Deaths from COVID-19 in healthcare workers in Italy—What can we learn?

On April 16, 2020, the Italian National Institute of Health (ISS) reported that 16,991 healthcare workers (HCWs) had tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). On April 17 the latest estimate of medical doctor deaths reached 119, which is 57.8% of total HCW deaths;followed by nurses 16.5% (n = 34), nurse aides 8.3% (n = 17) and dentists 5.8% (n = 12) (Fig. 1).3 The COVID-19–related deaths include 2 nurses who committed suicide due to unsustainable pressure at work.4 No other country has seen the same elevated number of doctor deaths;China, where the epidemic began in December, had fewer.5 General practitioners seem to be the worst hit among all medical specialties, registering 32% deaths (n = 66) (Fig. 1).3 This high rate could reflect their presence in the first line of defense for anyone presenting with the initial symptoms. Nurses and midwives together are the most represented with 43.2% (n = 6,988) of all infected HCWs, followed by doctors 22% (n = 3,574) divided between hospital doctors 19% (n = 3,071), general practitioners 0.8% (n = 130) and other doctors 2.3% (n = 373).1 Data for the healthcare context in which the infections presumably occurred are available for 11,738 HCWs;of these, 70.9% have contracted COVID-19 while serving in hospitals or in emergency care services (ambulance assistance).1 Interestingly, according to the National Federation of Orders of Surgeons and Dentists (FNOMCeO) registry,2 general practitioners accounted for the highest number of HCW deaths (Fig. 1) despite being the least infected group (as reported in the latest ISS analysis).1 Furthermore, according to the National Federation of Professional Nursing Orders (FNOPI), 32% of the nurse deaths by April 16, 2020, initially contracted the virus while on duty in nursing care homes where personal protective equipment (PPE) was mostly lacking, and 50% were working in nonhospital healthcare facilities.4 The sheer intensity of the COVID-19 outbreak in Italy, the recruitment of elderly retired doctors and shortages of PPE, particularly in nonhospital care, might be among relevant factors contributing to the elevated number of fatalities among HCWs in this country. [...]it is essential to carry out another retrospective epidemiological investigation and a prospective study to identify the main risk factors contributing to COVID-19–related deaths in the different HCWs categories in order to produce viable schemes for their protection.

SARS-CoV-2 infection in acute pancreatitis increases disease severity and 30-day mortality: COVID PAN collaborative study.

OBJECTIVE: There is emerging evidence that the pancreas may be a target organ of SARS-CoV-2 infection. This aim of this study was to investigate the outcome of patients with acute pancreatitis (AP) and coexistent SARS-CoV-2 infection. DESIGN: A prospective international multicentre cohort study including consecutive patients admitted with AP during the current pandemic was undertaken. Primary outcome measure was severity of AP. Secondary outcome measures were aetiology of AP, intensive care unit (ICU) admission, length of hospital stay, local complications, acute respiratory distress syndrome (ARDS), persistent organ failure and 30-day mortality. Multilevel logistic regression was used to compare the two groups. RESULTS: 1777 patients with AP were included during the study period from 1 March to 23 July 2020. 149 patients (8.3%) had concomitant SARS-CoV-2 infection. Overall, SARS-CoV-2-positive patients were older male patients and more likely to develop severe AP and ARDS (p<0.001). Unadjusted analysis showed that SARS-CoV-2-positive patients with AP were more likely to require ICU admission (OR 5.21, p<0.001), local complications (OR 2.91, p<0.001), persistent organ failure (OR 7.32, p<0.001), prolonged hospital stay (OR 1.89, p<0.001) and a higher 30-day mortality (OR 6.56, p<0.001). Adjusted analysis showed length of stay (OR 1.32, p<0.001), persistent organ failure (OR 2.77, p<0.003) and 30-day mortality (OR 2.41, p<0.04) were significantly higher in SARS-CoV-2 co-infection. CONCLUSION: Patients with AP and coexistent SARS-CoV-2 infection are at increased risk of severe AP, worse clinical outcomes, prolonged length of hospital stay and high 30-day mortality.

First-in-man craniectomy and asportation of solitary cerebellar metastasis in COVID-19 patient: A case report.

INTRODUCTION: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak has an impact on the delivery of neurosurgical care, and it is changing the perioperative practice worldwide. We present the first case in the literature of craniectomy procedure and asportation of a solitary cerebellar metastasis of the oesophagus squamous carcinoma in a 77 years old woman COVID-19 positive. In these particular circumstances, we show that adequate healthcare resources and risk assessments are essential in the management of COVID-19 patients referred to emergency surgery. PRESENTATION OF CASE: The case here presented was treated in 2019 for squamous carcinoma of the oesophagus. In April 2020, she presented a deterioration of her clinical picture consisting of dysphagia, abdominal pain, hyposthenia and ataxia. A Head CT scan was performed, which showed the presence of a solitary cerebellar metastasis. Her associated SARS-CoV-2 positivity status represented the principal clinical concern throughout her hospitalisation. DISCUSSION: The patient underwent a suboccipital craniectomy procedure with metastasis asportation. She tested positive for SARS-CoV-2 in the pre- and post-operative phases, but she was not admitted to the intensive care unit because she did not present any respiratory complications. Her vital parameters and inflammation indexes fell within the reference ranges, and she was kept in isolation for 16 days in our neurosurgical unit following strict COVID-19 measures. She was asymptomatic and not treated for any of the specific and non-specific symptoms of COVID-19. CONCLUSION: This is the first case reported of solitary cerebellar metastasis of oesophagus carcinoma operated on a COVID-19 positive patient. It shows that asymptomatic COVID-19 positive patients can undergo major emergency surgeries without the risk of infecting the operating team if adequate Personal Protection Equipment (PPE) is used. The patient remained asymptomatic and did not develop the disease's active phase despite undergoing a stressful event such as a major emergency neurosurgical procedure. In the current crisis, a prophylactic COVID-19 screening test can identify asymptomatic patients undergoing major emergency surgery and adequate resource planning and Personal Protective Equipment (PPE) for healthcare workers can minimise the effect of the COVID-19 pandemic.