SARS-COV-2 Pandemic: How to Maintain a COVID-free Hospital

*Marco Bassanello, Ugo Coli, Antonio Tegon, Maria Teresa Pasqualini, Aldo Farencena, Matteo Geretto and Maurizio D'Aquino*

#### **Abstract**

The emergence of severe acute respiratory syndrome type 2 coronavirus (SARS-CoV-2) and its complications have demonstrated the devastating impact of a new infectious pathogen since the first months of 2020, especially on Health Systems. The work to maintain a COVID-free hospital in terms of reorganization of operational processes and surveillance against SARS-CoV-2 has allowed us to maintain the structure suitable for activities for non-positive patients. The commitment related to this reorganization (not only in terms of costs) is largely satisfied by the responses to the health needs of non-COVID patients. The results obtained during the First Pandemic phase at the Giovanni XXIII Hospital in Monastier di Treviso have allowed the maintenance of the status of a COVID-free hospital. These results are supported by multiple studies in other parts of the world.

**Keywords:** SARS-CoV-2, COVID hospital, COVID- 19, coronavirus, pandemic, vaccines, immunity

#### **1. Introduction**

COVID-19 [1] (acronym of Coronavirus Disease 19), or Severe Acute Respiratory Syndrome from SARS-CoV-2 or more simply Coronavirus disease 2019, is an infectious respiratory disease caused by the virus SARS-CoV-2 belonging to the Coronavirus family. The first cases were found in China (Wuhan Province) during the COVID-19 pandemic of 2019–2020 [2]. Coronavirus mainly affects the lower respiratory tract with flu-like symptoms [3, 4], such as fever, cough, shortness of breath, muscle pain, fatigue and diarrhea [5]; up to pneumonia, ARDS, sepsis and septic shock, and death of the patient. More studies indicate the endothelium as the virus site of the attack, therefore the involvement is systemic. A mass vaccination campaign is underway with two types of vaccines: mRNA and protein vaccines. Currently, treatment consists of isolating the patient and managing clinical symptoms [3]. An infected person may present symptoms after an incubation period that can vary between 2 and 14 days approximately (although there have been cases of 29 days), during which they can still be contagious [6, 7]. To limit its transmission,

precautions must be taken, such as adopting careful personal hygiene, washing hands frequently and wearing Personal Protective Equipment (PPE) [8]. Those who believe they are infected must remain in quarantine, wear a surgical mask and call a doctor immediately in order to receive appropriate guidance [4, 9]. Today monoclonal antibodies and antivirals prevent serious complications when taken in the first days of infection [10]. But the only weapon in our possession is the isolation of infected communities. Due to its characteristics, a hospital is the structure with the greatest risk of transmission of pathogenic microorganisms, due to the high number of users, the permanence of many of them in the wards or common areas (emergency room, polyclinics), invasive diagnostic-therapeutic procedures to which patients are subjected and the immunosuppression state of many of them. The occurrence of epidemic clusters within hospitals can lead to such serious consequences that it is essential to take all necessary measures to prevent these. In the United Kingdom, during the second wave, some hospitals were defined as COVID-free Hospitals in order to guarantee the National Health Service (NHS) the possibility of treating cancer patients or other diseases, without suspending elective management as during the first pandemic wave. In fact, this approach was criticized by doctors and charities as it would increase the number of deaths and slow down millions of elective treatments in an unsustainable manner. The March closures allegedly denied vital care to non-COVID patients, with the exclusive treatment of COVID-positive patients. Planned treatments such as oncological surgery, joint prosthetic surgery, and ophthalmic surgery were discontinued. According to the NHS, a COVID-free Hospital should have been kept as free as possible from COVID-positive patients, unlike what happened during the first pandemic wave. This should also have reduced the risk of patients hospitalized for normal care being infected with COVID-19 while inwards. In north London, Whittington Hospital has designated a COVID-free site. It did not receive infected patients so that it could make time for planned non-urgent surgeries. COVID-19 patients would have been treated at University College London hospital or the nearby Royal Free hospital. Likewise, for hospitals in northwest London. In fact, millions of people have been denied NHS assistance after the fight against the coronavirus became a priority in the first wave. A record total of more than 2 million people - three times the figure from the same period last year - had to wait more than 18 weeks to begin hospital treatment in England, according to data from that period. Some hospitals, however, continued to provide COVID and non-COVID care in the same facility while maintaining strict infection control (by The Guardian of 21.09.2020 "Some hospitals in England to be kept COVID-free in second wave").

During the Italian pandemic of February–April 2020, the small hospital "Giovanni XXIII" in Monastier di Treviso, in the province of Treviso, was declared COVID-free by the local health authorities.

During this pandemic phase, SARS-CoV-2 circulated in this territory involving about 2.1% of the population [11].

This function has changed the management of hospitalized patients and the duties of health personnel working there.
