ABSTRACT
Background: Italy was one of the first European countries to report COVID-19 cases, at the end of January 2020.1 In mid-February, the country reported community-based transmission, especially in the northern regions of Lombardia, Piemonte and Emilia-Romagna.2 The COVID-19 pandemic overstretched the structural capacity of health care facilities, and several hospitals in Emilia-Romagna undertook emergency measures to renovate, expand and reconstruct existing facilities. The Italian Ministry of Health required that emergency rooms be reorganized and restructured to separate the flow of human traffic and create permanent isolated areas for patients waiting for the results of tests for COVID-19.3 Emilia-Romagna, with WHO headquarters and the WHO regional and country offices, then launched the "hospital of tomorrow" project to set new standards to be applied to health-care facilities after COVID-19. Below, we present the preliminary results of the initial steps, covering 3 months of project (Figure 1). The case study will last one year (October 2020-November 2021) and further results will be discussed at the end of the project. Setting: St Orsola-Malpighi polyclinic, the facility selected for this pilot project, is an internationally acclaimed institution that dates back more than 4 centuries. It represents the European architectural heritage, with a mix of old and new pavilions, integrated into a city context. It is organized into 7 departments with 91 operative units. Before the COVID-19 pandemic, it was equipped with 1758 beds and had more than 5000 staff, with annual outpatient and inpatient turnovers of 400 000 and 72 000 patients, respectively. On any given day, approximately 20 000 staff, students, university lecturers and researchers, patients, visitors and suppliers are present on the hospital grounds.4 Process and outcomes: The hospital directors in collaboration with the WHO team defined the key macro areas for the intervention to enhance the facility's strengths and reduce its weaknesses in the health-care standards required to prevent the spread of SARS-CoV-2 and other infections and to improve the well-being of patients and staff and the quality of services. Working groups were established for each macro area, with representatives and group members selected by the hospital's Board of Directors. Representatives of the groups met weekly to coordinate activities and to serve as contact persons for group activities and liaison among the groups. The groups formed initially addressed staff spaces, high-tech logistics, "wayfinding", patient and visitor spaces, operational system support, user reception and access and telemedicine.
ABSTRACT
Introduction: All contacts of individuals with a confirmed or probable COVID-19 should be quarantined in a designated facility or at home for 14 days from their last exposure. Although shorter quarantine periods may lessen health system's burdens especially when new infections are rapidly rising, prolonging the quarantine duration could be prudent for high-risk scenarios and in regions with insufficient test resources. Objectives: To describe the rationale for different COVID-19 quarantine durations during the on-going pandemic in select countries. Methods: An online search was conducted to document countries' rationale for different quarantine durations during the ongoing COVID-19 pandemic. Only countries that stated a quarantine duration and its rationale were eligible for inclusion. A country was stated to have no quarantine, reduced, or prolonged its COVID-19 quarantine duration if it recommended 0, 1- < 14, or > 14 days. Country's names were anonymized based on the focus of this study. Results: Countries that did not impose a quarantine period recommended self-isolation or quarantine on a case-by-case basis. E.g. persons who had been at sea for more than 14 days did not have to undergo quarantine. Countries that increased their quarantine period found persons testing positive after the recommended 14-day period, identified mutated viral strains, and did so in response to increased COVID-19 activity. Countries that reduced their quarantine period based it on the virus' incubation period, a day 7 COVID-19 test result, a traveler's vaccination status, the reduced risk of contagion over time and the country's prevailing COVID-19 cases. Quarantine duration was reduced based on a traveler's COVID-19 risk profile, his or her country of origin, to encourage compliance and lessen cost of governmentfunded quarantine. Conclusion: Quarantine durations was adjusted to in country disease burden, disease dynamics, the natural history of the disease, COVID- 19 vaccination status, existence of mutant strains and for efficient resources' use. Countries also wanted to encourage vaccination, testing and boost quarantine guideline's compliance. A comprehensive country-specific longitudinal analysis ought to incorporate testing guidelines and vaccination status for each quarantine duration and each country's epidemic curve would provide useful information on best practices.