From the Front Line of Italy: A Follow-Up Talk with Emergency Physician Enrico Storti

March 23, 2020

Dr. Enrico Storti is the Anesthesia and ICU Director/Unit Coordinator of the Emergency Department at Maggiore Hospital in Lodi, Italy, near Milan. Lodi was hit very hard by the COVID-19 pandemic, and Dr. Storti is on the frontlines treating patients and helping to contain the outbreak.

On March 17, Fujifilm Sonosite Chief Medical Officer Diku Mandavia, M.D. interviewed Dr. Storti to gain a better understanding of the clinical situation in Italy. That interview can be found on Sonosite’s COVID-19 resource page, or you can read the full transcript. In addition to this interview, we asked Dr. Storti several follow-up questions and his advice for what the community can do for its local hospitals.

How are the people of Italy doing throughout this crisis?

In the very beginning, people were told that the outbreak was not so critical, it wasn’t all that important, that China is far away, and so on. When I talked to politicians and to other, bigger hospitals, I reported what was happening here. In the very beginning, they didn't believe me because it was too much. It was simply too much, my words were unbelievable to them.

Then they finally sent someone here to see what was going on. This person was a friend of mine, an expert ICU physician. I showed him the emergency department, the step down unit, the other hospital wards, and my ICU. We went back to our CO, our reporters, and he met all the key decision makers for our hospital. He started crying. He was, believe me…he's 55 years old like me, and he's an absolutely competent expert, and he told me, "This is something that I have never seen in my life. It’s unbelievable that could happen in Italy."

Since that, the report was given to the key decision makers in our region (Lombardy) and our politicians in Rome. By then, the situation was clearly depicted. Day by day, the true numbers of the infection grew worse. The Italian people changed the speed of their response. Now you know, we are in a sort of war scenario. Nobody can go out, and all the schools and bars are completely closed.

The Italian people are now doing their best. They do collaborate so believe me, yesterday and this morning in Milan was completely empty and there was nobody. No cars, nothing on my way to the hospital. So I think that it's now very clear what we are fighting.

Aside from just financial assistance, what are some of the other ways that the government and the administrators of the hospital helped you to adjust for the crisis?

I think that this has been something very important because finally they clearly understood that this is something important for our country, it's important for Europe, it's important for the world. So it's clear that we are fighting something which deserves a real huge investment. And again, let me say that everybody here in Italy has a clear idea about what the real impact will be, the financial impact on our economy, on our hospitals, and on our healthcare system.

But to be sincere, I think that here in Italy the government is fully-supporting what physicians and epidemiologists, and everybody involved in this task force is doing. So let me say that now, it has not been complicated for us to ask for the right things, and much easier to obtain the proper support.

What could have been done different in the beginning of those three or four weeks to make the situation better?

From the very beginning, all the physicians clearly understood that this is a situation which was totally unknown. And I think that more or less all of our physician immediately got that we couldn't go on like we were accustomed to do. For example, I now have a cardiologist helping in the emergency department, and surgeons have now completely stopped elective procedures—not only in my hospital, but in all of Italy. So surgeons, for example, are helping in the emergency department, for all the other kind of patients that they are not accustomed to looking after. They clearly understood that now a physician is a physician—not a cardiologist, an intensivist, or a neurologist.

For example, we have more or less 250 beds for only patients who have tested positive—not intensive beds, not ICU or step down beds. We have rebuilt these new areas from scratch because they were simply not present before. We have brought all the physicians available to take care of these patients. And it doesn't matter if you are an orthopedist, if you are a cardiologist, if you are a surgeon, if you are a cardiovascular surgeon. Whoever is able to give a hand, they’re fully called on duty. And this is also for nurses. Nurses who came from the nephrology department are now working ICU. Whoever is able to contribute, they are on the field. They are in the front line.

What can the average person not involved directly in the medical community do to support their local hospital?

I think that now what is important is they are committed to stay at home. Because staying at home is the only way to reduce the spread of coronavirus. This is now a mantra in Italy. So everybody and the government, the factories, schools, teachers, actors, are contributing by telling everyone to stay home.

Right before this call with you, I recorded a small clip with help from the Italian Army. In this clip, an army lieutenant and I say, "We are doing our best here. We are fighting here. We are working as a team, the army and hospital physicians. If you wish to help, to give your contribution and make our job easier, please stay at home."

There is also a large number of people giving financial support anonymously, spontaneously. So this is also another way to contribute. But now what is most important is stopping this virus outbreak by staying home.

That’s very sound advice. I think Americans are starting to wake up to that.

But this is not also just America. Two days ago I had a conference call with the UK Critical Care Society. I was the only foreign speaker. And there were physicians who are absolutely concerned about what is going to happen. But from the politicians’ perspectives, it was quite a confused situation. And my message was, "Please be careful. If our epidemiologists are doing the proper forecast, you are 10, 15 days ahead of Italy. I mean, you have 10, 15 days to think about what you're going to do. Please use this time to accept the seriousness of the situation, and to understand that this situation will probably will happen in your country. And if you are not well-prepared, in the UK, just like in Italy, just like in France, or Germany, it will be a mess."

You’ve been using social media, including LinkedIn, to send articles out. Do you have any thoughts about the role social media can play in dealing with COVID-19? Are there things that you would recommend people do with Twitter, LinkedIn, Facebook, or other social media channels?

You know that social media has a potentially fantastic role, but may also be harmful. So you must always refer to medical experts on social media. Please avoid people that have no titles, have no role, and have no transparent and proper message to give. So again, social media should be and is potentially a very important tool, but again, should be used really carefully. And if you write something on social media, you have to be responsible for what you are writing or recording.

And other thoughts you’d like to share?

I think that the strong message, in my humble opinion, is that you have to reshape your way of working when you are in a sort of mass casualty event, just like we are in now. You have to do different things. Ultrasound is flexible at the bedside and valuable too, not only for the diagnosis, but also for monitoring the patient. And this is another important thing when you have an ultrasound background in terms of point-of-care. It’s very, very effective in changing your way of working. Because here, I've seen many people doing different things just because they had the probe in their hands. So it was easier to reinvent your job title, as you mentioned, when you have an ultrasound machine. And ultrasound's the perfect tool for doing this. This is the message I’d like to give.

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