The rebirth of health system in Italy after COVID-19 pandemia: starting points.

After COVID-19 pandemia we have to think how to rebuild our national health care system. Balance between health measures and social consequences, reformulation of the chain of command during emergency, clear guidelines for territorial medicine, census of health system are initial points of debate to carry on.

To the Editor,

Italy is experiencing the worst crisis since the second world war. Its national healthcare system, considered excellent all over the world, has risked a collapse (1). A few more thoughts than already pointed out on this journal (2,3) can be useful for the current debate.

The national health services and health protection are pillars of european democracy. The delicate balance between health measures and economic, social and psychological consequences (2) for citizens is nowadays at the basis of our society and freedom (2-4).

The emergency chain of command should be clear, fast and – respecting regional differences - its management should be more centralized (1,5). In the event of a public health risk, the crisis unit of the health ministry should promptly give clear guidelines to the territories concerning personal protective equipments (PPE), therapy, drugs. This is fundamental when evidence based medicine cannot yet come to aid our clinic and fake-news can create disorders. A national emergency group consisting of a representative for each medical specialization, activated in a very short time, could be used to draw up guidelines that general practitioners and territorial specialists can use immediately. This group, in turn, using sentries at regional level, can itself request the activation of the crisis unit. The territory needs to be strengthened in terms of number of doctors.

A new list of essential medical instruments, drugs and PPE must be drawn up; an adequate stock must be set up and stored, i.e. in national army depots; production of such stock must be encouraged at national level (this helps also Small Medium Enterprises).

A national health service census is fundamental for two reasons. The first one is to establish the exact number of departments and machinery needed for any type of health emergency. At the same time this is important to discover deficient areas and the necessary hospital recruitment for normal activities, certifying with transparency the economical funds to request. The second reason is that we must put the “medical doctor” back at the middle of the system itself, valuing the individual professionals. Each department head in chief should indicate and network visible and bookable services defined “premium”. Lets have some examples. If there is a good pediatric allergist in a peripheral hospital, this should be enhanced at a regional level. An ophthalmologist who deals with uveitis or glaucoma in a small city hospital is precious also for patients living in the larger towns of that area. Even in small and peripheral areas we have excellences that are little known and little valued. In Italy this can be reached boosting up and networking regional health booking services.

Excellence and wisdom, in a strong alliance of both politics and medicine, are fundamental to win this fight.