Treat all COVID 19-positive patients, but do not forget those negative with chronic diseases

Abstract

The outbreak of coronavirus disease 2019 (COVID-19) has distressed our working practice. Infectious disease specialists, pneumologists and intensivists were not enough to face the enormous amount of patients that needed hospital care; therefore, many doctors have been recruited from other medical specialties trying to take care of as many patients as possible. The 'call to duty' of such doctors for urgent COVID-19 cases, however, diverted the attention from the care of patients with chronic conditions, which might have been neglected or undervalued. In this extremely difficult time, the standard of care of chronic patients has been reduced and this might have determined an increased rate of complications secondary to undermanagement. Thousands of patients with acute and chronic non-COVID-19 conditions have not accessed specialist care in the last weeks in Italy. Moreover, even those patients who have had scheduled an outpatient visit did not attend it for fear of leaving their home or due to the inability to go. During the pandemic, there was a drastic reduction in the number of hospital admissions for any medical conditions different from COVID-19. Self-presentation to the emergency department (ED) has been discouraged and the patients' own fear of being infected by going to the hospital led to also a significant decrease in ED access. During the lockdown, in San Giuseppe Hospital MultiMedica IRCCS, Milan, the ED admissions dropped from the mean of 2361/ month in December 2019-February 2020 to 1102 (− 53%) and 861 (− 63%) in March and April 2020, respectively. For all the above-mentioned reasons, it is possible that some clinical conditions will further progress with a significant increase in morbidity and mortality. To prevent this, it is essential that patients with chronic conditions should be at least monitored and managed with telephone or online health consultation, identifying those who need urgent access to care, prioritizing outpatient visits based on disease severity. Patients with mild conditions could be managed outside the hospital by implementing telemedicine and creating networks of general practitioners who can consult with in-hospital specialists. Keywords Chronic disease • COVID-19 • SARS-CoV-2 • Emergency department Newly identified SARS CoV-2 may cause mild and selflimiting illness with upper respiratory tract symptoms,

The impact of COVID-19 pandemic in a cohort of Italian psoriatic patients treated with biological therapies

“…COVID-19 pandemic led to inevitable changes in the healthcare system, since the overwhelming of hospitals resulted in a substantial reduction of specialist care for non-COVID patients with chronic conditions (4). During the shutdown period, patients affected by chronic skin diseases have been deprived of their regular dermatological consultations, since outpatient visits were mostly limited to urgent cases.…”

“…The national lockdown, lasting from March 9 to May 3 2020, resulted in huge economic consequences and health implications as well as an important psychological impact on the Italian population (2), in addition to the predictable effect on healthcare workers involved in COVID-19 management, experiencing both physical and psychological pressure while facing this novel situation (3). In many European and non-European healthcare systems, the pandemic also led to difficulties in managing patients affected by chronic diseases, because of the suspension of most outpatients' services and the redirection of many medical specialties to manage COVID-19 patients (4). In this context, psoriasis represents the stereotypical example of a chronic inflammatory skin disease, affecting the 3.1% of the population in Italy (5), and ranging from mild to moderate-to-severe forms.…”

Impact of COVID-19 on primary care visits: lesson learnt from the early pandemic period

“…Therefore, the WHO has strongly advised the public to take several precautions including hand and respiratory hygiene, physical distancing, and staying home. 8 As the number of confirmed cases increased exponentially, reports from USA [9][10][11] , Canada 12 , Norway 13 , Italy 14 , Austria 15 , Greece 16 , Turkey 17 , India 18, and Hongkong 19 suggested sharp declines in the number of patients looking for medical care, both in outpatient and emergency department (ED) settings. This has raised some concerns, especially when serious conditions such as stroke or acute coronary syndrome, also have decreased.…”

“…This has raised some concerns, especially when serious conditions such as stroke or acute coronary syndrome, also have decreased. 12,15,18,19 A big data analysis was conducted by the Centers for Disease Control and Prevention (CDC-P), USA, comparing the number of visits to ED from a subset of hospitals in 47 states during the early pandemic period (week 14-17, 2020) to a comparison period (week [14][15][16][17]2019). They found that the number of visits for conditions including nonspecific chest pain and acute myocardial infarct decreased.…”

A New Personalised Telehealth Model in Chronic Pediatric Diseases and Disability During The COVID-19 ERA

“…During the rst months of the pandemic, severely affected countries had no choice but to cancel all elective surgeries, follow-up appointments, rehabilitation services (2). This pressurized physicians and patients to nd alternative ways to comply with care recommendations, especially in patients with chronic diseases, who require regular follow up assessments and of a multidisciplinary approach to prevent complications caused by undermanagement (3). The challenge was to nd alternative ways to continue treatment while maintaining safety measures.…”