Before, during and after the COVID-19 pandemic

The social disruption that had characterized the rapid progression of CoVid-19 infection in Italy in the first months of 2020 appeared again in the days in which this journal issue is being published. Due to what is defined as the second wave of the SARSCoV-2 pandemic, measures to contain the contagion were still necessary, such as social distancing, isolation, the suspension of some production activities, closure of the majority of educational activities in presence in schools and universities. Once again, professionals within the field of health profession, without distinction of qualification, have to compensate with great sacrifices the chronic shortage of personnel put in serious crisis by the massive increase in the demand for health care. They are again defined as “heroes” as they were named last spring, only to be forgotten during the cheerful summer months. On the part of the editorial committee of this journal, the gratitude is even greater towards the persons who, despite the burden of healthcare commitment, have continued to contribute to the progression of knowledge with scientific researches that constitute the valuable material of these pages. High-level scientific research is also carried out by researchers belonging to the health professions, and among them the number of women who publish in prestigious journals is far greater than that of men, even if Vitale E. et al. document in these pages how this happens throughout the entire Western world, but, unfortunately, not in Italy.

The observation reported in this journal in the article by Rubbi I. et al., that the spread of COVID among healthcare workers is relatively low, perhaps due to the correct use of protective devices, certainly cannot change the appreciation for their great commitment. In the article by Latina R. et al. however, we read that the nursing staff, and in particular female staff, easily experience health problems; their selfless commitment, therefore, is to be appreciated even more.

During the summer, the shortcomings of the national health service highlighted by the pandemic were forgotten; a national health service which is considered among the best in the world. But we have also forgotten the fears, the worries, even the reflections that the sudden social change had brought about (1-5). Beaches full of people, aperitifs, discos have become the emblem of the return to normality. Nothing will be as it was previously was said in the spring during the lockdown period, but this has also been forgotten. The effort of our society has been to make everything go back to normal. But the virus did not allow it, it continued to replicate and in most of the world the spread of the infection was massive just in the period when in Italy it was hoped that everything was over.

Now we got back to getting worried, but also to protest. “Society is tired, people can’t take it anymore, people protest” we read in the newspapers not only in Italy, but throughout the Western world, from the Americas to Russia. And here is the devastating awareness that alongside the biological damage caused by the virus which affects about 2% of the population of the affected countries, alongside the economic damage that has ensued and which certainly affects a higher percentage of people, there is a psychological damage which is serious because it affects almost the entire world population. Healthcare staff is well aware that any agent that tries to change homeostasis causes stress and stress has a psychological component. Mass media offer us sometimes contradictory opinions of doctors, virologists, epidemiologists, infectious disease specialists, biologists, sociologists, anthropologists, statisticians, but psychologists are missing.

The mass media, with rare exceptions, do not highlight how serious and how dangerous the psychological damage caused by the pandemic and all its consequences is. Fortunately, science has not made the same mistake and scientific research on what causes psychological damage, what can prevent it and how to cure it is considerable (6,7). Examples are provided by the article by D’Ettorre G. et al., the article by Vitale E. et al. and that of Provenzano S. et al. published in the issue of this journal. The three articles deal with the supports necessary to face stressful situations such as the Covid-19 pandemic in the best way possible: the first analyzes the needs of healthcare workers while the other two analyze the needs of nursing students. Surprisingly, all three of these articles identify adequate training as their main support. Undoubtedly, training is also one of the areas affected by the spread of the SARS-CoV-1 virus (8), however the pandemic has also highlighted pre-existing gaps. The training courses of schools, of some university courses, and in particular of those in the health sector have not taken into account the changes in society, the consequent change in the behavior and habits of the populations; they have not taken into account the cultural changes due to globalization and to migrations and, above all, they have not taken into account how the spread of new technologies has increased the gap between the expectations of young students and the offer of old programs, both from the point of view of contents and from that of delivery methods. Yet science increasingly documents that proper training improves the quality of professional commitment, especially in the health sector. In addition to the articles already mentioned, in this issue we can read that training is essential to obtain a correct sanitation in health facilities and a better prevention of infectious risk (Ricci F. et al., that the training of caregivers of Parkinsonian patients improves the quality of life of the latter and that of the caregivers themselves (Cianfrocca C. et al.), that training and information have allowed an improvement in the assessment of pediatric pain during triage (Granata C. et al.), that the greater the capacity of nurses in interpreting an ECG reduces the risk of incorrect procedures (Giannetta N. et al.) and that simulation exercise in the manikin made it easier for operators to correctly position supraglottic airway devices (Liti A. et al.). In the field of training, the opinion that after the pandemic nothing will really return to the way it was before is strongly desirable (9). A small group of health professionals, mostly nurses who are now graduates in majority, eager to enrich their skills, had enrolled before the SARS-CoV-2 infection spread to post-graduate higher education courses including those that in the Italian university system are defined as 1st or 2nd level Masters. The sudden transition from in presence teaching to online learning has allowed the professionals, students of the courses organized by the University of Parma, albeit with some discomfort, to continue to follow the courses and carry out the scientific research activity envisaged by the programs which in some cases is the subject of articles published in this journal. Some of their ongoing research focuses on issues related to this pandemic and we hope to publish the results soon. The pandemic has significantly involved the scientific world in the search for knowledge that would make it possible to identify solutions as quickly as possible. This is the reason why the number of articles on topics related to Covid-19 infection has gradually increased even in the most important scientific journals. Unfortunately, in some cases the results of one study are contradicted by those of another study and this divergence of opinions, which in quieter moments would represent the expression of the normal scientific dialectic, emphasized by the mass media, causes confusion in society and discredits on the whole world of scientific research. It is probable that the need to quickly find solutions to the problem and perhaps also a certain desire to be protagonist have led in some cases a somewhat speedy application of the scientific method, however the vast majority of the published studies have been conducted correctly and the contribution they are providing to scientific knowledge in an attempt to restore a state of “normality” in society, is certainly of fundamental importance. It is sufficient to think of the experiments for the development of safe and effective vaccines that are leading us in a very short time to think that we can already plan the distribution of vaccines for the prevention of this viral infection.

In addition, the issue important to this journal of the significance of inter-professionalism for a decisive improvement in the quality of assistance found great support in the months in which the so-called heroes were represented by all professional categories engaged in the difficult attempt to save lives. Public opinion did not distinguish between doctors, nurses, socio-health workers, laboratory technicians, radiology technicians. Professionals from different sectors made their skills available, trying to provide the necessary contribution to the assistance of more or less serious Covid-19 patients, relatives, operators, healthy people who try not to lose their psychological balance. The collaboration between professionals of different training, often volunteers, certainly constituted an added value. The article by Cappi V et al. published in this issue of the magazine highlights how, even if there is no commonly-shared opinion among the different professionals in terms of appropriateness of “care”, the collaboration between different professionals helps improve the quality of “care”. Furthermore, the article by Foà C. et al., highlights how the satisfaction of the operators of the centers that assist the elderly is favored by the use of inter-professionalism as well as by good relations with superiors. The efficacy of the contribution of various professions to the health organization also emerges from other articles on these pages. We have already said of the importance of the contribution of psychologists along with that of nurses, doctors, health workers in general, social workers and even educationalists. The articles by Cosentino C. at al. , which deals with the usefulness of testing the spiritual needs of patients, by Lupo R et al., which highlights how the stigma related to eating disorders is favored by the media and by poor social support, and by Calamassi D. et al. which documents how music improves the clinical course of some serious patients, highlight how the professional skills that can contribute to improving the quality of care are much more numerous than is normally believed. The infection produced by the SARS-CoV-2 virus has made us live in the recent past painful experiences that we never imagined we would have to live, it continues to rage even this autumn extending its field of action to practically the whole world and highlighting pre-existing gaps and will leave the mark of its passage also in the future when the pandemic has been defeated and, it is hoped, we will be able, in addition to repairing the damage, also to identify the positive consequences of this extraordinarily new event.

Conflict of interest:

Each author declares that he or she has no commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licensing arrangement etc.) that might pose a conflict of interest in connection with the submitted article