Mental health support to staff in a major hospital in Milan (Italy) during the COVID-19 pandemic: a framework of actions

To the Editor, As of 31 March 2020, more than 100 000 cases of coronavirus disease 2019 (COVID-19) have been confirmed in Italy.1 Progressive mitigation measures have been introduced by the Italian government since 9 March 2020 to undermine and break the virus transmission chain. However, the COVID-19-associated hospitalisation rate in Lombardy, the epicentre of the outbreak, has risen since the late days of February 2020, by 30% each day, and it is only very recently that it slowed down to 5% daily, which still translates to 500 new patients every day who are in absolute need of hospital care. This has put enormous pressure on healthcare providers and hospitals, up to the point where departments and daily shifts have been assigned in either of the following two categories: COVID-19 and non-COVID-19. In Policlinico, one of the most relevant university hospitals in Milano, the entire organisation has been transformed in less than 2 weeks, moving from 900 inpatient beds with 18 intensive care to 110 intensive and subintensive beds and more than 200 COVID-19 beds, thus completely reorganising the wards. Health workers and emergency medical technicians are at a high risk of developing post-traumatic stress disorder (PTSD) and other psychiatric disorders2 3 in standard operating conditions, and the risk increases during natural disasters.4 Early evidence suggests that the COVID-19 outbreak may cause adverse psychological reactions in healthcare workers. Liu et al 4 reported psychological distress (15.9%), anxiety (16%) and depressive symptoms (34.6%) in 4679 doctors and nurses in 348 Chinese hospitals during the COVID-19 outbreak. Immediate/rapid measures implemented by the hospital’s administrators may be a protective factor in these cases.5–7 The COVID-19 pandemic has peculiar characteristics that push the human mind, including those of doctors and nurses, into the uncertainty zone, given the speculations on the mode …