European Union of Private Hospitals

Gruppo San Donato plays a central role in the daily fight against the coronavirus

The evolution of the situation has reinforced the central role of the Gruppo San Donato in the continuous and daily fight against the virus in its hospitals.
To date, we have 1 943 COVID-19 patients hospitalized in our facilities, including 220 critically ill patients on CPAP and 165 intubated patients in intensive care beds.

This means that Gruppo San Donato, which represents 13% of all beds in the Lombardy Region, cares for 18% of all COVID-19 patients hospitalized throughout the Region.
The effort made by the Group, in each establishment, to go from 350 COVID-19 patients to 2 000 in just 3 weeks was remarkable and deserves consideration.
This effort was necessary to cope with the peak arrivals of more than 250 COVID-19 patients per day during the first week.

The week of March 16 was particularly critical, especially in Bergamo, Brescia and Vigevano, with the arrival of more than 70 patients a day in the emergency departments in these provinces. The establishments resisted and the height of the crisis was managed with dedication and professionalism.
These days, new patients continue to arrive but without the flooding of the emergency departments that we had experienced in the previous weeks.
We currently have an average of 105 new hospitalizations per day at Group level and we can be proud of having already been able to discharge 600 patients, completely cured. A number which is strongly increasing daily.

In order to face this crisis, GSD has put the patients and the needs of the country at the centre of its action.
Significant investments (around 16 million euros) in machinery and construction were necessary to have a capacity of up to 270 CPAP beds and 200 intensive care beds dedicated to COVID-19 patients.
Furthermore, each week, we invest around 3 million euros to cover our weekly PPE needs, including more than 80 000 gowns, 200 000 masks and 1 000 000 disposable gloves, and around 1.2 million euros for the purchase of specific drugs essential for the care of COVID-19 patients.

Our scientific research, leader in Italy, explores various alternatives to bring new effective solutions to the patient’s bed in record time.
San Raffaele Hospital in Milan has become the national leader in models of care and in the use of investigational drugs. All the experience of the first Research Hospital in the country was made available to each establishment of the Gruppo San Donato with daily interaction between the chief doctors and the intensive care departments.

Clinical trials and data collection at Group level have started: the only way to rigorously define what really works and in which context. A large observational study is currently underway and includes several hundred patients with COVID-19 already treated in our establishments as well as all those who will be hospitalized in the future. It is a uniform protocol that will systematically collect clinical and biological information and therefore obtain reliable data on the effectiveness of the drugs administered today in Italian hospitals. As part of the study, each patient follows the same therapeutic procedure, even though it can be managed by more than 7 different departments which are today dedicated to emergency COVID-19 at San Raffaele Hospital.

The process begins with the collection of several biological samples, including blood, plasma, urine and viral swabs.

By comparing the information that emerges from the samples with the treatment protocols and the clinical data collected by the patients during the entire hospital stay, the medical researchers at San Raffaele hope to be able to:

  • Better understand what the most affected patients have in common;
  • What are the indicators that allow us to predict the course of the disease;
  • Which drugs work best in different cases.
It is only thanks to high quality studies, carried out on a sufficient number of patients, that we will be able to provide scientifically valid answers to this need for treatments sought by the Italian and international medical community “, declared professor Fabio Ciceri , deputy scientific director for clinical research at San Raffaele Hospital and head of the haematology and bone grafting unit.
“On the contrary, impromptu statements, based on the experimental treatment of a few patients in an emergency context, risk only confusing the public but also the medical profession. This is even more true for a disease which presents a great clinical variability like COVID-19 “.

In nearly 80% of patients, the presence of the virus is not or not very symptomatic and in the remaining 20%, it causes severe pneumonia.
A great variability is also observed in these 20% who are hospitalized patients in serious condition. It is in these patients, in the most critical phase, that we are testing the use of Angiotensin II, a vasoconstrictor already used in intensive care and which could bring them clinical benefit.
As there are no specific drugs yet for the disease, the experimental therapies tested in recent weeks in Italy on patients with COVID-19 are all carried out with off-label drugs.

These are approved drugs, but indicated for other pathologies, or even not yet approved and therefore administered for compassionate purposes after evaluation by the Institutional Ethics Committee.
The first class of drugs are antivirals, which prevent replication of the virus and help the immune system contain the infection.

The most widely used – off-label drug – is chloroquine or hydroxychloroquine, molecules marketed since the first post-war period as medicine against malaria, but also endowed with antiviral and anti-inflammatory properties.
According to the first studies carried out in China, the use of chloroquine improves patients’ symptoms and reduces the length of hospital stay.
Other antiviral drugs used in patients with COVID-19 are Kaletra, generally used for HIV, and Remdesivir, originally developed for Ebola, but which, in early laboratory tests, had also been shown to be effective on a coronavirus. (different from SARS-Cov-2).
Unlike the others, having never been commercially approved, Remdesivir is currently administered for compassionate purposes in intensive care.

However, we should soon enter the first clinical trials with patients in less advanced stages of the disease.
One of the consequences of COVID-19 is the extreme pulmonary inflammation, which in some cases contributes to severe pneumonia and respiratory failure, often requiring admission to intensive care.
Therefore, it was decided to use molecules capable of deactivating the extreme immune response and thus contributing to the functional recovery of the lungs. In this case, the most used molecule is Tocilizumab, a monoclonal antibody already on the market for the treatment of rheumatoid arthritis which acts by blocking the production of interleukin-6 (IL-6), an inflammatory molecule produced by the immune system in response to viral infections.

There are others in experimentation, such as Anakinra, which acts on Interleukin-1 (IL-1), or Sarilumab, which also works on IL-6.
We are also carrying out experiments on the blood serum of people who have already developed immunity to COVID19 as well as on therapies involving the use of stem cells.

The GSD Crisis Management Team