In the case of ND patients, the approach depends on general morbidity and frailty (Fig. 3). A man over 70 years old presented to the ER of the spoke hospital, complaining of dyspnoea and night orthopnoea; he had a recent history of respiratory syndrome causing chest pain that was treated with antibiotic therapy. During hospitalization, he had a SARS-CoV-2 nasal swab screening (results were negative). The CT scan showed pleural effusion, pulmonary oedema, no COVID-19 pneumonia, an aortic root aneurysm (56 mm × 53 mm diameter) and subocclusive stenosis of the left internal carotid artery. The transthoracic echocardiogram (TTE) demonstrated severe aortic valve regurgitation, 30% ejection fraction and end-diastolic volume 180 ml. No severe stenosis was found on coronary angiography scans. The case was therefore discussed with our THT. The patient met the criteria to be classified as ND, so he was transferred from the spoke to the hub. He was accepted in the ER, had a second screening and was hospitalized in the pink area. Unfortunately, the result of the swab test was positive for COVID-19. Consequently, the patient was moved to the red area. Considering the recent respiratory syndrome and the positive COVID-19 screening result, the THT decided to transfer the patient back to the COVID-19 area of the spoke for appropriate medical care.