Covid, Massimo Galli: “The time for gradualism has passed, we need decisive measures. In March Milan was saved thanks to the blockade”

“I think we must intervene decisively on the population asking to reduce everything that is not strictly necessary. I do not mean superfluous, because they tell us that we terrorize people and we don’t pay attention to the psychological aspect. I assure you that we also have to take care of the psychological aspect of ourselves. I can assure you that the staff, who are holding on, are extremely discouraged by this second wave of illness that is weighing us down again. At this moment the simile with him war. If to keep people, I have to do something propaganda I don’t, it’s not correct. I think we should tell people to regulate and self-determine and collaborate in the collective design to free ourselves from this virus or contain the damage as much as possible. We have to hold on ”. In this drawing Massimo galli, head of the department of infectious diseases at the Sacco hospital in Milan and now a well-known face on television, inserts “decisive and well-done measures” with the “local administrations” that must identify risk areas and allow a buffer. And if they don’t then “decisions are made from above. It is done like this and closes much more ”.

Right now, is it better to take action gradually as Prime Minister Conte says and then risk a very harsh blockade or rather do it right away?
The time of gradualism has passed. Some measurements must be firm and well done.

So do I lock up now?
No. I’m fine with the curfew right now. I am fine with the immediate reduction in school and workplace attendance. I’m fine with some meaningful action on public transportation right away.

But the mayor of Milan said today that the boys must go to school.
It is not that the mayor is not right, the truth is that in order to get them to go to school, you have to make sure that the infection does not go beyond what is happening. Otherwise, in 15 days everything will be over, but worse.

Worse than March?
No. But we will have to face a problem that worsens even more

But in his opinion, what was missing since we are in a situation that obviously worsens by the hour.
But have you seen the map of Italy in terms of the spread of the infection? In Lombardy you will find that there is a whole concentration of points on the side that was less affected before, even if this is also changing because we are starting to have problems even where they were very involved before. Certainly not like us in Milan, where it goes pretty bad. And in any case, between September 28 and October 11, Lombardy made 8,110 diagnoses. It is a series of diagnoses that already takes away the significant possibility of making strokes because there are too many. No health system in the world is sustained. Do you want an example?

Of course.
In Korea, in 2015 it happened that 185 cases of MERS arrived at the Seoul hospital, a disease a little cousin of SARS. It was necessary to follow 16 thousand contacts and there were 33 deaths. All this generated from a single case of a disease that has the ability to spread less efficiently than this. Let me tell you it’s clear that you can’t hold on if you keep walking.

You also had a bunch at the Sacco.
Unfortunately.

So if you were the prime minister, what would you do today?
I would do what has been done in terms of defining a curfew, but do it the way it should be done. Give the signal to people to stay home as long as possible. You can’t tell people to get out carefully, this is the time to tell them to stay indoors as much as possible and to get out if necessary. We are always confused about the true scope of a situation and its dangers. The danger is there and it touches the whole world to notice it deeply and that we move accordingly. The first precaution is to stay home and see friends and family on Skype or talk to them on the phone. And this in particular in some metropolitan areas like Milan, Rome, Naples where even the high population density is a danger in itself. To try to keep factories, offices and schools open, we need to have moments of greater exposure in terms of transportation, concentrations of people. If this is the case, it should be considered with all prudence and also with the appropriate decisions. The curfew signal is a strong signal and if people cooperate, there is likely to be an improvement. The next step is the local administrations. I believe that they can and should have a greater capacity to identify the riskiest situations and put ourselves in a position to cushion. You need to do this right now in some specific situations.

Specific locations and measurements?
Decisions Redefinition of the basis of a decree that can allow decisions. Asking the problem now, because if the issue is that important decisions are delegated anyway, then the decisions are worth making from above. This is done and closes much more. However, full closure is the sanction of bankruptcy. If everything has to be closed, it means that we have not been able to affect the fulcrums and nodes at higher risk. We can also take note and say we can’t do it. I hope is not like that. And I hope that what can be put in place immediately is enough to stop everything. Unfortunately, however, there is great individual responsibility. If the behaviors are not appropriate, it only remains to close everything.

Therefore, there is a risk that we will die as a national system.
In this way, we will be part of a world crisis and it can be expected that the recovery can be, as the great war events have shown, generalized. Right now you have to sacrifice something, otherwise it could be worse.

As if we were at war?
There is an analogy. The trend for more than a month was terribly explicit. Maybe for the insiders. To those of us who, like me, have not worried for a week, but from August 15 to how things were going and then until September because the results of the summer were evident. Even for the surrounding countries that suggested that some behaviors had been harmful.

Is it true that we have gone from the sick left at home in March to the excess of hospitalized?
Be patient, the ones I have here are because they are very sick. We are also making tampons for those who would not have dreamed of being able to have them in March when the few tampons were reserved for those who were terribly ill. We, in the big wave, have documented perhaps 10-15% of the actual number of infected people. Now this is not the case and it happens that even symptomatic swabs become ill and therefore arrive earlier than they arrived before. We are rapidly shifting towards an increase in the demand for people with serious illness, which is an expression of the fact that the denominator is widening and that the number of patients in the denominator is increasing rapidly. The percentage is always the same: about 5% of total infections are life threatening for those who contracted them. Others may be left out, but this is the same percentage as in March when we had the row of caskets. Only that it is a much higher percentage of the number of infected.

Why did Milan hold out in March and now they don’t seem to hold out?
Because it is very likely that the closure came in time to prevent the virus, in its inscrutable movement through Lombardy and Italy, infecting such a significant number of people in Milan that it puts us in the same conditions as all those. areas of Lodigiano, Cremonese, Bergamasco, Bresciano and Mantovano that have been severely affected. But frankly, we don’t know why.

A hypothesis?
The hypothesis is that it arrived around January 25 and began to spread from the Lodi area to then quickly reach the Bergamo and Brescia area and from there to Veneto. Probably in a week.

You surely know that there have been cases of pneumonia “with an unknown pathogen” in the Bergamo area at the end of December.
These are all things that perplex me. My take on the epidemic is that as such it came around January 25th and passed through there and it wasn’t enough here in Milan. Do you want proof?

sure
In Castiglione D’Adda (Lodi, ed), the seroprevalence test between May 18 and June 7 in 90% of the population with a lancing device: 22.2% were positive. There have been many hospitalized and many deaths and that is why we have to go up a little: to almost a quarter of the population. Of these, a good 30/40% are completely asymptomatic. If we go to Carpiano (the last town in the province of the metropolitan city of Milan to the south) we do not exceed 6%. In Vanzaghello (last locality of the metropolitan city to the northwest towards Varese) we found 3.5% and zero positives. We went to Carpiano (the province of Milan that borders that of Pavia) and in June we found 89 positives out of 1564 swabs, 5.7%. A tail of the infection that is not at all widespread in that area. In the center of Milan, our hypothesis is that at least in the 20-50 age group a prevalence of around 7% has been reached. They tell us the data of the ATM, the data of the donors of the Policlinico di Milano and the data of another large Milanese industry that I cannot now cite for confidentiality.

We have to hold out much longer then.
I next year in my 70s and after retirement I wanted to take a tourist trip, not jump from one conference to another or a mission like in the past. Something long, for a month, maybe in the Pacific. I do not think it does.

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