Protecting our health care workers while protecting our communities during the COVID-19 pandemic: a comparison of approaches and early outcomes in two Italian regions, Italy, 2020

Nancy Binkin; Stefania Salmaso; Federica Michieletto; Francesca Russo

Currently, the applicability of the community approach may be limited to countries where public health and curative services are integrated. In other countries such as the United States, where health care is privatized, and integration with public health services is limited, it nonetheless may be possible to implement most of the major components in specific settings. One such setting may be Kaiser Permanente, which covers an estimated population of 12.2 million and integrates prevention and treatment, has its own laboratories and hospitals, has a tradition of community-based care, maintains a sophisticated information system, and often has good working relationships with local health departments that are responsible for contact tracing. However, even in settings where full implementation is not possible, it may be feasible to identify human and financial resources to increase non-facility-based screening, contact tracing, and home follow-up activities rather than providing expensive and labor-intense hospital-based care, which appears to result in poorer patient and HCW outcomes. In preparation for additional waves, every effort should be made to strengthen health department capacity for extensive contact tracing and isolation, community monitoring of patients, and communication between public health and health care providers and to establish robust informatics systems that allow for real-time information transfer among the many entities involved in controlling community spread.