Gastroenterology department operational reorganisation at the time of covid-19 outbreak: an Italian and Chinese experience
Gastroenterology department operational reorganisation at the time of covid-19 outbreak: an Italian and Chinese experience
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DOI：
10.1136/gutjnl-2020-321143
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发表时间：
2020-06-01
期刊：
影响因子：
24.5
通讯作者：
Malesci, Alberto
中科院分区：
文献类型：
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作者：
Danese, Silvio;Ran, Zhi Hua;Malesci, Alberto
2019年12月，中国武汉首次报告了急性呼吸窘迫综合征（ARDS）病例。一种新型冠状病毒被世界卫生组织命名为严重急性呼吸综合征冠状病毒2（SARS-CoV-2），被确定为引起covid-19的病原体。 1 尽管与 MERS-CoV 和 SARS-CoV 相比，这种新病毒的致命性似乎较低，但它的传染性似乎更高，2 因此自疫情爆发以来，全球已确诊病例超过 20 万例。 3 月 11 日，世界卫生组织宣布全球大流行，意大利和中国是风险最高的地区。 3 Covid-19 的临床表现与其他类型肺炎相似，4 即流感样表现，如发烧和咳嗽，可能发展为严重低氧血症、ARDS 和缺氧性呼吸衰竭。有趣的是，胸部 CT 的异常发现也可能出现在无症状患者中，正在成为一种早期诊断工具。 5 幸运的是，大约 10% 的感染患者出现这些症状，死亡率为 2%–8%，6 最严重的患者是 60 岁以上的男性，患有糖尿病、高血压、心血管疾病和癌症等基础健康问题。虽然 covid-19 患者的管理是一项相对简单的任务，即提供支持性护理（即通气），而且迄今为止还没有经过验证的特定抗病毒药物，7 主要问题来自最终需要重症监护 (IC) 的患者数量援助。旨在指导政治领导人的数学模型显示，感染人数和需要 IC 的人数都呈指数增长。 6 在大多数预测中，估计需要 3 个月的时间才能完全控制疫情。 8 在中国，事实证明，社区隔离措施对于减少疫情蔓延和限制卫生系统基础设施超出其承受能力的压力至关重要。 9因此，可以想象，基于感染社区隔离以及广泛的社会疏远的遏制干预措施可能会减缓每日新增病例的数量，从而减少总体病例数，进而将卫生系统的能力保持在可管理的水平，并避免所有资源都用于应对 covid-19 紧急情况（图 1A）。
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 infrastructures that were requested to exceed their capacity. 9 Therefore, it is conceivable that containment interventions based on segregation of infected communities, as well as on widespread social distancing, may slow the number of daily new cases, thus reducing the number of overall cases and, in turn, keeping the health system capacity at a manageable level and avoiding that all resources be devoted to covid-19 emergency (figure 1A).