This model for early care applied in a day hospital is part of a comprehensive strategy to respond to the health emergency due to the pandemic. It was implemented by the Health Department of the Municipality along with researchers of the University of Buenos Aires, the Regional Association for Sanitation Development (Adesar) and Mundo Sano Foundation. The model includes a network of epidemiological trackers for the telephone follow-up of patients and close contacts.
At 180 km away from the city of La Plata, where the availability of beds is critical due the demand triggered by the Covid-19 second wave, a team of the San Antonio de Areco Hospital reduced the number of patients with 2019 novel coronavirus pneumonia who need
hospitalization; average case fatality rate and mortality rate are half of the values in nearby towns and the province of Buenos Aires.
How do they do it? Through an intensive search of cases and contacts –symptomatic and asymptomatic– in this district of northern Buenos Aires province, a team of 15 professionals of the day hospital for Covid-19 of the Emilio Zerboni Municipal Hospital rapidly identifies patients that might progress to complications due to their age, other diseases (diabetes, heart conditions, obesity, among others) and persistence of symptoms for more than four days.
With an early outpatient treatment that combines available therapeutic options (intravenous or oral), they manage to reduce the chances that patients with moderate Covid-19 pneumonia, who were indicated hospitalization, need more complex care. Yesterday, for instance, of 27 outpatients treated in the day hospital, only two were hospitalized due to a dangerous drop in blood oxygen level.
This outpatient facility of the Zerboni Hospital started to operate in October last year. Since November, when the number of beds started to expand, with eight being available today, 452 risk patients received care; of them, 242 were moderate cases with bilateral pneumonia, of which only 30 eventually needed general or intensive care hospitalization; however, none of them needed invasive mechanical ventilation.
All the moderate cases received treatment intravenously at the day hospital; as the team explained, treatment combines plasma or horse serum with immuno-modulators and anticoagulants. The other 210 patients, with mild pneumonia, received an oral treatment that included vitamin administration.
“In all cases, they were COVID-19 pneumonias. As they were treated aggressively and early, we avoided patient hospitalization; and none of those that were hospitalized needed invasive mechanical ventilation”, said Favio Crudo, deputy secretary of Health of San Antonio de Areco and member of the group.
With 19 deaths, Covid-19 fatality rate (proportion of deaths among the detected cases) is 0.9% in San Antonio de Areco, compared to the 2.6% of the neighbouring towns that are part of the IV Sanitary Region and to the 2.7% of the province of Buenos Aires. In the country, fatality is 2.3%. Mortality due to Covid-19 is 7.5 per 10,000 population, unlike the 15.3 in the region and 16.8 in the province. In Argentina, mortality is 12.8/10,000 population.
“Last year, with the opening of the day hospital, the Covid-intensive care unit area was never completely occupied in the hospital, and neither has been until now…, fortunately”, stated Crudo in dialogue with LA NACION.
He also stated that the strategy might be replicated in any urban area in the modality of “nodes” (San Antonio de Areco has about 25,000 inhabitants) distributed strategically according to a given number of population.
The day hospital is now treating just over 50 cases.
“Using an app, we identify all the Covid-19 positive patients that might progress into complications. A health team is devoted to detect all the patients with risk factors and that, for some reason, have symptoms persisting for more than four days, regardless of the age. They are called and appointed for assessment in the day hospital, on the same day or the next day”, said Crudo.
Evaluation
This first evaluation, which lasts one hour and a half, includes monitoring of lung inflammation by CT scan and of blood oxygen saturation. Risk factors and comorbidities are considered. The next consultations, consisting of the administration of the treatment agreed upon by professionals, take between half an hour and 40 minutes. The health team uses a WhatsApp group to evaluate the CT scan images and the results of any other complementary test that may be indicated and to decide the steps to be taken.
Zerboni is the only hospital with in-patient facilities in San Antonio de Areco. There are a total of 56 beds for general hospitalizations and intensive care units for children and adults; 20 are assigned to Covid-19; yesterday, 13 of them were occupied. At the intensive care unit (ICU), the isolation area has four beds, which can be expanded to six. Yesterday three beds were occupied, in all cases without invasive mechanical ventilation. Three other beds are for non-Covid patients, which can be expanded to four, if necessary. Due to the second wave, another in-patient facility is being set up, outside the hospital, with 12 beds that will be used for patients with other pathologies so that the hospital is solely destined to Covid-19 cases, who have more intensive oxygen requirements.
Transfer from the house to the hospital is performed without breaking isolation. Most of the patients go on their own or accompanied by a relative who is also infected with Covid-19, or the day hospital sends a mobile unit to bring them when they cannot move without assistance. So far, according to the local epidemiological surveillance, this has not generated situations involving risk of infecting others.
“In San Antonio de Areco there is a telephone consultation system through a line well known by the population (2326 500600) and 95% of the consultations are made by that means. Very few people go to the hospital emergency service –explained Crudo. When a person from the town calls, if applicable, he/she is appointed for a swab test the following morning, from 8 to 10; we use the common techniques, PCR either individual or pool (in groups) testing, or the rapid test (antigens), which we combine according to the epidemiological situation. The results of the rapid tests are delivered immediately, and PCR results, in the afternoon or evening.”
This model of early care through a day hospital is part of a comprehensive strategy to respond to the sanitary emergency due to the pandemic implemented by the Health municipal department and researchers of the University of Buenos Aires, Regional Association for Sanitation Development (Adesar) and Mundo Sano Foundation. The model includes a network of epidemiological trackers for the telephone follow-up of patients and close contacts.
