LAUSR

This is a report of the daily experience from February 28 to April 5, 2020, collected by our Emergency Endoscopy Service during the COVID-19 (coronavirus disease 2019) pandemic in the North of Italy, throughout the pre-peak and peak phases. The following description is related to the virus outbreak at St. Orsola University Hospital in Bologna (EmiliaRomagna district, Italy): The first COVID-19-positive patient was admitted to our hospital on February 28, 2020. Due to the pandemic course of the virus in Emilia-Romagna (district quarantine starting on March 8, 2020—4.5 million people) and in Italy (national lockdown starting on March 11, 2020—60 million people), St. Orsola University Hospital (1500 beds, founded in the sixteenth century) was fully devoted to the treatment of patients with COVID-19. Since then, routine activity has changed substantially; the need of ICU and ID (infectious disease) beds necessitated repurposing most of the operating rooms, wards, and patient suites to COVID-19 care. All physicians and surgeons switched their daily tasks to become temporary ICU and ID specialists. The crisis, due to the aggressiveness and rapid spread of the virus, affected other hospitals, necessitating admission of patients coming from the entire Emilia-Romagna and from other districts of the Northern Italy to our wards. Following Lombardy, Emilia-Romagna suffered the greatest impact; to this date, the district paid its tribute to the virus with 19.100 infected and 2.400 fatalities, the peak on March 20 with more than 100 victims in 1 day. We are still deeply involved with a crisis, with doctors constrained to their hospitals to the present. In Italy, 109 physicians and surgeons have lost their lives fighting COVID-19. Endoscopy entails a high risk of SARS-CoV-2 transmission due to (a) the short physical distance between patients and healthcare providers [1], (b) the presence of the putative SARS-CoV-2-binding site, the angiotensin-converting enzyme (ACE)2 receptor highly expressed in the duodenal brush border [2], and (c) the oral–fecal mode of transmission as an alternative route of contagion [3–6]. Such as in other Italian districts with the highest peaks of COVID-19 incidence, our endoscopy service was centralized to our referral hospital in order to improve the response to the increasing number of COVID-19 admissions, reducing the district workload. In a rapid progression, our local healthcare system was challenged to the maximum level, threatening our ability to offer adequate care. We were forced to deal with these challenges through emergency brainstorming sessions, acting as a united medical–surgical community in order to define our action plan that was based on a practical strategy, reorganizing the hospital pathways of emergency endoscopy in order to avoid virus dissemination. We report our experience with emergency endoscopies in the COVID-19 era; the goal was to sustain a full emergency endoscopic capability despite the hospital overload due to SARS-CoV-2-infected patients. Following recommendations released by the Italian Society of Digestive Endoscopy (S.I.E.D.) [7], all routine endoscopies were postponed and rescheduled. Instead, emergency endoscopies were performed on SARS-CoV-2-negative and positive patients; a negative-pressure room outside the endoscopy department was planned, but, at the beginning of the pandemic, the only practical possibility was to create a separate suite for SARS-CoV-2-positive patients needing Editor’s Note: This report is one of a series documenting the impact of the pandemic caused by the SARS-CoV-2 virus with resultant morbidity and mortality due to COVID-19. We would like for our readers to hear about experiences in regions in which the virus was particularly ferocious, such as in Northern Italy as reported by our colleagues Augusto Lauro et al., who provide a fascinating first-hand report of the planning, hard work, courage, skill, and dedication that provided needed endoscopic services to an epicenter of viral activity without infecting additional patients or caregivers.