Stesura Seveso Archivio Italiano di Urologia e Andrologia 2020; 92, 280 LETTER TO EDITOR Comment on Hospital care in Departments defined as COVID-free: A proposal for a safe hospitalization protecting healthcare professionals and patients not affected by COVID-19 Submitted 7 May 2020; Accepted 13 May 2020 No conflict of interest declared. DOI: 10.4081/aiua.2020.2.80 To the Editor The COVID-19 outbreak dramatically changed hospital everyday life, impairing the course of previous routine activi- ty, also in urology (1, 2). In the next months, together with keeping the focus on the prevention of contagion recrude- scence, the health care system will face another stringent issue, i.e. to restore all the services not COVID-related. Leonardi et al. in their paper (3) report an equilibrate overview on the incoming “Phase 2”, in order to set up so-called COVID-free hospitals and departments. The authors offer an insight from a practical point of view, detailing protocols for any of the steps of the path of care, from the outpatient visit to surgery. The aim is to ensure a safe healthcare flow, based on the early identification of the positive subjects and the rigorous protection of the negative ones. The corner- stones of this framework are: microbiological and instrumental COVID screening for patients but also for healthcare workers; furniture of personal protective equipment to the medical and administrative staff; re-definition of outpatient and inpatient scheduling to guarantee distancing; regulation of operating theaters by general protocols (as intubation in dedicated rooms, adoption of filters and smoke evacuation devices, etc), but also others dedicated to specific proce- dure (endoscopic, open, minimally-invasive). Although these actions will undoubtedly be pivotal to prevent virus contagion, to date no solid evidence is available on the safety of contemporarily hospitalization (4). Furthermore, the feasibility and sustainability of such measures have still to be established, first of all concerning economical resources. Secondly, many hospitals will be required to engage structural works in order to create appropriate spaces for distancing patients and personnel. Thirdly, the dilution of scheduling and increasing intervals between procedures will result in a significant extension of sessions and need for additional personnel, otherwise posing conflicts with the regulatory on shift and rest. Similarly, restricting surgical teams to a few operators periodically screened for COVID will result in the escalation of workload. Fourthly, academic institutions shall conjugate safety requirements with their educational mission; this objective will become even more challenging considering the emerging calls to increase the number of residency positions, already initiated before the COVID emergency. Besides these considerations there are several issues related to the patient side, mainly due to the withdrawal of procedures and consequent delay in execution of adequate new diagnostical examination (5) and in choice of best treatments occurred in this emergency period (6), with consequent repercussions on the quality of life of the patients (7). All these points should be read taking into account the peculiarities of Italian scenario, where marked differences in the epidemiology and effects of the pandemic have occurred (8). Additionally, our universalistic health systems, articulat- ed in independent regional subsystems, count on institutions of various nature (academic, public, private), with differ- ent facilities, delivery capacity and attractiveness towards patients and investors. Such disparities have been already dra- matically highlighted by the COVID emergency, but could be more and more emphasized if further phases will be man- aged on a local basis. Reasonably, supra-regional and, hopefully, supra-national coordination are needed to control such heterogeneity, sharing protocols and regulating funding allocation, in order to ensure that each institution could han- dle with both COVID and non-COVID patients. REFERENCES 1. Puliatti S, Eissa A, Eissa R, et al. COVID-19 and Urology: a comprehensive review of the literature. BJU Int. 2020. 2. Rocco B, Sighinolfi MC, Sandri M, et al. The dramatic covid 19 outbreak in italy is responsible of a huge drop of urological surgical activi- ty: a multicenter observational study. British Journal of Urology International. 2020; In Press. 3. Leonardi R, Bellinzoni P, Broglia L, et al. Hospital care in Departments defined as COVID-free: A proposal for a safe hospitalization pro- tecting healthcare professionals and patients not affected by COVID-19. Archivio Italiano di Urologia e Andrologia. 2020; 92(1). 4. Maida FD, Antonelli A, Porreca A, et al. Letter to the Editor: "Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection". EClinicalMedicine. 2020:100362. 5. Vagnoni V, Brunocilla E, Bianchi L, et al. State of the art of PET/CT with 11-choline and 18F-fluorocholine in the diagnosis and follow-up of localized and locally advanced prostate cancer. Arch Esp Urol. 2015; 68:354-70. 81Archivio Italiano di Urologia e Andrologia 2020; 92, 2 Hospital care in Departments defined as Covid-free 6. Grasso AA, Cozzi G, DE Lorenzis E, et al. Multicenter analysis of pathological outcomes of patients eligible for active surveillance accord- ing to PRIAS criteria. Minerva Urol Nefrol. 2016;68:237-41. 7. Gacci M, Noale M, Artibani W, et al. Quality of Life After Prostate Cancer Diagnosis: Data from the Pros-IT CNR. Eur Urol Focus. 2017; 3:321-324. 8. Simonato A, Giannarini G, Abrate A, et al. Pathways for urology patients during the COVID-19 pandemic. Minerva Urol Nefrol. 2020 Mar 30. Correspondence Alessandro Tafuri, MD Alessandro Antonelli, MD Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy Andrea Minervini, MD Department of Urology, Careggi Hospital, University of Florence, Florence, Italy. Antonio Celia, MD Department of Urology, St. Bassiano Hospital, Bassano del Grappa, Italy Luca Cindolo, MD Department of Urology, "Villa Stuart" Private Hospital, Rome, Italy Riccardo Schiavina, MD Department of Urology, University of Bologna, St. Orsola-Malpighi Hospital, Bologna, Italy Bernardo Rocco, MD Department of Urology, University of Modena and Reggio Emilia, Modena, Italy Angelo Porreca, MD (Corresponding Author) angeloporreca@gmail.com Department of Urology, Policlinico Abano Terme, Abano Terme, Italy Alessandro Tafuri 1, Andrea Minervini 2, Antonio Celia 3, Luca Cindolo 4, Riccardo Schiavina 5, Bernardo Rocco 6, Angelo Porreca 7, Alessandro Antonelli 1 1 Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy; 2 Department of Urology, Careggi Hospital, University of Florence, Florence, Italy; 3 Department of Urology, St. Bassiano Hospital, Bassano del Grappa, Italy, 4 Department of Urology, "Villa Stuart" Private Hospital, Rome, Italy; 5 Department of Urology, University of Bologna, St. Orsola-Malpighi Hospital, Bologna, Italy; 6 Department of Urology, University of Modena and Reggio Emilia, Modena, Italy; 7 Department of urology, Policlinico Abano Terme, Abano Terme, Italy.