Coronavirus in Italy – Report From The Front Lines

A JAMA livestream from March 13: Insights from Maurizio Cecconi, MD, of Humanitas University in Milan, at the epicenter of the pandemic where the overwhelming majority of Italy’s COVID-19 cases are being treated.

Some important points:

• Despite reports from China, the Italian experience so far is that the clinical picture is like any other interstitial pneumonia: respiratory distress with hypoxemia and hypoxia leading to MODS in the worst cases.
• Traditional AIP/ARDS treatments are being used: supportive measures such as low tidal volume ventilation and prone positioning.
• The main challenge is that the rapidity of the spread of infection is leading to a mismatch between the volume of patients requiring ICU beds and the capacity of the healthcare system in Lombardy (which must simultaneously continue to provide ICU care to the regular patient population).
• Healthcare providers treating COVID-19 in the ICU undertake 6-hour rotations in full PPE.
• Short-term goal: Continue ongoing expansion of capacity in order to “provide an ICU bed to every patient who needs it.”
• Long-term goal: Country-wide mitigation strategies to slow and prolong the spread of the virus.