- The COVID-19 outbreak in Italy is following an exponential trend, with the number of infected patients doubling every 3-4 days. If this trend continues, there will be over 30,000 infected patients by mid-March, exceeding Italy's intensive care capacity.
- Between 9-11% of infected patients in Italy have required intensive care, and intensive care needs are also following an exponential trend. If not addressed, intensive care needs could reach several thousand beds by mid-April, far more than currently available.
- The analysis can help political leaders allocate sufficient health-care resources like beds, facilities, and personnel to manage the situation in upcoming weeks. Strict social distancing is needed to potentially reduce new cases and
Similarities and Differences between the New Coronavirus Infectious 2019 COVI...ijtsrd
From late fall to winter of 2020, the further challenge of medical care for thetwindemic of coronavirus infectious disease 2019 COVID 19 and seasonal influenza is imminent. The key to that is the ability of family doctors to protect the front lines of community medicine. It is difficult not only for patients but also for doctors to distinguish COVID 19 from seasonal flu only based on initial symptoms such as fever and malaise. Every year, patients with suspected seasonal flu are tested and, if positive, are treated with influenza drugs. However, due to the expansion of COVID 19, tests using a nasopharyngeal swab have a high risk of droplet infection. In this review, we would like to discuss the clinical similarities and differences between COVID 19 and seasonal influenza, including new findings.The coronavirus infectious disease 2019 COVID 19 pandemic, also known as the coronavirus pandemic, is an ongoing global pandemic of COVID 19, caused by severe acute respiratory syndrome coronavirus 2 SARS CoV 2 1 .The outbreak was first identified in December 2019 in Wuhan, China 2,3 .The World Health Organization WHO declared the outbreak a Public Health Emergency of International Concern on 30January 2020 and a pandemic on 11March 2020 4,5 .As of 30 August 2020,more than 25million cases of COVID 19 have been reported in more than 188 countries and territories, resulting in more than 843,000 deaths more than 16.4million people have recovered 6 .The WHO has published a report summarizing the differences between the COVID 19 and influenza 7 . Takuma Hayashi | Ikuo Konishi "Similarities and Differences between the New Coronavirus Infectious 2019 (COVID-19) and Seasonal Influenza" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-4 | Issue-6 , October 2020, URL: https://www.ijtsrd.com/papers/ijtsrd33370.pdf Paper Url: https://www.ijtsrd.com/medicine/other/33370/similarities-and-differences-between-the-new-coronavirus-infectious-2019-covid19-and-seasonal-influenza/takuma-hayashi
This report specifically looks at the impact COVID-19 has had on nursing homes and the nursing home industry. Contributors are students, faculty, and alumni located in a variety of geographic locations from Yale, Tulane, and Sacred Heart Universities. It provides information gathered from situation reports, government and non-governmental organization, media reporting, and a variety of information sources, verifies and synchronizes the information and provide real-time information products to federal, state, local, nongovernmental and international response organizations.
Contributors are students, faculty, and alumni located in a variety of geographic locations from Yale, Tulane, and Sacred Heart Universities. It provides information gathered from situation reports, government and non-governmental organization, media reporting, and a variety of information sources, verifies and synchronizes the information and provide real-time information products to federal, state, local, nongovernmental and international response organizations.
Contributors are students, faculty, and alumni located in a variety of geographic locations from Yale, Tulane, and Sacred Heart Universities. It provides information gathered from situation reports, government and non-governmental organization, media reporting, and a variety of information sources, verifies and synchronizes the information and provide real-time information products to federal, state, local, nongovernmental and international response organizations.
Similarities and Differences between the New Coronavirus Infectious 2019 COVI...ijtsrd
From late fall to winter of 2020, the further challenge of medical care for thetwindemic of coronavirus infectious disease 2019 COVID 19 and seasonal influenza is imminent. The key to that is the ability of family doctors to protect the front lines of community medicine. It is difficult not only for patients but also for doctors to distinguish COVID 19 from seasonal flu only based on initial symptoms such as fever and malaise. Every year, patients with suspected seasonal flu are tested and, if positive, are treated with influenza drugs. However, due to the expansion of COVID 19, tests using a nasopharyngeal swab have a high risk of droplet infection. In this review, we would like to discuss the clinical similarities and differences between COVID 19 and seasonal influenza, including new findings.The coronavirus infectious disease 2019 COVID 19 pandemic, also known as the coronavirus pandemic, is an ongoing global pandemic of COVID 19, caused by severe acute respiratory syndrome coronavirus 2 SARS CoV 2 1 .The outbreak was first identified in December 2019 in Wuhan, China 2,3 .The World Health Organization WHO declared the outbreak a Public Health Emergency of International Concern on 30January 2020 and a pandemic on 11March 2020 4,5 .As of 30 August 2020,more than 25million cases of COVID 19 have been reported in more than 188 countries and territories, resulting in more than 843,000 deaths more than 16.4million people have recovered 6 .The WHO has published a report summarizing the differences between the COVID 19 and influenza 7 . Takuma Hayashi | Ikuo Konishi "Similarities and Differences between the New Coronavirus Infectious 2019 (COVID-19) and Seasonal Influenza" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-4 | Issue-6 , October 2020, URL: https://www.ijtsrd.com/papers/ijtsrd33370.pdf Paper Url: https://www.ijtsrd.com/medicine/other/33370/similarities-and-differences-between-the-new-coronavirus-infectious-2019-covid19-and-seasonal-influenza/takuma-hayashi
This report specifically looks at the impact COVID-19 has had on nursing homes and the nursing home industry. Contributors are students, faculty, and alumni located in a variety of geographic locations from Yale, Tulane, and Sacred Heart Universities. It provides information gathered from situation reports, government and non-governmental organization, media reporting, and a variety of information sources, verifies and synchronizes the information and provide real-time information products to federal, state, local, nongovernmental and international response organizations.
Contributors are students, faculty, and alumni located in a variety of geographic locations from Yale, Tulane, and Sacred Heart Universities. It provides information gathered from situation reports, government and non-governmental organization, media reporting, and a variety of information sources, verifies and synchronizes the information and provide real-time information products to federal, state, local, nongovernmental and international response organizations.
Contributors are students, faculty, and alumni located in a variety of geographic locations from Yale, Tulane, and Sacred Heart Universities. It provides information gathered from situation reports, government and non-governmental organization, media reporting, and a variety of information sources, verifies and synchronizes the information and provide real-time information products to federal, state, local, nongovernmental and international response organizations.
The first three months of the COVID-19 epidemic:
Epidemiological evidence for two separate strains of SARSCoV-2 viruses spreading and implications for prevention
strategies
COVID 19 is a contagious disease caused by a betacoronavirus, which began in Wuhan, China in late 2019. Until now, this new illness has affected more than 6 million people worldwide, and has claimed more than 300 000 human lives. Governments around the globe were faced with the coronavirus pandemic crisis and designed strategies to slow or halt viral transmission. Measures undertaken included enforcing countrywide lockdowns, banning mass gatherings, closing schools and businesses and halting international travel.
Emergency management 11
Emergency Management
Abstract:
In the month of December, 2019 there was outbreak of pneumonia with unknown reason in Wuhan, China. Wuhan is the center of attention because of the respiratory disorder cause by a virus called Corona and also known as Novel COVID – 19. Validate the existence of this virus was also diagnosed in Wuhan. Then it start spreading all over the world due to the social gatherings. It ultimately take thousands of people towards death. Then after its huge destruction a final step of lockdown is taken up by the government of each country. The animal-to-human transmission was presumed as the main mechanism. It was concluded that the virus could also be transmitted from human-to-human, and symptomatic people are the most frequent source of COVID-19 spread. The virus-host interaction and the evolution of the epidemic, with specific reference to the times when the epidemic will reach its peak.
Introduction:
There is scanty knowledge on the actual pandemic potential of this new SARS-like virus. It might be speculated that SARS-CoV-2 epidemic is grossly underdiagnosed and that the infection is silently spreading across the globe. There are no comparable analogies to corona virus. This virus is not like any of the other epidemiological threats that have emerged in recent decades; it is less fatal but much more contagious.
Distribution of cases by the following:
· Time: The outbreak of 2019 novel coronavirus disease (COVID-19) was first reported on December 31, 2019.
· Place: the epidemiology of 2019 novel coronavirus disease (COVID-19) in a remote region of China, far from Wuhan, we analyzed the epidemiology of COVID-19 in Gansu Province
Explanation of the research topic (corona virus):
As the outbreak of coronavirus disease 2019 (COVID-19) is rapidly expanding in China and beyond, with the potential to become a world-wide pandemic, real-time analyses of epidemiological data are needed to increase situational awareness and inform interventions. The current most likely hypothesis is that an intermediary host animal has played a role in the transmission. Identifying the animal source of the 2019-nCoV would help to ensure that there will be no further future similar outbreaks with the same virus and will also help understanding the initial spread of the disease.
Numerator (cases of corona virus):
Deaths divided the total of deaths plus recoveries. In early days because of the exponential increase new cases significantly outpace recoveries. You’re dividing by new cases but the numerator hasn’t had a chance to catch up to the death toll yet to be associated with those cases. If you look at COVID 19 on Feb 17, you get the 2% number only if dividing by total cases. If you look vs recovered cases, it’s 13%.
The WHO’s fatality percentage, announced March 17, 2020, is based simply on the number of deaths g.
Impact of COVID-19 caronavirus on poverty in Pakistan: a case study of SindhSubmissionResearchpa
The current research investigated the COVID-19 is spread vigorously in China, USA, France, Italy, Germany, and European countries and Iran Pakistan being as a neighbor country of china & IranOne was for the incoming Pakistani from various countries, such as Iran, China, Afghanistan, and India. The other was arranged inside various hospitals for COVID-19 positive cases. As hundreds and thousands of Pakistani were in Iran for religious purposes, they were. Most of the students and businessmen, inside China, were not allowed to come back. Handling of large scale influx from Iran was the main problem. Out of the total COVID-19 cases, 78 percent of cases were reported from visitors coming from Iran. Pakistan announced the closure of all schools, colleges & universities with a partial lockdown across the country for major cities. by Dr. Faiz Muhammad Shaikh, Ali Raza Memon and Kashaf Shaikh 2020. Impact of COVID-19 caronavirus on poverty in Pakistan: a case study of Sindh . International Journal on Integrated Education. 3, 6 (Jun. 2020), 72-83. DOI:https://doi.org/10.31149/ijie.v3i6.415. https://journals.researchparks.org/index.php/IJIE/article/view/415/391 https://journals.researchparks.org/index.php/IJIE/article/view/415
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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1. Health Policy
www.thelancet.com Published online March 12, 2019 https://doi.org/10.1016/S0140-6736(20)30627-9 1
COVID-19 and Italy: what next?
Andrea Remuzzi, Giuseppe Remuzzi
The spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has already taken on pandemic
proportions, affecting over 100 countries in a matter of weeks. A global response to prepare health systems worldwide is
imperative. Although containment measures in China have reduced new cases by more than 90%, this reduction is not
the case elsewhere, and Italy has been particularly affected. There is now grave concern regarding the Italian national
health system’s capacity to effectively respond to the needs of patients who are infected and require intensive care for
SARS-CoV-2 pneumonia. The percentage of patients in intensive care reported daily in Italy between March 1 and
March 11, 2020, has consistently been between 9% and 11% of patients who are actively infected. The number of patients
infected since Feb 21 in Italy closely follows an exponential trend. If this trend continues for 1 more week, there will be
30 000 infected patients. Intensive care units will then be at maximum capacity; up to 4000 hospital beds will be needed
by mid-April, 2020. Our analysis might help political leaders and health authorities to allocate enough resources,
including personnel, beds, and intensive care facilities, to manage the situation in the next few days and weeks. If the
Italian outbreak follows a similar trend as in Hubei province, China, the number of newly infected patients could start
to decrease within 3–4 days, departing from the exponential trend. However, this cannot currently be predicted because
of differences between social distancing measures and the capacity to quickly build dedicated facilities in China.
Introduction
According to Nature, the spread of coronavirus disease
2019 (COVID-19) is becoming unstoppable and has
already reached the necessary epidemiological criteria for
it to be declared a pandemic, having infected more than
100 000 people in 100 countries.1
Therefore, a coordinated
global response is desperately needed to prepare health
systems to meet this unprecedented challenge. Countries
that have been unfortunate enough to have been exposed
to this disease already have, paradoxically, very valuable
lessons to pass on. Although the containment measures
implemented in China have—at least for the moment—
reduced new cases by more than 90%, this reduction is
not the case in other countries, including Italy and Iran.2
Italy has had 12 462 confirmed cases according to the
Istituto Superiore di Sanità as of March 11, and 827 deaths.
Only China has recorded more deaths due to this
COVID-19 outbreak. The mean age of those who died in
Italy was 81 years and more than two-thirds of these
patients had diabetes, cardiovascular diseases, or cancer,
or were former smokers. It is therefore true that these
patients had underlying health conditions, but it is also
worth noting that they had acute respiratory distress
syndrome (ARDS) caused by severe acute respiratory
syndrome coronavirus 2 (SARS-CoV-2) pneumonia,
needed respiratory support, and would not have died
otherwise. Of the patients who died, 42·2% were aged
80–89 years, 32·4% were aged 70–79 years, 8·4% were
aged 60–69 years, and 2·8% were aged 50–59 years (those
aged >90 years made up 14·1%). The male to female ratio
is 80% to 20% with an older median age for women
(83·4 years for women vs 79·9 years for men).
On March 8, 2020, the Italian Government implemented
extraordinary measures to limit viral transmission—in
cluding restricting movement in the region of Lombardy—
that intended to minimise the likelihood that people
who are not infected come into contact with people who
are infected. This decision is certainly courageous and
Published Online
March 12, 2020
https://doi.org/10.1016/
S0140-6736(20)30627-9
Department of Management
Information and Production
Engineering, University of
Bergamo, Dalmine, Italy
(Prof A Remuzzi EngD); and
Istituto di Ricerche
Farmacologiche Mario Negri
IRCCS (Prof G Remuzzi MD)
Figure 1: Measured and predicted number of patients reported to be infected in Italy using an exponential
curve
PanelA shows number of infections in previous days and B shows projections forthe coming days.
Feb 19 Feb 21 Feb 23 Feb 25 Feb 27 Feb 29 March 2 March 4 March 6 March 8 March 10
0
1000
2000
3000
4000
5000
6000
7000
9000
8000
Numberofinfectedpatients
A
Feb 14 Feb 19 Feb 24 Feb 29 March 5 March 10 March 15 March 20
0
5000
10000
15000
20000
25000
35000
30000
Numberofinfectedpatients
Date (2020)
B
Measured
Simulated
2. Health Policy
2 www.thelancet.com Published online March 12, 2019 https://doi.org/10.1016/S0140-6736(20)30627-9
Correspondence to:
Prof Andrea Remuzzi,
Department of Management
Information and Production
Engineering, University of
Bergamo, Dalmine 24044, Italy
andrea.remuzzi@unibg.it
important, but it is not enough. At present, our national
health system’s capacity to effectively respond to the needs
of those who are already infected and require admission to
an intensive care unit for ARDS, largely due to SARS-CoV-2
pneumonia, is a matter of grave concern. Specifically, the
percentage of patients admitted to intensive care units
reported daily in Italy, from March 1, up until March 11,
was consistently between 9% and 11% of patients who
were actively infected.
In Italy, we have approximately 5200 beds in intensive
care units. Of those, as of March 11, 1028 are already
devoted to patients with SARS-CoV-2 infection, and in
the near future this number will progressively increase to
the point that thousands of beds will soon be occupied by
patients with COVID-19. Given that the mortality of
patients who are critically ill with SARS-CoV-2 pneu
monia is high and that the survival time of non-survivors
is 1–2 weeks, the number of people infected in Italy will
probably impose a major strain on critical care facilities
in our hospitals, some of which do not have adequate
resources or staff to deal with this emergency. In the
Lombardy region, despite extraordinary efforts to restrict
the movement of people at the expense of the Italian
economy, we are dealing with an even greater fear—that
the number of patients who present to the emergency
room will become much greater than the system can
cope with. The number of intensive care beds necessary
to give the maximum number of patients the chance to
be treated will reach several thousand, but the exact
number is still a matter of discussion among experts.
Health-care professionals have been working day and
night since Feb 20, and in doing so around 20% (n=350)
of them have become infected, and some have died.
Lombardy is responding to the lack of beds for patients
with COVID-19 by sending patients who need intensive
care but are not infected with COVID-19 to hospitals
outside of the region to contain the virus.
Modelling predictions
We present the following predictions to prepare our
political leaders—those who bear the greatest respon
sibility for national health systems and the government at
the regional level, as well as local health authorities—for
what is predicted to happen in the days and weeks to
come. They can then implement measures regarding
staff resources and hospital beds to meet the challenges
of this difficult time. Official numbers of infected people
during the COVID-19 virus outbreak in Italy are indicative
of the spread of the infection, and of the challenges that
will be posed to Italian hospitals and, in particular,
intensive care facilities. The number of patients who are
infected has been published daily since Feb 21, 2020. It is
possible to fit the available data for the number of
patients who are actively infected into an exponential
model, as reported in figure 1A. The value of the exponent
can be computed as r=0·225 (1 per day) and is consistent
with the number of infected patients reported by the
Italian Health Ministry. The consistency between the
exponential prediction and the reported data is very close
up until day 17. If the increase in the number of infected
patients follows this trend for the next week, there will be
more than 30 000 patients infected by March 15, as shown
in figure 1B. On the basis of the exponential curve
prediction, and the assumption that the duration of
infection ranges from 15 to 20 days, it is possible to
calculate that the basic reproduction number ranges
from 2·76 to 3·25. This number is similar to that
reported for the initial phase of the infection outbreak
in the city of Wuhan, China3
and slightly higher than 2·2,
as reported by Li and colleagues in a more recent report.4
The number of patients admitted to intensive care
units increased similarly in Italy, with an exponential
trend up until March 8. The best fit of the data reported
by the Italian Ministry for Health can be obtained using
the same exponent that best fits the number of patients
Figure2:Measured and predicted number of patients in intensive care units in Italy using an exponential curve
Panel A shows number of patients in intensive care units in previous days and B shows projections for the coming
days.The dotted line represents the estimated capacity of intensive care beds in Italy.
Feb 27 Feb 29 March 2 March 4 March 6 March 8 March 10
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Numberofpatientsinintensivecareunits
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March 16Feb 27 Feb 29 March 2 March 4 March 6 March 8 March 10 March 12 March 14
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Numberofpatientsinintensivecareunits
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For the Italian Health Ministry
see http://www.salute.gov.it/
portale/home.html
3. Health Policy
www.thelancet.com Published online March 12, 2019 https://doi.org/10.1016/S0140-6736(20)30627-9 3
who are infected, as shown in figure 2A. The data
available up until March 8 show that the trend in the
number of patients who will need admission to intensive
care units will increase substantially and relentlessly in
the next few days. We can predict with quite a good
degree of accuracy that this number will push the
national health system to full capacity in a matter of days.
Considering that the number of available beds in
intensive care units in Italy is close to 5200, and assuming
that half of these beds can be used for patients with
COVID-19, the system will be at maximum capacity,
according to this prediction, by March 14, 2020. This
situation is difficult, given that the number of patients
who will need to be admitted to the intensive care unit is
predicted to further increase after that date, as shown in
figure 2B.
At this point, the most important question is whether
the increase in the number of patients who are infected
and those requiring intensive care admittance will
continue to rise exponentially and for how long. If the
change in the slope of the curve does not take place soon,
the clinical and social problems will take on unmanage
able dimensions, which are expected to have catastrophic
results. The only way we can make such predictions is by
comparing the trends in the data collected in the Hubei
region in China for COVID-19 infection with that for the
Italian population. From the official report of the WHO–
China Joint Mission on Coronavirus Disease 2019,5
it is
possible to derive the cumulative curve of the patients
who are infected from the start of the data series. These
data, as reported in figure 3, show that the initial phase of
the infection outbreak followed the expected exponential
trend, with the same exponent previously calculated for
the number of Italian patients who were infected. Starting
Jan 7, the cumulative number of patients who were
infected started to diverge from the exponential trend
20 days later. If the Italian outbreak follows a similar
trend to that in China, we can suggest that the number of
newly infected patients might start to decrease within
3–4 days from March 11. Similarly, we can foresee that the
cumulative curve of patients who are infected will peak
30 days later, with the maximum load for clinical facilities
for the treatment of these patients foreseen for that
period.
Discussion
The most difficult prediction is the maximum number of
infected patients that will be reached in Italy and, most
importantly, the maximum number of patients who will
require intensive care unit admission. This prediction is of
crucial importance to plan for new facilities in Italian
hospitals and to calculate the time period in which they
need to be available. On the basis that the region of Hubei
in China has a slightly smaller population than Italy
(approximately 50 million in Hubei and 60 million in
Italy), we tentatively assumed that the trend for the
maximum number of patients who are actively infected
would be similar in the two territories. In doing so, we
cannot overlook the fact that the effect of travel restrictions
on the spread of the COVID-19 outbreak and the
extraordinary community measures taken within and
outside of Wuhan are unlikely to be replicated elsewhere.
Moreover, the current approach to these patients in
Lombardy implies non-pharmacological and pharma
cological interventions, including antiretroviral medi
cation, which might be different from the Wuhan outbreak,
and could distort the calculation. We also realise that there
is heterogeneity in the transmission dynamics between
the city of Wuhan and elsewhere in the province, where
the number of people who are infected remains lower.
Therefore, it might not be unrealistic to assume that what
is going to happen in Italy soon might mirror what
happened in Hubei. Of course, it would have been more
appropriate to directly compare Greater Wuhan (19 million
people) with the region of Lombardy (9 million people),
the most seriously affected region in Italy at the moment,
but such data are not available.6
We do not currently have
additional evidence we can take into consideration to make
more robust assumptions regarding the exact number of
patients who will be infected in the future days or weeks.
On the basis of the available data,5
the number of infected
patients reached approximately 38 000 at the end of
February, 2020, in the Hubei region, when the number of
new cases decreased to almost zero. Given that so far the
percentage of patients requiring ARDS treatment is close
to 10% for patients who are actively infected, at least in
Lombardy, we can assume that we will need approximately
4000 beds in intensive care units during the worst period
of infection, which is expected to occur in about 4 weeks
from March 11. This is challenging for Italy, as there are
now just over 5200 intensive care beds in total. The aim
now is to increase this number to safely meet urgent future
Figure 3: Fitting of cumulative curve of measured infected patients in Hubei,China, with an exponential curve
The dotted line represents the timepoint of the infection outbreak in Italy. It is expected that the number of
cumulative patients who are infected will start to deviate from the exponential low in 3–4 days.The plateau of the
cumulative curve will be reached just over 30 days from March 11, 2020.
Jan 5 Jan 10 Jan 15 Jan 20 Jan 25 Jan 30 Feb 4 Feb 9 Feb 14 Feb 19 Feb 24
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