COVID-19: the crucial role of internal medicine and geriatrics in the management of a complex disease

Background: Italy has been particularly affected by the COVID-19 pandemic, with 239,706 infected subjects and 34,678 deaths on June 25, 2020 The multi-organ implications of the SARS-CoV- 2 infection and the worst outcomes in fragile patients can valorize the role of internists Materials and Methods: We explored the role of a COVID-19 'grey-area' managed by specialists in internal medicine and activated in a large hospital in southern Italy (Policlinico Di Bari, Apulia region), which served a metropolitan area of 1 3 million inhabitants Results: Before the outbreak, the Clinica Medica 'A Murri' was a typical academic division of Internal Medicine Until March 16, a total of 383 new infected subjects and nineteen COVID-19- related deaths were recorded in the Apulia region On the same day, all COVID-19 negative in-patients were discharged from our unit or transferred to other medical wards The staffs of two internal medicine divisions (one academic and one non-academic) were merged and re-located in a 'grey zone' equipped with 64 beds, in a building entirely dedicated to COVID-19 As internists, the specific mandate was the screening of a wide range of patients received from the ER, suspected for SARS-CoV- 2 infection Confirmed negative patients were transferred to specific COVID-19 negative wards or discharged Positive patients were clinically managed in the unit, transferred (depending on the clinical evolution) to other COVID-19 wards, to post-acute facilities in the territory or placed in quarantine at home, after receiving full instruction on preventive measures On June 26, a total of 770 patients were screened in this grey-area and 151 COVID-19 positive patients were clinically managed, with the worst outcome (death) in a minority of cases (13/151 subjects, 8 6%) Conclusions: In conclusion, this organization facilitated the initial management of both non-COVID- 19 and COVID-19- patients, and decreased the burden of patients entering other COVID-19 dedicated wards (i e ICU, infectious diseases) Due to the most severe clinical presentations and the highest risk of death in the elderly and/or in fragile patients, internists can play a critical role, since typically trained to manage the complexity of systemic diseases, and to coordinate a multidisciplinary approach