The Coronavirus in Florence told by Professor Alessandro Bartoloni, director of the Infectious Diseases Department of Careggi

Our interview with Professor Alessandro Bartoloni, director of the Infectious Diseases and Tropical Diseases Department at Careggi Hospital

Day One of Phase Two. Among the desire to return to normal, hopes and fears we meet Professor Alessandro Bartoloni, director of the Infectious and Tropical Diseases Department of Careggi Hospital to talk about Coronavirus, the emergency that the first hospital in Florence had to face in recent months, but also the moments that made the smile appear under the masks and protective helmets of doctors and nurses. What is striking about this chat literally stolen from a doctor who has lived in the front line in the last two months is the simplicity with which explains the shocking dynamics that have changed the course of a piece of history, but also a constant that we can not let it go unnoticed: every time Bartoloni talks about sick and patients always uses the same term, people. A reassuring sign - don't you think? - in the midst of an ocean of uncertainty.

Professor, what image can describe your impact with Covid19?

A hurricane. It really was a hurricane and we're still in the hot phase. When we started with the first patient, on 25 February - who stayed here, in isolation, but pampered until improvement and discharge - the situation was still quiet.

And then what happened?

In the first days of March, daily admissions began. Only hospitalizations in the infectious diseases department. At the time, there was still discussion about the problem of the garrisons, about the fact that the infectious disease wards were not sufficient. But immediately afterwards we were faced with an emergency, with admissions to the intensive care unit. All in a matter of weeks. Since then, there hasn't been a minute's suspension. 

What was the capacity of the Infectious Diseases Department and the other departments involved in Careggi?

Timetables, rest periods, with the total involvement of the Hospital, even of the wards not properly dedicated to the management of the problem, have been skipped. Careggi reduced its surgical and outpatient activities, and the number of patients grew by the hour, with the Emergency Department having to manage the growing number of accesses with the utmost care. The Laboratory of Microbiology and Virology, with its indispensable work in the analysis of nasopharyngeal swabs, underwent a tour de force to guarantee, still today, a twenty-four hour work. I have to say that we have put in place a non-stop collective work with oiled and effective organizational and logistic dynamics activated in a very short time to monitor the beds, the supplies of devices and drugs that had to be insured - because there were times when we really had difficulty finding them. The support of the Pharmacy was fundamental. The staff also underwent specific training quickly to be able to manage the new emergency in their departments. All coordinated by a constant: at least one videoconference a day for all departments.

How is the situation evolving now? 

We're starting to breathe a little. The intervention processes that were initially affected by the emergency and the urgency have now been recorded. We treat Covid19 as a normal but serious condition, especially in some cases.

What is your team's most successful therapy to date in patients with coronavirus infection?

So far, apart from a few important supporting measures, there is no scientifically proven successful therapy. We are waiting for the results of the studies carried out in an appropriate manner in order to have real evidence of the effectiveness of the different treatments used. In order to cope with the most acute phase, we have used off-label drugs, i.e. off-indication drugs, because they are authorised for the treatment of a number of autoimmune diseases, such as rheumatoid arthritis and malaria. This is the case of hydroxychloroquine, a drug that is already considered valid in some works produced by Chinese colleagues, and all in Italy we have decided to use it. Other drugs have also been used for their immunomodulating action, to counter the famous 'cytokinic storm' caused by the Coronavirus in the most serious cases.  It is, in practice, a violent reaction of the immune system that instead of protecting against the virus attacks the patient until it becomes harmful. The use of these drugs in many cases has avoided the need for intensive care and intubation. In addition to this, the management of integrated teams - from infectivologists to anaesthetists - for forms that are already serious but do not require the patient's intubation, has helped and is helping to avoid the worst in many cases. 

The hospital staff in recent months has been put to the test, how did you cope with the emergency?

The hard test was really there, I've seen people working with their heads down with fatigue, even physical. There were times when we worked relentlessly. And everyone, from doctors to nurses to social workers, has been a great example of responsibility. Great work was also done by the cleaning staff, more important than ever in this pandemic.

There must have been some good stories and moments that made you smile. Can you remind us of any of them?

When people get better and come home, that is the best moment that pays off every effort and every sacrifice. But there was also another very emotionally involving aspect. It was the recognition of the relatives, in the saddest cases, those of the deaths, their gratitude for the attention and sensitivity with which we were able to relieve them from the problem of total isolation. Every day, in fact, our staff called the relatives of serious patients at least twice a day to update them and support them in those critical moments, and all of us, who are so hard pressed to understand the difficulty of interacting and establishing human relationships with the sick, are doing everything we can to overcome that obstacle, inventing various ways to be recognized individually. Because you know, it is really important for a person who is in a hospital bed to be able to understand who he is dealing with and to whom he is referring.

Let's close with a positive holiday thought. Sea, spas, hills and mountains, Tuscany offers many scenarios where you can spend your free time. Which of these will be safer in the coming months?

There are some precise indications on this subject from the Region of Tuscany, but in any case, in my opinion the most important thing is to maintain the physical distance and avoid the assemblage, as well as the respect of the rules that we all know by now. So, also in light of this, the coming summer could be an opportunity to discover or rediscover places less frequented by tourism. You will be surprised by the quantity and variety of beautiful and remote places that Tuscany can offer!