The epidemiological models under review in the White House Situation Room in late March were bracing. In a best-case scenario, they showed the novel coronavirus was likely to kill between 100,000 and 240,000 Americans. President Trump was apprehensive about so much carnage on his watch, yet also impatient to reopen the economy — and he wanted data to justify doing so.
The BMJ has made a selection of key topics and patient information freely available to support clinical decision making during this covid-19 crisis. Their evidence-based topics provide step-by-step guidance on symptom evaluation, test ordering, treatment, follow-up and prevention. The accompanying patient information provides concise, user-friendly summaries to reassure patients and carers and help them to make informed, shared decisions about their treatment and management. Updated daily, the BMJ Best Practice will provide you with the latest and most practical clinical information to support your decision making.
COVID-19 has already taken a huge social and economic toll on our nation – and the reality is that it will continue to do so for some time. We are at a critical moment. We need to weigh up the balance of risks between easing restrictions, to enable more pupils to return to school, more businesses to open and more social connections to happen, with the risk of causing a resurgence of infections. Directors of Public Health are increasingly concerned that the Government is misjudging this balancing act and lifting too many restrictions, too quickly. This is a new disease; evidence is still emerging and there is much uncertainty. However, based on what is currently known, several leading scientists and public health experts have spoken out about a string of recent national policy announcements affecting England which project a degree of confidence that many – including ADPH members – do not think is supported by the science.
Lombardy, and particularly the province of Bergamo, has been the area of Italy most affected by Covid-19. As of April 26, 2020, the province had 11,113 confirmed cases and 2932 deaths from Covid-19. Delays in recognizing SARS-CoV-2 in the few infected patients admitted to the small hospital in Alzano Lombardo — and delays in activating measures to protect other patients, hospital personnel, and visitors, as well as in implementing adequate containment measures in patients’ villages — allowed the virus to spread rapidly and into the city of Bergamo. The province was not locked down until March 8, which was 2 weeks after the first documented cases at the Alzano hospital on February 23. By then, the virus had sickened thousands of people, many of whom visited the emergency department (ED) at ASST–Papa Giovanni XXIII, a referral hospital for high-need patients throughout the province, and were admitted. These patients rapidly overwhelmed the hospital’s capacity, forcing a major reorganization led by a crisis team established on February 23. The infectious disease unit was reconfigured to treat only patients with Covid-19, and other patients were redistributed throughout the hospital or, when possible, discharged.
The patient journey from home to hospital and back is fraught for rural people. Timely clinical handover, relevant discharge summaries, improved medication management and effective team care reduce secondary impacts such as readmission rates and reduced quality of life, and improve outcomes. Setting up a “digitally connected” practice, and delivering the quality outcomes that can be achieved is a journey.