We are pleased to present an interview with Professor Girolamo Sirchia, memorable head physician of Haematology at the Milan Polyclinic Hospital, and Minister of Health from 2001 to 2005, during the SARS emergency; he is also known for his law against smoking (Law no. 3 of 16 January 2003), which not only had an impact on the health of Italians but was taken up as a model in all European countries.
MGM. Good morning Professor, and welcome. I read your posts on social networks and I always come out enriched, with an impression of great competence and calmness. You were Minister in 2003 during the SARS emergency and now here we are with COVID-19.
GS: COVID-19, this second SARS, unlike the first, is a demonstration of an incredible lack of epidemic emergency management. At the time of SARS, I was fortunate enough to have a strong friendship with US Secretary of State Tommy Thompson, who was dealing with health issues (under the Bush administration, he insisted – unheard – on the problem of lack of health insurance coverage for citizens, while the US continued to invest money in the army, ed.), for discussions on tobacco smoke. SARS broke out and I learned of their organisation of a Center for Disease Control. Indeed, I took up the American model and the organisation of the centres, and I issued the Decree Law no. 81/2003 (converted into Law no. 138/2004): the CDC is governed by the Director of Prevention of the Ministry and the regional directors for prevention, and its aim is to analyse epidemics in an international network with a core group of experts, and whether they can reach Italy. If the probability does not exist, we monitor without intervening; if it does, on the contrary, we build an epidemiological plan with three possible scenarios, mild, medium and severe. For each of these plans, a programme of actions is then made, from the involvement of the whole nation, to the evaluation of the supply of personal protective equipment (PPE), to the definition of protocols for hospital and local doctors, nurses, army and civil protection. So in the serious scenario, like this last one in 2020, when the epidemic arrives you are not in the situation.
MGM: But we were in the situation, we could say in chaos, to date there is still no plan for territorial medicine, there is still discussion about who should do the swabs; so what happened to this CDC?
GS: It was financed until 2012, and in 2012 health care was massacred (together with the school ed): the plans for managing the epidemic were skipped, we found ourselves without general practitioners, without protective devices produced in Italy, continuing to give China the production of these PPE, instead of increasing production in Italy. This is why China also sold shoddy products to the highest bidder. In short, there has been a lack of a culture of risk, a culture of seriousness scenarios and what to put in place. SARS COVID-19 is an alarming disease, and it won’t even be the last pandemic if you don’t engineer these situations.
MGM: So we missed Risk management and Disaster recovery; dealing with narrative and therefore communication, with you we would like to examine two aspects: the narrative that scientists and doctors had with the public and the narrative of journalists during the pandemic in 2020.
GS. In the epidemiological plan of the CDC there is precisely a chapter that provides for communication to health care staff and the population: everything that did not happen here, and was disregarded. For example, there has not been a single spokesperson for the scientific technical committee, a single assigned, or a couple of people delegated to issue communications. For lack of these spokesmen, everyone has the right to speak in a frightening uncertainty: see the contrasts between the scientists who appear and are fomented by talk shows.
MGM: On the other hand, science also goes ahead because of disputes, confutations, the results by their nature must be questioned.
GS: Yes, but these disputes remain behind the scenes for public opinion. It is this uncertainty among scientists that leads people to be, on the one hand, terrified and, on the other hand, not to believe in any information because of the constant rethinking of action: people are intelligent, but at a time like this, in a great crisis, there is a need for clarity.
MGM The effect of the confusion is this polarisation between “denialism” and “terrorism”: in Germany Chancellor Angela Merkel informed all her citizens with great clarity, without hiding anything.
GS: In fact, and this is not the daily uproar we are witnessing: no one here is more credible, everyone has his or her own way. The Ministry of Health – which for us was represented by the CDC – should have organised an institutional communication, twice a day with clarity and transparency. Instead, every night we have a talk show of people fighting against each other.
MGM: Makes me think, maybe the doctors should take a step back?
GS: Sometimes they really should keep quiet. The truth is that we are at war, against an enemy called the virus. So we need a strict chain of command, and in a war there are only a few people in command, not everyone, and there are orders and prohibitions on intervention. The population must always be informed and in truth, things should not be sweetened and mitigated at all. Exactly as Anthony Fauci, who is good, credible, authoritative and respected (later dismissed by the Trump administration, ed), had set up the communication.
MGM: We are at war; thanks to those who told us about the Second World War, because they experienced it as a child, we know that children and young people did not go to school for some time because they were closed. Now there is the issue of distance learning.
GS: Walter Bergamaschi, director of ATS in Milan, with a degree in physics, had shown me the projection of the contagions when the schools reopened in September: the data were already dramatic, with projections that left no hope. I am perfectly aware that I am saying something extremely painful for children, young people and families, but distance education remains the least bad thing today. For a few months it is a necessary evil, at least to bring home some time while waiting for more effective therapies.
MGM: Professor, let’s come to the learning curve of treatments: from point 0, the moment the Virus appeared on 21 February, has anything changed?
GS: At first, nobody knew anything about the management of these patients, but then important information came to light: people died of pulmonary venous thrombosis, and this finding came about thanks to autopsies performed for the first time in Germany. Our DRG funding system provides for autopsy, but it is expensive, so what more can you do to save money? You cut money there instead of investing in knowledge. Because the autopsy is the key to understanding how the disease takes place: everything that came afterwards, the cortisone, the heparin, the aspirin, we owe to this procedure. Of course, we are waiting for the vaccine, or an antiviral, of monoclonal antibodies, tools that will allow us to resume a normal life.
MGM: In the book Spillover, David Quammen, biologist and reporter of National Geographic, writes that through continuous deforestation, pollution with consequent global warming, spills of oil, anthropization, we have destroyed biodiversity in its flora and fauna. And so viruses, which have always existed long before Homo Sapiens, come into contact with us more easily, even in our pets because we have destroyed the intermediate species – wild animals that did not get sick. In fact, never before in our history have so many epidemics been recorded as since the Second World War: and never before has the forest been so quickly felled as it has been in the last seventy years. Do you think there could be a relationship between zoonoses and the way we have treated the earth?
GS: The relationship is certain: we are talking about One Health, which is the collaborative efforts of several disciplines working at local, national and global level to achieve optimal health for people, animals and our environment. Let’s think of the animals that we raise in a shameful way, indoors with no possibility of moving, stuffed with hormones, forced in an uncivilized way, to make the cooks in the Masterchef’s to talk about recipes. But one could talk more about the Divine Comedy. I respect profit, but I cannot accept that profit comes before health; of course, we are all connected, we live in the same environment and we must keep the air unpolluted and the environment healthy.
MGM: You have made an extraordinary law, the law against smoking, trying to act on lifestyle: positive lifestyles act and strengthen the immune system, thus putting us in a situation of potential defence against the virus?
GS: Just look at the mortality data from COVID-19: these are “frail elderly people”, where “frail” means carriers of multiple chronic diseases. Fragility is therefore the threat, not just old age. Chronic diseases are the cause of death and derive from inadequate lifestyles: those who live well since childhood, eat healthily, do not smoke, move, become old, yes, it is inevitable, but not fragile …
MGM: Not fragile. “Anti-fragile” is a term that goes beyond resilient. Thank you again Professor for this vision of yours, which gives clarity to what is happening and also leaves us with a bit of a bitter taste for how it could have been handled both from the point of view of risk management and from the point of view of communicative narrative.