Covid-19 : what has been missing


Since December 2019, the world is potentially facing one of the most difficult infectious situations of the last decades. A large amount of patients have been suffering from Covid-19 presenting to the attention of the medical personnel inside and outside the hospitals.
In some locations, almost 10% of cases have presented with severe respiratory impairment necessitating of intensive care. Despite intensive life support, however, many of the sick have died of this new respiratory viral infection. Beyond fatalities, a greater percentage have necessitated admission to hospitals for diagnosis and treatment. Sanitary systems of different parts of the world have been in great troubles, and some of them have been at risk of collapsing under this infectious emergency due to discrepancies between system resilience and an overwhelming number of patients requiring attention.
Covid-19 has been shown to affect different demographics to a greater degree than others. Individuals with underlying health issues or advanced age tend to have a more difficult time coping with the disease. Affected individuals over the age of 65 have significantly higher fatality rates with individuals over 85 having the highest fatality rate based on the age ranges. It should be noted that the fatality rates in some data are based primarily on a population that contracted the virus at a time when healthcare capacity was high. As the number of cases increases, the availability of healthcare resources diminishes and thus a higher fatality rate occurs.
Evaluating how it has evolved, Covid-19 would have deserved consideration as a mass casualty incident (MCI) of the highest nature. Generally, a MCI conjures up imagery linked to a scene of catastrophic and impressive events either natural or man-made. This typically involves patients who are severely injured, bleeding, and screaming, brought to the hospital by emergency services. This is not what the Covid-19 pandemic looked like. However, Covid-19 must be considered as a MCI.
A mass casualty incident is defined as an event that overwhelms the local healthcare system, where the number of casualties vastly exceeds the local resources and capabilities in a short period of time. It requires exceptional emergency arrangements and additional or extraordinary assistance. It affects more and more people, disrupting health sector programmes and essential services, and slowing the process of sustainable human development. Many lives can be saved if the affected communities are better prepared, with an organized scalable response system already in place.
An optimal MCI  management should consider all four phases of the so-called disaster cycle: mitigation, planning, response, and recovery. Covid-19 outbreak has demonstrated the worldwide unpreparedness to face a global MCI specially if “unconventional”.
An analysis of the actual characteristics features of the responses to Covid-19 may open many criticisms. We hope our comments can encourage further discussion and debate on how to further optimize the management of Covid-19 continuum and to prepare next pandemics when they occur.
Some of the devastating effects of MCI may be reduced before the event. In fact, useful measures may be posed in action in the affected region before the event happening, in all those events that can be preventable or are realistically announced (i.e., economic and political attempt to mitigate MCI effect local, regional, and national hospital and infrastructure reorganization, activities and personnel redistribution, material supplying, patient and people advising). Taking into account the evolution of Chinese cases and the progressive spread within the world, there would have been time to organize a mitigation phase. The epidemic initially spread to those countries that are probably less virtuous in infection prevention and control. In these countries, the problem was handled by policymakers and technicians who did not perceive the real potential of this emergency, even after Covid-19 had already fully impacted in China and some alternative models for the containment of the virus had already been successfully implemented. However, no countries, apart from some particular cases, have managed to anticipate the events and prepare for the spread of the pandemic. On a global level anticipating the pandemic state would have increased awareness of the emergency of the pandemic.
The lack of effective presence of national and international agencies for the disaster management was immediately evident. In reality, international organizations in charge in disease prevention and control published quickly protocols and guidelines (sometimes conflicting with each other as in the case of protective masks for healthcare workers), but they have been implemented very slowly at local level. The lack of coordination of the activities between and within the international and national levels was evident from the first phase.
The common gaps in health system preparedness around the world are generally well understood, but they are often not addressed in a comprehensive and systematic way. In particular, many countries have not yet developed mass casualty management plans, and communities are too often left alone to develop preparedness and response plans without guidance from higher levels. The lack of effective national action plans has impacted considerably the consequences of this epidemic.The action plans have progressively followed during the pandemic. Probably, well-structured action plans aimed at containing a potential disaster would have created fewer difficulties in managing Covid-19.
However, the most outrageous failure has been, and continues to be, the inability to adequately protect professionals and healthcare workers. Many thousands of health care workers have been infected amid the ongoing coronavirus outbreak, a sign of the immensely difficult working conditions for doctors, nurses, and health care workers in general. They should be instead among those best protected. The infections, along with the deaths of many healthcare workers around the world, have underscored the deeply challenging, chaotic environment that healthcare workers faced with when toiling on the front lines of an epidemic outbreak. They have faced long hours, changing protocols, potential medical supply shortages, and risks to their own personal health and that of their loved ones. In every mass casualty event, the healthcare workers who go to the forefront are the main actors. The lack of action plans forced healthcare workers to work in a situation of extreme unsafety.