LAUSR

During the pandemic outbreaks of coronavirus disease 2019 (COVID-19), in Italy, some hospitals became fullydedicated COVID-hospitals, whereas in most of the others, a large number of units with different degrees of intensity of care were converted or created to treat COVID-19 patients. However, some “no-COVID-19” wards were kept to assist patients in need of hospital care and without COVID-19 disease. At the Città della Salute e della Scienza, Molinette, a University-teaching hospital in Turin, north-western Italy, four medical units were converted as COVID-19 wards, and two were designated to remain no-COVID-19 wards. We report our experience within a no-COVID-19 acute Internal Medicine and Geriatric ward, where patients without clinical signs and symptoms of COVID-19 and/or with negative SARS-CoV2 viral genome detection using real-time reverse-transcription polymerase chain reaction (RT-PCR) on samples obtained with naso-pharyngeal swabs (NPSs), were admitted. To increase the safety of patients and personnel, since the beginning of March 2020, we defined two separate sections within our 28-bed ward: one was dedicated to patients with confirmed or suspected infectious diseases and the other was reserved for patients admitted for non infectious diseases. Relatives’ visits were not allowed in both parts of the ward. In keeping with the recommendations from the national Superior Institute of Health, SARS-CoV2 NPS testing in the Emergency Department (ED) was initially addressed to persons with symptoms and/or signs suspected for COVID-19 and/or suspected exposure to a SARS-CoV-2 positive person, and the same rules applied to hospital staff [1]. During the study period, along with rapid community spreading of COVID-19, there was a wider adoption of SARS-CoV2 NPS testing in patients admitted to the ED. Due to shortage of personal protective equipment (PPE) use of protection dressing (coat, surgical face mask, gloves) for medical staff and nurses was initially authorized within the infectious area when caring for patients with recognized or suspected respiratory infections. During the period between March 18th and April 24th, 2020, 81 patients (mean age 81.5 ± 9.3 years, 64.2% men) were admitted. Main causes of admission were decompensated heart failure (24.7%), infections (23.5%), anemia and other blood disorders (6.2%), acute renal failure (4.9%), malignancy (4.9%), and respiratory failure (3.7%). A negative SARS-CoV2 NPS test in the ED was available in 47 of the 81 admitted patients (58%). During hospitalstay (mean 8.2 days), 45 SARS-CoV2 NPS tests were performed, including 26 tests in the 47 patients with a previous negative test at entry (55.3%) and 19 in the 34 patients who did not have a previous SARS-CoV2 NPS test at entry (55.9%). Among the 81 patients admitted, a diagnosis of SARS-CoV-2 infection was made in 25 (30.8%) patients (mean age 77.8 ± 10.3 years, 52% men). Nine cases (36%) occurred among patients admitted for infectious diseases, and 16 (64%) cases were diagnosed among patients admitted for other medical disorders and without documented or suspected infection at entry. Of the 25 SARS-CoV-2 infection diagnosed, 15 were detected in patients with a negative NPS test at entry (5 of them with at least another negative test during hospital-stay) and 10 cases were documented in patients who did not undergo NPS test in ED (4 of them with at least one previous negative test during hospitalization). The median time between the first negative SARSCoV-2 NPS test and the first positive test was 10 days. In 52% of cases, the SARS-CoV-2 NPS test was performed in patients with new onset of symptoms or signs suggestive * Roberto Presta [email protected]