Primary Health Care and Hospital Management During COVID-19: Lessons from Lombardy.

The pandemic due to SARS-CoV-2 tested the resilience of health systems worldwide. The outcome of the pandemic is impacted by health management choices made over the course of the disaster, which in turn are strongly dependent on the underlying healthcare system - as mirrored by the fact that regional pandemic experiences differ considerably: In Italy (a country most impacted by the COVID-19 outbreak), infection and mortality rates vary vastly between regions, with Lombardy - a comparatively well-equipped region with regard to hospitals and centers of scientific excellence - being amongst the worst-affected areas. Within this article, we focus on the challenges within primary health care and hospital organization, cooperation between primary and specialist care, and access to health care services: In Lombardy, neglected primary health care with a comparatively low availability of general practitioners (GPs) per inhabitant, the initial prioritization of hospitals during the pandemic while neglecting primary health care in terms of personal protective equipment (PPE), the lack of testing resources, and a failure to achieve coordinated support contributed to a quick overburdening of hospitals, where the dissolution of traditional departments into "macro-areas" may favor nosocomial infections during an ongoing pandemic. Neither specialized medicine nor privatization, but rather flexible public healthcare services working in consistent cooperation with GPs, show better efficiency in containing viral spread and managing patients. Strengthening the primary health care sector with regard to human and technical resources and supporting the coordination between the different levels of health care providers help to avoid overcrowded hospitals, while protecting patients and health care workers during large-scale health emergencies. Overall, further in-depth analysis of structural determinants is needed in order to develop more-resilient and integrative health care systems.