Letter to the Editor: The Overnight Successful Change of a Facility into a COVID-19 Center During the SARS-CoV-2 Pandemic

As a result of the SARS-CoV-2 pandemic, the Italian Government established a first national lockdown on March 11, 2020. The epicenter was in the North, with 79% of cases versus 21% in the South. As of April 16, 2020, ¹ at the peak of the pandemic, the Region Emilia-Romagna (population of 4.5 million), with 21,800 patients and 2900 deaths, was the second most affected region in the world (Lombardy being the first).

The Regional Health Service decided to devote the Sant'Orsola University Hospital in Bologna (1500 beds) solely to the treatment of COVID-19. This strategic public health choice was implemented before the Italian Government issued the lockdown. Because of patient overload, wards, operating rooms, and other areas soon needed to be converted into intensive care unit (ICU) and infectious diseases (ID) departments. Following the adequate training procedures, a SARS-CoV-2 center was then established overnight: personal protective equipment was promptly made available for all personnel, with rigid dressing and undressing protocols. A 24/7 support was provided by anesthesiologists, pulmonologists and ID physicians.

As an example, the local trauma surgery unit was converted into a COVID-19 unit. Twenty-six surgeons and 30 residents were quickly trained, changing their routine daily activity and serving as ICU and ID physicians. All trauma, emergency, and elective surgical patients were treated in the other metropolitan hospital (Maggiore Hospital). The COVID-19 patient population of the trauma surgery unit was 70.9% male with a mean age of 66.7 years. Comorbidity and pneumonia rates were 75.0% and 83.4%, respectively. Two fatalities (8.3%) were reported: a 65-year-old female with obesity (body mass index: 40 Kg/m²) and a 90-year-old male with severe hypertension.

Because of the sudden onset of the pandemic, staff and bed shortages required a temporary reorganization ² of all services. This was particularly challenging within the National Health Service, ³ where physicians and surgeons collaborate but do not share wards. However, the reorganization of the trauma surgery unit succeeded in responding readily to changed circumstances. ⁴ Through personnel flexibility, efficient teamwork, and cross-specialty collaboration, all COVID-19 patients of a large metropolitan area were treated exclusively in a dedicated facility, minimizing viral spread and allowing other hospitals to continue all routine surgical and medical treatments with no interruption in care.

This is an effective population health management strategy that can be implemented easily in all health systems, ensuring continued care to millions of people, avoiding economic loss, and enforcing national security, while also supporting the population's morale. This public health model has set an example in Italy and the Government has now decided to establish a number of COVID-19 dedicated hospitals.