ICU network can provide the initial immediate surge response to allow every patient in need for an ICU bed to receive one."
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