2. Ensuring sufficient physical infrastructure and workforce capacity
ENSURING SUFFICIENT PHYSICAL INFRASTRUCTURE AND WORKFORCE CAPACITY is crucial for dealing with the COVID-19 outbreak, as there may be both a surge in demand and a decreased availability of health workers. The section considers the physical infrastructure available in a country and where there are shortages, it describes any measures being implemented or planned to address them. It also considers the health workforce, including what countries are doing to maintain or enhance capacity, the responsibilities and skill-mix of the workforce, and any initiatives to train or otherwise support health workers.
2.1 Physical infrastructure
At the beginning of outbreak in San Marino there was no laboratory that carried out in vitro diagnostics for novel coronavirus (nCoV). Tests were sent to laboratories in the Italian regions of Emilia-Romagna and Le Marche. Since April 6, the laboratory in San Marino is able to perform blood tests for the detection of IgM and IgG and PCR analysis on swabs.
Until the COVID-19 pandemic, the hospital in San Marino offered about 120 beds divided into: 6 Intensive Care Unit (ICU) beds; 70 internal medicine (internal medicine, geriatrics, pediatrics); 50 surgical (general surgery, orthopaedics, obstetrics and gynecology). There are also day surgery and day hospital beds. In the emergency department there are 3 beds for fast track.
The hospital has been reorganized to address the novel coronavirus and the distribution of bed is now as follows: 20 ICU beds, 70 COVID beds with potential to expand to 90 beds, with the remainder dedicated to emergency and essential surgery. Until the reorganization of hospital beds, there were no beds dedicated to infectious diseases (ambulatory care was available for HIV, hepatitis, and other communicable diseases).
A private health facility is also used and staffed by public health service personnel.
The use of Personal Protective Equipment (PPE) and medical equipment is monitored on a daily basis; at the end of March some issues with shortages of masks were reported but have now been solved. While at the beginning of the pandemic there were 9 ventilators in the territory of San Marino, 21 were available as of April 10.