As the number of confirmed cases of coronavirus in Italy continues to rise, the reorganization
of the hospitals outlined by Grasselli et Al. [1] across the country made wards slowly
emptied, elective activities interrupted, and intensive care units freed up to create
as many beds as possible.
Simultaneously, in many small, non-hub hospitals, because of the chronic shortage
of staff, internal medicine teams -doctors and nurses- often without any formal, adequate
training, have been moved to the newly, hastily created COVID wards, where, beside
caring for patients' general needs, they just implement the therapeutic protocol the
hospital chose (if ever) to treat SARS CoV-2 positive patients, hoping that the drugs
they're prescribing out of any evidence do more good than harm [2]. All the clinical
competence of the teams most of the time has come down to watching out for clinical
deterioration, when the patient is not responding to high-flow nasal oxygen or positive
end-expiratory pressure (when available), trying not to miss the right moment to call
the intensivist [3].
At the same time, what is left of the internal medicine wards has been clumsily staffed
with doctors and nurses with different competences, bewildered and anxious about their
new tasks when facing patients of all ages with a wide range of diseases and clinical
presentations, from severe dyspnea to acute abdominal pain, from apparently accidental
fall to general critical conditions, with different workups, differential diagnoses,
prognoses and therapies [4].
Once again, in these small, non-hub hospitals, we are facing a floor-ceiling effect
in human resources management: high skilled internal medicine nurses and doctors are
(mis)used to take care of patients mostly admitted just because SARS CoV-2 positive
and whose clinical course is often sadly dichotomous, whereas non-SARS CoV-2 positive
critical patients, whose clinical course has yet to be inferred from medical history,
clinical presentation and workup, are taken care of by nurses and doctors with competencies
ordinarily developed and valuably implemented in quite different settings of care.
Although "Res nova et regni novitas me talia cogunt moliri"
[5], still the feeling that in these days "ordinary patients" are deemed sons of a
lesser God is strong and worrisome. SARS CoV-2 pandemic has drained all medical attention
on treating affected patients, jeopardizing the ability to mantain the standard of
care we were used to provide for non- SARS CoV-2 related disease. Public messages
on social distancing make people refrain from seeking medical care going to the hospital.
Moreover, procedures to protect caregivers from infection will impose to rule out
SARS CoV-2 infection on any patient admitted, and any urgent procedure the internist
would advise will be delayed awaiting for the results. Non-SARS CoV-2 patients might
eventually pay a heavy, unexpected toll because of the dramatic change in practicing
medicine we have been forced to. We hope, as Grasselli et Al. pointed out [1], that
our health care system, not organized in collaborative emergency networks, will work
toward one now, without prejudicing any longer and again internal medicine practice,
the very heart of many hospital activity.
Declaration of Competing Interests
I have no actual or potential conflict of interest