ABSTRACT
Background: The Fondazione IRCCS Policlinico San Matteo, the largest academic Hospital in the south-west part of Lombardy has been involved in the management of the COVID-19 outbreak since its inception. The Oncology Unit had to face with the challenge of to keep on active oncological treatments without compromising the safety of our pts and healthcare personnel both in the inpatients, as well as in the outpatients. Patients and methods: From the very beginning of the emergency, the inpatient ward and the outpatient clinic were moved to the main building of the Hospital as their original locations become COVID-19 wards. From Feb. 24th, we reorganized our Unit, with the introduction of a double-step triage strategy for cancer pts under treatment in order to identify pts at risk from COVID-19, and to avoid their admission to Hospital.-First step: a phone call the day before active therapy or admission (virtual swab);-Second step: a clinical evaluation upon entry the outpatient and inpatient wards. Results: From February 24 to April 7, 2020, 819 phone calls were performed, leading to the authorization of 788 accesses to the outpatient clinic for active treatments. 26 pts (8.3%) with symptoms were kept at home and managed by repeated telephone calls in collaboration with the family doctor;of these subjects, 3 were hospitalized for suspected COVID, while 23 were managed at home with symptomatic treatments and antibiotics. At the second triage level, 5 pts were hospitalized and proved positive for SARS-CoV-2 by nasal swab. In the same period, 177 pts were admitted to the inpatient ward: none has been found to be COVID-19-suspected or swab-positive. Both outpatient and inpatient areas were still COVID-19 free. No healthcare workers resulted infected by SARS-CoV-2, including 2 physicians who had fever during this period, but resulted SARS-CoV-2 negative by 2 sequential nasal swabs, performed 14 days apart. Conclusions: During the emergency phase of the COVID-19 outbreak the behavior of health care workers had to be arranged to appropriately manage it, according to risk management strategies particularly to that defined as 'resilience'. Our screening strategy, which requested neither human nor economic extra resources, put successfully into practice the capacity to adapt the management to a global health emergency as we could maintain the pre-COVID approach to cancer care, while protecting pts and healthcare workers from COVID-19 infection.