Bergamo is the town most affected by the COVID-19 epidemic, not only in the Lombardy Region but also throughout Italy, with >9000 COVID-positive cases, and 2300 ascertained deaths. Unfortunately, the infection is not even sparing young people. The consequences of the COVID-19 emergency for the entire ‘Papa Giovanni XXIII’ Hospital of Bergamo have been dramatic. At present (mid-March), from a total of 779 hospital beds, >500 are occupied by COVID-positive patients. The 46 beds previously reserved for the ICU (intensive care unit) have been increased to 100, of which 88 are occupied by COVID-positive patients, all of them intubated and with an average age of 61 years. Due to the shortage of resources , a triage of the patients to be intubated was needed, based on data such as age, presence of comorbidity, degree of respiratory failure severity, and life expectancy. Although our hospital structure is at the forefront and with great flexibility for organization, during the last month it has run the risk of collapse, facing such a violent epidemic comparable to a tsunami, from which it differs in terms of time, lasting not a single day but more than a month. Clinicians are living in permanently stressful conditions, caused by concern for their own health and safety, severity of the infection, by seeing patients dying alone, and finally, by exhausting shifts and workload. Like many other colleagues (so far 12 out of 36 in our Cardiology Unit), I have contracted the infection at the hospital, and, as a consequence, I have been placed in isolation at home for about 2 weeks. This isolation has had personal effects, on family (my whole family was infected) and, not least, professional effects, since I was unable to manage ‘on the spot’ the other different Units of the Cardiovascular Department (Invasive Cardiology, Cardiac Surgery, and Vascular Surgery), except through video conferencing. My experience, similar to that of many other colleagues, teaches us, the physicians, how the hospitals can be the primary infection vehicle and that priority for the protection of medical staff must be given. To avoid them becoming an infection source, the medical staff must undergo swab tests at the onset of the first symptoms (even mild fever, sore throat, or cough) and all those who enter the hospital, i.e. patients, health staff, or others, must be supplied with and obliged to wear surgical masks. Our Cardiology Unit, as many other Units of the hospital, has had to face the need to change its own organization. At present, the Cardiology Unit has only 4 ICU beds and 40 ward beds (previously they were 8 and 50, respectively) 60% of which are occupied by COVID-19-positive patients. Non-urgent outpatient visits have been cancelled. However, particularly challenging is the management of patients listed for heart transplantation, LVAD patients, and heart transplant patients. The Cardiology Unit has become the hub for the cardiovascular emergencies of coronary revascularization and electrophysiology of Bergamo Province, which accounts for 1 150 000 people. We have modified the cardiology triage system to find functional and operative solutions to the increasing wave of patients arriving at the Emergency Department, and, at the same time, to manage the cardiological emergencies by limiting the infection risk. In detail, we have organized a fast track for patients arriving as emergencies from outside, avoiding the Emergency Department, reducing the infection risk, and allowing them to be directly managed by the cath. lab staff. Therefore, some possible suggestions that could help cardiologist colleagues to be prepared to start and face this health emergency are: (i) give priority to the protection of hospital health staff; (ii) provide adequate protective systems for the health staff and masks for hospitalized patients, outpatients, helpers, and visitors; (iii) adjust the hospital organization, with units dedicated to the treatment of COVID-positive patients, who should be separated from other patients; (v) change the

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意大利贝加莫的 COVID-19 体验

贝加莫是受 COVID-19 流行病影响最严重的城镇，不仅在伦巴第大区而且在整个意大利，有超过 9000 例 COVID 阳性病例和 2300 例确定的死亡。不幸的是，感染甚至没有放过年轻人。COVID-19 紧急情况对整个贝加莫“Papa Giovanni XXIII”医院的影响是巨大的。目前（3 月中旬），在总共 779 张病床中，超过 500 张被 COVID 阳性患者占用。之前为ICU（重症监护病房）预留的46张床位已增至100张，其中88张床位为COVID阳性患者，均已插管，平均年龄为61岁。由于资源短缺，需要根据年龄、合并症的存在、呼吸衰竭的严重程度、和预期寿命。我院结构虽然走在前列，组织上也有很大的灵活性，但在过去一个月里，它冒着倒闭的危险，面对如此猛烈的海啸般的疫情，与海啸相比，时间不同，持续不一。一天不过一个多月。由于担心自己的健康和安全、感染的严重性、看到患者独自死亡，以及最终因轮班和工作量而筋疲力尽，临床医生一直生活在压力之中。像许多其他同事（到目前为止，我们心脏病科的 36 名同事中有 12 名）一样，我在医院感染了这种病毒，因此，我在家中被隔离了大约 2 周。这种隔离对个人、家庭（我全家都被感染）以及尤其是职业影响产生了影响，因为我无法“现场”管理心血管科的其他不同科室（侵入性心脏病学、心脏外科和血管外科），除非通过视频会议。我的经验与许多其他同事的经验相似，它告诉我们这些医生，医院如何成为主要感染媒介，以及必须优先保护医务人员。为避免他们成为感染源，医务人员必须在出现最初症状（甚至轻微发烧、喉咙痛或咳嗽）时进行拭子检测，所有进入医院的人，即患者、医护人员或其他人，必须提供并必须佩戴外科口罩。我们的心脏科和医院的许多其他科室一样，不得不面临改变自己组织的需要。目前，心脏病科只有 4 张 ICU 病床和 40 张病床（以前分别为 8 张和 50 张），其中 60% 被 COVID-19 阳性患者占用。非紧急门诊已取消。然而，特别具有挑战性的是对心脏移植患者、LVAD 患者和心脏移植患者的管理。心脏科已成为贝加莫省冠状动脉血运重建和电生理等心血管急症的中心，该省有 115 万人。我们修改了心脏病学分诊系统，以找到功能性和操作性的解决方案，以应对越来越多到达急诊科的患者，同时通过限制感染风险来管理心脏病学急症。详细，我们为从外部紧急到达的患者组织了快速通道，避开了急诊室，降低了感染风险，并允许他们由导管直接管理。实验室工作人员。因此，一些可以帮助心脏病专家同事准备好应对这一突发卫生事件的可能建议是：(i) 优先保护医院卫生人员；(ii) 为医护人员提供足够的防护系统，为住院患者、门诊患者、助手和访客提供口罩；(iii) 调整医院组织，设置专用于治疗新冠肺炎阳性患者的单位，应与其他患者分开；(v) 改变 实验室工作人员。因此，一些可以帮助心脏病专家同事准备好应对这一突发卫生事件的可能建议是：(i) 优先保护医院卫生人员；(ii) 为医护人员提供足够的防护系统，为住院患者、门诊患者、助手和访客提供口罩；(iii) 调整医院组织，设置专用于治疗新冠肺炎阳性患者的单位，应与其他患者分开；(v) 改变 实验室工作人员。因此，一些可以帮助心脏病专家同事准备好应对这一突发卫生事件的可能建议是：(i) 优先保护医院卫生人员；(ii) 为医护人员提供足够的防护系统，为住院患者、门诊患者、助手和访客提供口罩；(iii) 调整医院组织，设置专用于治疗新冠肺炎阳性患者的单位，应与其他患者分开；(v) 改变 (iii) 调整医院组织机构，设置专用于治疗新冠肺炎阳性患者的单位，应与其他患者分开；(v) 改变 (iii) 调整医院组织，设置专用于治疗新冠肺炎阳性患者的单位，应与其他患者分开；(v) 改变