key: cord-0912396-hctfmjhv authors: D'Avanzo, Barbara; Nobili, Alessandro; Tettamanti, Mauro; Pasina, Luca; Mannucci, Pier Mannuccio title: What changed in the Italian internal medicine and geriatric wards during the lockdown date: 2020-11-07 journal: Eur J Intern Med DOI: 10.1016/j.ejim.2020.10.024 sha: 78c3c1385b2765afff97b798de7eb51dedc5cbfa doc_id: 912396 cord_uid: hctfmjhv nan Italy was the most affected European country in the first few weeks of the COVID-19 pandemic, with a dramatic burden on sub-intensive and intensive care units. Among the several arrangements implemented to tackle this burden, hospital wards of almost all medical and surgical specialties were closed or converted into wards for sub-intensive care of COVID-19, and in many cases entire hospitals were converted into COVID hospitals. With this background, a total of 48 internal medicine or geriatric wards among the 93 adhering to the register REPOSI [1] answered an online questionnaire aimed to investigate the characteristics and activities of converted and non-converted wards in the crucial period of the first wave of the epidemic, 22 February-4 May 2020. Twenty wards, corresponding to 37% of the 48 which answered, were converted into COVID-19 wards. This occurred more commonly in Northern Italy (59% of the respondent wards) than in the South (14%), that was less affected by the COVID-19 burden (Table 1) . Converted wards (CWs) were on average larger than the non-converted ones (NCWs): the median of their normally active beds was 33 and 27, respectively. Seventeen of the CWs and 16 of the NCWs had a member of their staff infected by COVID-19, with relatively more physicians than nurses infected in the CWs (36% versus 13%) and more nurses than physicians in the NCWs (26% versus 20%), but none of these healthcare professionals died. Other professionals replaced those who became ill in almost half of the CWs and in a small proportion of the NCWs. 85% of the CWs needed and enrolled additional staff, half or more of them involving at least 4 more doctors, 4.5 nurses and 3 aides, corresponding to a relative increase of the normally available professionals of 66%, 77% and 110% respectively (Table 1) . CWs admitted 3250 ill people in the index period. The mean number per ward was 180 (SD 163) and the median was 130, with 734 deaths. In the same period, 3074 non-COVID patients were admitted to the NCWs and 262 died (Table 1) . Whereas the total death rate was 23% among COVID patients, it was 8.5% among non-COVID patients in the NCWs in the same period (Table 1) . Rules and prescribed procedures implemented for ward conversions were fulfilled and personal protection devices for patients and professionals made available, even though they were judged fully adequate in only 40% of the CWs and 14% of the NCWS. In 9 CWs more beds were added, and in 19 wards full bed occupancy was reached. All the 20 CWs stopped all or most research concerning other medical conditions, 22 among the 28 NCWs. Sixteen CWs (80%) and 6 (21%) NCWs implemented protocols for the use of off-label drugs for the treatment of COVID-19. Follow-up of patients discharged from hospital was initiated in 11 (55%) CWs and in 10 (36%) NCWs. The country distribution of the converted wards mirrors that of the pandemic and witnesses the efforts made in Italy by the internists [3] to guarantee appropriate care for those infected. However, it is likely that this effort had a negative impact on patients with illnesses other than COVID-19, both from the clinical and research standpoint, for the following reasons. Professionals were transferred to COVID-19 wards from a variety of different subspecialty wards (including a certain number of physicians and nurses already retired), hospital admissions were restricted to severe or urgent conditions, so that clinical research were mostly interrupted. There was a high mortality rate in the population infected by COVID-19, the observed rate largely overlapping with that reported in the same period by Richardson et al. [2] in New York City. Unfortunately, we collected no information on the number of patients transferred from internal medicine and geriatric ward to intensive care units. The high rate of infected professionals is likely to be associated with inadequate personal protection devices, at least at the time of the very first period of the emergency [4] . At the time of this survey, only half of COVID-19 wards had chosen to implement a regular follow-up of patients discharged alive, even though it is possible that a follow-up was put in place more extensively later than when this survey was conducted, when hospitals were too busy with the organization and immediate delivery of acute care to be able to implement regular follow-up for those discharged. This view is supported by the small number of publications available till now on the follow-up and clinical state of patients who survived COVID-19 [5] , often limited to specific conditions [6] . Given the array of body systems affected by the virus, it will be paramount to describe to which extent COVID-19 patients have recovered and which sequelae they suffer from. In conclusion, even though only half of the REPOSI wards completed this online questionnaire, we managed to gain a comprehensive description of what happened during the early peak of COVID-19 in the activity of front-line internal medicine facilities in Italy. The authors declare they have no conflict of interest. Conversion of internal medicine and geriatric REPOSI wards into COVID-19 wards. Multimorbidity and polypharmacy in the elderly: lessons from REPOSI Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area Reorganizing Italian Internal Medicine wards for COVID 19 Critical supply shortages -The need for ventilators and personal protective equipment during the Covid-19 pandemic Clinical sequelae of COVID-19 survivors in Wuhan, China: a single-centre longitudinal study Leukoencephalopathy associated with severe COVID-19 infection: sequela of hypoxemia?