Gastroenterology department operational reorganisation at the time of covid-19 outbreak: an Italian and Chinese experience

In December 2019, cases of acute respiratory distress syndrome (ARDS) were first reported in Wuhan, China. A new coronavirus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by WHO, was identified as the pathogenic agent causing the covid-19.1 Even if this new virus appears to be less fatal when compared with MERS-CoV and SARS-CoV, it appears to be highly more contagious,2 so that there have been more than 200 000 confirmed cases worldwide since the beginning of the outbreak. On 11 March, the WHO declared a global pandemic—Italy and China being the areas at highest risk.3 Covid-19 clinical presentation is similar to that of other types of pneumonia,4 namely flu-like manifestations, such as fever and cough, possibly evolving to severe hypoxaemia, ARDS and hypoxic respiratory failure. Interestingly, abnormal findings at chest CT, which may be present also in asymptomatic patients, are becoming an early diagnostic tool.5 Luckily, these symptoms are present in about 10% of infected patients with a 2%–8% mortality rate,6 the most severe patients being men over 60 years with underlying health conditions, such as diabetes, hypertension, cardiovascular diseases and cancer. While the management of patients with covid-19 is a relatively simple task, namely to provide supportive care (ie, ventilation), and no specific antivirals are so far validated,7 a major concern comes from the number of patients eventually requiring intensive care (IC) assistance. Mathematical models, aimed at instructing political leaders, show an exponential increase both in the number of people being infected and in those requiring IC.6 In most predictions, a 3-month period is estimated to be required in order to fully control the outbreak.8 In China, community isolation measures have been shown to be pivotal in reducing the spread of the outbreak and in limiting the pressure on health system …