Just did virtual rounds @bidmchealth with Dr Francesco Blasi, who runs a major COVID program in Milan, and a major pulmonary authority. First, I encourage all of you to seek his wise input for your conferences. A few high points to follow.1/

Their data suggest that young people are the major reservoir of virus, and old folks are the major targets, as seen elsewhere. 2/

They have been employing many therapies, including HCQ, remdesivir, as well as in some cases anti-IL-1 and steroids. Clinical observations don't suggest that any clearly beneficial, also not surprising based on lack of RCT's and much anecdotal observations. 3/

Why so bad in Lombardia region. He is quite sure these were key factors: 1. initial infections coinciding with flu caused confusion; 2. initially no PPE employed in hosps; 3. super-spreader events from football games & partying; 4. initial nosocomial spread by health workers. 4/

Initial spread to older health workers/MDs led to over 150 deaths. Importantly, since end of Feb when his unit became involved with COVID units and ICUs, he says no MDs or nurses have been infected, as they employ proper PPE. 5/

Milan currently has 63% increased total mortality vs prior years. He believes 2/3 is from COVID deaths, and 1/3 from deaths brought on by patients with other disorders, like MI's, not going to hospital. 6/

Their ICUs exceeded capacity at key moments. They decided to intubate younger vs older patients when confronted by this horrible choice. 7/

Threat today to health workers may be on non COVID floors where some patients viewed as negative with tests prove to be infected on later testing, and staff less protected on these services. TAKE NOTE! 8/