Two out of three surgeries postponed, more than one exam or outpatient visit out of three refered, just one in ten cancer screening performed during the first lockdown. Pazienti dimenticati, Italian for forgotten patients, are those who could not, or in some cases would not for fear of contagion, access health services during the first wave of the Sars-CoV-2 pandemic.
A situation resulting from a political decision: on March 16, 2020, a week after a general lockdown was imposed, the Minister of Health Roberto Speranza signed the Guidelines for the reshaping of the scheduled activity that can be deferred from COVID-19. A document that had the purpose of “making homogeneous any initiatives to reorganize the hospital activities of daytime, ordinary and outpatient hospitalization that may be necessary in order to meet the potential increase in hospitalization needs and to limit the flow of patients within of the assistance structures”. In other words, to avoid the collapse of the National health system.
The ministerial choice was to postpone elective non-oncological hospitalizations with priority classes B and C (i.e. to be carried out within 60 and 180 days respectively) and elective class D hospitalizations (without a defined maximum waiting period and linked to clinical cases that do not cause pain, dysfunction or disability) and to postpone deferred (30 days) and programmable (90/120 days) outpatient services.
Pazienti dimenticati is a data driven investigation that seeks to reconstruct what this political decision meant, hospital by hospital. A decision, the judgment on which it is left to the reader, which has affected the national territory in a homogeneous way, in a context in which the pandemic has hit the country in a way that is anything but homogeneous. Infections data demonstrate this: on April 30, 2020 in Bergamo (Lombardy) 1,020 people per 100 thousand inhabitants tested positive for Sars-CoV-2, just 35 in Oristano (Sardinia). But also the numbers related to healthcare personnel who tested positive for the new coronavirus and on patients hospitalized in ICUs, considered the litmus test of the pandemic impact on the health service. Data, the latter two, that Pazienti dimenticati is able to return hospital by hospital.
To obtain these data, 200 Foias (Freedom of information act) were sent to as many Nhs local offices (Aziende sanitarie locali, Asl) and hospitals (Aziende ospedaliere, AO). The request was to provide data relating to surgical interventions, outpatient visits and examinations and oncological services performed and postponed between 1 March and 30 April 2020. Or, were the number on referrals not available, those relating to services carried out in the same period of 2019. Of the 200 local health districts and hospitals surveyed, 57 ignored our request, another 21 rejected it. The other 122 sent the requested data, although not always in complete form.
The numbers obtained provide a photograph, albeit partial, as detailed as possible of the impact that the pandemic containment policies have had on patients not affected by Sars-CoV-2. The effects of these postponements are still all to be assessed. A study published in May 2020 in the British Journal of Surgery estimated the time needed to recover from postponed surgeries to be 45 weeks. While a July 2020 study published in the Lancet calculated an increase in deaths from breast cancer 5 years after the diagnosis of between 7.9 and 9.6% and an increase in deaths from colorectal cancer, again 5 years after the diagnosis, between 5.8 and 6%.
Only time will tell whether these forecasts will prove to be accurate or not. As we hope for them to be overestimated, what can be done is to try to tell how many patients have been forgotten during the first wave of the pandemic.