ABSTRACT
Background: The progressive diffusion and high mortality rate of the new Coronavirus, SARS-CoV-2, has underlined critical needs for the management of patients with relevant acute and chronic diseases. Cancer patients are often immunocompromised, therefore at higher risk for severe illness from COVID-19 and, at the same time, they experience anxiety and fear due to treatment uncertainty. Material (patients) and methods: At the aim of protecting the safety of our patients and healthcare workers, a novel sequence of pre-triage and triage has been implemented at our Institution. Despite the importance of protective devices and telemedicine for deferred follow-up outpatient consults, we have also introduced a telephone pre-triage in order to avoid the access of symptomatic patients (asking specific questions relating to the risk and possibly sending a selfcertification form by mail) with subsequent confirmation of non-deferrable visits for therapy needs. This predefined approach has proved to be an effective way to generate a stronger sense of patient's responsibility and safety. After the first step, everyone entering our hospital is subject to a careful external triage with an accurate admission assessment and immediate isolation of suspected cases in a surveillance zone separated from other patients, waiting for COVID-19 laboratory testing. All these steps have been performed respecting the safety distancing, temperature monitoring and always wearing at least a surgical mask, whether symptoms exist or not. Moreover, visitors are not allowed at any time during this emergency period. Results: Between March 9nd and May 15nd 2020, we have registered 1772 triaged accesses compared to 1165 in the same period last year, with a 52% increase for outpatient treatments and without recording any COVID-19 positive case, due to the high pressure on regional Calabrian oncology facilities for the lack of patients referral to out-region institutions. Thanks to the promptly introduction of a containment approach, based on a pre-triage and triage double algorithm, our daily activities have been guaranteed, without any decrease, preserving the continuum of patients' care and developing a quality approach to reduce distress. Conclusions: Our institutional procedure of pre-triage and triage sequence has proven to be effective and can serve as model to safely reorganize working activities during the pandemic, without hampering oncologists' desire to assist their patients.
ABSTRACT
COVID-19, the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, showed higher severity and lethality in male older adults . There are currently no specific treatments. Studies are evaluating the efficacy of monoclonal antibodies against interleukin-6 receptor. Here we present the case of a 98-years old man admitted to our COVID-Hospital with acute respiratory failure. Comprehensive geriatric assessment showed no signs of frailty. First-line therapy with hydroxychloroquine and anticoagulants was not effective. Patient was administered intravenous monoclonal antibodies, and he showed remarkable clinical improvement. This case suggests that age alone should not preclude access to new therapeutic approaches. Comprehensive, multisciplinary, multidomain approaches are needed to develop patient-tailored treatments against COVID-19.