Coronavirus. UPMC Salvator Mundi in the management of the Covid-19 emergency. Interview with Prof. Giovanni Vizzini.

We asked some questions to Prof. Giovanni Vizzini, Chief Operating Officer and Medical-Scientific Director of UPMC Italy, Medical Director of UPMC Salvator Mundi International Hospital.

UPMC Salvator Mundi International Hospital is welcoming people with symptoms that could be traced back to COVID-19 for an initial assessment. How does that work?

In the context of the current SARS-CoV-2 pandemic, all people who suffer from flu-like and/ or respiratory disorders must adopt behaviors to avoid that, if the origin of the symptoms is an infection caused by COVID-19, the infection spreads to family members, cohabitants and other possible contacts. The most effective tool is simply the isolation (voluntary self-isolation) of the patient at home (this is the recommendation of all national and international health bodies). However, when the patient's condition worsens, really or is perceived as such, it is natural that the same patient or more often family members seek assistance at a health facility.

In the last period we have assisted at UPMC Salvator Mundi a large number of patients with "suspicious" symptoms. For this reason, we have activated the "Rapid Response Team" for the coordinated management of the emergency and developed and put into practice a patient triage procedure that provides a protected path at our facility (separate access, dedicated observation area, etc.) and the use by all the health personnel involved of personal protective equipment for the maximum possible protection of the health of the operators and for the reduction of the risk of contagion. Most of the patients, after the execution of the tests, were found to be suffering from "common" respiratory infections, but we also identified, among the many symptomatic patients, SARS-Cov-2 infections.

Can you give us an example of a case of a patient who tested positive? What process did you follow?

All patients with flu-like and/or respiratory symptoms were kept in isolation and subjected to the diagnostic test currently considered "gold standard", i.e. the molecular biology test on material taken with nasal and oropharyngeal swab. Through an agreement with the Regional Reference Center "L. Spallanzani Hospital" in Rome, we sent the biological samples to their laboratory, receiving the result within 12-18 hours after sending. In case of negative result, the protocol provides for the repetition 24 hours later, of a second swab examination. Only after a second negative result the patient is considered "non-COVID-19" and admitted to the inpatient department of our facility, no longer in isolation. In cases where the swab test was positive, the transfer to one of the COVID-19 Centers of the city of Rome was promptly organized, with the help of the regional emergency system of 118.

How is the rest of the clinical activity taking place?

Social distancing measures and restrictions on the movement of people have obviously strongly influenced clinical activity, significantly reducing all outpatient activity and all surgical activity in election. For the management of problems that do not require hospitalization, but that require prompt evaluation by the doctor, we have started a program of remote visits, supported by telemedicine systems, which will be activated in the coming days. However, we have kept the structure active for surgical emergencies and hospitalizations, especially in the medical area, motivated by the presence of clinical problems that cannot be postponed. A significant number of patients, especially the elderly and/or with associated chronic diseases, have been admitted for severe flu-like and/or respiratory (non-COVID-19) symptoms associated with severe pulmonary complications (pneumonia).