Italian spine surgeon aids respiratory care in converted orthopedic hospital — Here's his story

Angie Stewart -  

Pedro Berjano, MD, PhD, is chair of the GSpine4 Spine Surgery Division at IRCCS Instituto Ortopedico Galeazzi in Milan, Italy.

He spoke to NEJM Catalyst about what the COVID-19 pandemic looks like in his hospital as well as in his country, where there have been more than 139,000 confirmed cases and 17,000 deaths.

In the Lombardy region where Dr. Berjano practices, intensive care facility occupation has risen from 25 percent to approximately 200 percent. Dr. Berjano said the situation at his hospital changes every day.

It began with a slowdown of elective cases, which were later brought to a complete halt. After receiving instructions from the regional government, within one month, Instituto Ortopedico Galeazzi converted from an orthopedic hospital to a pulmonary hospital. Its orthopedic surgery center is now only performing minor trauma cases.

The hospital has made structural changes such as converting operating rooms to intensive care rooms and installing walls to separate providers from infected patients. Healthcare workers have taken courses on how to practice isolation in COVID-19 areas and received special equipment to enter those spaces.

While the hospital now has enough personal protective equipment to handle the emergency, "it has been, for all the country, difficult to find enough equipment," Dr. Berjano said. And some hospitals are still struggling with personnel shortages.

Dr. Berjano, a spine surgeon specializing in deformity and complex cases, is currently only on call for trauma cases. He's also assisting with respiratory care in a resident-like capacity. As a team leader, he's convening frequent online meetings, closely managing workflow, and providing additional education for surgeons and residents.

With every country deeply interconnected, it was a mistake to think Italy wouldn't be affected like China. Dr. Berjano said that should serve as a lesson for other countries.

"We have been reactive, but we should have been proactive, and that is the big difference," he explained. "If you wait to see people who are dying to act, then you will see in the next two weeks many more people dying for the decisions that were not taken."

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