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An unprecedented wave of patients with acute respiratory failure due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease 2019 (COVID-19) hit emergency departments (EDs) in Lombardy, starting in the second half of February 2020. This study describes the direct and indirect impacts of the SARS-CoV-2 outbreak on an urban major-hospital ED.
Data regarding all patients diagnosed with COVID-19 presenting from February 1 to March 31, 2020, were prospectively collected, while data regarding non-COVID patients presenting within the same period in 2019 were retrospectively retrieved.
ED attendance dropped by 37% in 2020. Two-thirds of this reduction occurred early after the identification of the first autochthonous COVID-19 case in Lombardy, before lockdown measures were enforced. Hospital admissions of non-COVID patients fell by 26%. During the peak of COVID-19 attendance, the ED faced an extraordinary increase in: patients needing oxygen (+239%) or noninvasive ventilation (+725%), transfers to the intensive care unit (+57%), and in-hospital mortality (+309%), compared with the same period in 2019.
The COVID-19 outbreak determined an unprecedented upsurge in respiratory failure cases and mortality. Fear of contagion triggered a spontaneous, marked reduction of ED attendance, and, presumably, some as yet unknown quantity of missed or delayed diagnoses for conditions other than COVID-19.
Erica Butti, Neuroimmunology Unit San Raffaella Scientific Institute–DIBIT Via Olgettina 58 20132 Milano Italy,
Gianvito Martino, Neuroimmunology Unit San Raffaele Scientific Institute–DIBIT Via Olgettina 58 20132 Milano Italy,
Roberto Furlan, Neuroimmunology Unit San Raffaele Scientific Institute–DIBIT Via Olgettina 58 20132 Milano Italy
Therapies targeting the central nervous system (CNS) are a crucial challenge for future medicine. In fact, degenerative and immune-mediated disorders of the CNS are a major threat to quality of life in the elderly, but diseases affecting the brain are also not infrequent in infancy and adult life. Transfer of recent progresses in the knowledge of molecular mechanisms involved in the pathogenesis of neurological disorders into novel therapies is difficult, because penetration of molecules into the brain is extremely limited by the presence of the blood–brain barrier (BBB). The BBB is characterized by tight junctions between endothelial cells which are impermeable to macromolecules and even ions, and by reduced endothelial endocytic activity that considerably decreases the number of molecules that can cross the BBB in a non-specific fashion. Most of conventional therapeutic agents effective in the CNS are supposed to cross the BBB because of their small size. However, more than 98% of small molecules cannot cross the BBB either, and only the presence of specific transport mechanisms assures that molecules essential for the brain metabolism (e.g., amino acids and glucose) reach the brain parenchyma. Thus, by employing conventional administration routes (i.e., oral, intravenous, intramuscular), which share the bloodstream as the final driving force to the brain, both rate and selectivity of the drug delivery are severely hampered, resulting in limited efficacy and potential side effects.
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