Boosting Public Health Resources in COVID-19 Times 
The experience of the the Residency Programmes in Italy and 
The University Vita-Salute San Raffaele

By Carlo Signorelli, Anna Odone, Roberto Croci, Beatrice Frascella
School of Public Health (Igiene e Medicina Preventiva), University Vita-Salute San Raffaele, Milan

The current COVID-19 pandemic has testified to the great importance of Public Health, both as an ever-changing field of biomedical culture and research and as a vital backbone for Healthcare and Health Systems. In Italy, Public Health professionals, including young professionals, have faced extraordinary challenges: most Public Health Residents rotate between University Departments, Health Directions of Hospitals and Local Health Authorities. Therefore, the pandemic has been a chance for them to engage in research activities, mainly literature reviews and original studies in cooperation with clinicians, and COVID-19-centered science communication – for instance, raising awareness about social distancing and hygienic measures in the population by spreading informative contents on both traditional and social media.

As for the collaboration with Local Health Authorities (AUSL), the role of Public Health Residents in contact-tracing and outbreak investigation has been instrumental in fighting off COVID-19 and breaking transmission chains in most parts of the country. In June, the Italian National Institute of Health (Istituto Superiore di Sanità) issued an e-learning contact-tracing course specifically targeted at the Public Health Residency Programmes. Many residents of Schools of Public Health participated with enthusiasm. Thus, the COVID-19 pandemics has proven to be an invaluable chance for current Public Health residents to learn unique skills and to help tackle a worldwide emergency. In Italy, where almost all Residency Programmes are supported by public funds, the total number of Public Health Residency contracts rose relevantly by 136%, from 231 in 2019 to 545 in 2020. Such an increase is justified by the increasing age of medical doctors and the high impact of retirements, especially in the hospital workforce. Indeed, a recent report by the trade union “ANAAO ASSOMED” forecasted a national shortage of more than 470 Public Health specialists by 2025. This year, mainly due to the acceleration brought about by the COVID-19 pandemic, has seen partial answers to the relevant need for more medical residents. Still, if the critical lack of Human Resource planning keeps progressing, the future risk of a National Health Service deadlock due to insufficient personnel cannot be averted. In March 2020, as COVID-19 was heavily striking Northern Italy, UniSR School of Public Health in Milan was inevitably faced with the burden of the emergency. As a consequence, all Public Health residents have been involved in activities that directly or indirectly concerned COVID-19. In hospital settings, their role has included:

• Expediting the implementation of national- and subnational-level laws and guidelines in a rapidly-changing legislative scenario;
• Helping supervise, reallocate and create ICU and internal medicine COVID-19 dedicated units and beds;
• Rearranging logistics: from ER reorganization and the definition of specific, “isolated” COVID-19 pathways for suspect or confirmed cases, to monitoring supply-chain and stockpiling of PPEs to prevent any possible disruption;
• Supervising the orderly suspension (“Phase 1”), and subsequently reorganizing (“Phase 2”), for all routine and ordinary healthcare activities.

In community settings:

• Collaborating with Local Health Authorities in COVID-19 surveillance, as well as processing, elaborating and interpreting administrative and statistical data;
• Helping Regional emergency services, with coordinating jobs ranging from telephonic triage of patients, to ambulance and inter-hospital Emergency Room management.

Furthermore, our School as many others has carried out intensive COVID-19 related academic activity, with a relevant number of publications authored as of August 2020. Among the topics dealt with are: “classic” epidemiology, with an emphasis on national-and subnational-level surveillance and mortality data, local health services and hospital response, impact of the pandemic on the general population and vulnerable subgroups, vaccine-preventable disease prevention in pandemic times, and bibliometric analyses of the literature carried out by a specific “COVID-19 Literature Task Force”.