The Italian Endo-COVID-19. Our response to the emergency.

Dear Editor,

The Sars-COV-2 virus, a mutated coronavirus spreading from China in the last months of 2019, has a marked respiratory tropism, but in some subjects can causes an aberrant inflammatory response leading to a systemic disease for the simultaneous involvement of the lung, cardiovascular, coagulative, gastrointestinal and nervous system. Therefore an internist management is advised and many Endocrinologists and Endocrinology trainees have been called to help in those NHS hospitals facing the epidemic crisis.

Between 8 and 14 April 2020, the Directors of the Italian Endocrinology Residency Programs were asked to fill in a survey on the number of hospital beds, physicians, residents, nurses and technicians were made available by the School for NHS reorganization during phase one of lockdown (7 March—7 April 2020). All agreed with 100% completion rate, for a total of 34 Programs, expression of 35 Universities and 45 Hospitals. The data are reported in the Table as cumulative national and stratified for macroregional areas (North, Middle, South and islands) because of different viral spread (Table 1).

Table 1

The response of the Endocrinology Residency Programs to the COVID-19 epidemic

	Total	North	Middle	South/Islands
Schools (n)	34	16	11	7
NHS Endocrinologist employed in the Programs (n)	502	223	163	116
Trainees in the 4-year Endocrinology Programs (n)	403	166	145	92
NHS Nurses/technicians (n)	543	247	174	122
Ordinary beds converted to hold COVID-19 patients (%)
0	45.8	26.3	62.4	53.8
1–50	12.5	5.3	12.5	23.1
51–99	18.8	31.6	18.8	0
100	22.9	36.8	6.3	23.1
Endocrinologists dedicated* to COVID-19 wards (%)
0	37.5	10.5	43.7	69.2
1–50	29.2	26.3	37.5	23.1
51–99	27.1	47.4	18.8	7.7
100	6.3	15.8	0	0
Nurses dedicated* to COVID-19 services (%)
0	35.4	21.1	50	38.5
1–50	29.2	26.3	25	38.5
51–99	22.9	31.6	25	7.7
100	12.5	21.1	0	15.3
Trainees dedicated * to COVID-19 patients (%)
0	52.1	5.3	68.8	100
1–50	16.7	26.3	18.8	0
51–99	16.7	36.8	6.3	0
100	14.5	31.6	6.3	0
Medical doctors transfer occurred (%):
Mandatorily	27.1	21.1	31.0	30.8
Voluntarily	41.7	57.9	43.8	15.4
No transfer occurred	12.5	0	6.3	38.4
Other	18.7	21	18.9	15.4

* > 50% working hours

In 22.9% of cases, the whole Endocrine Department was converted to hold COVID-19 patients (36.8% in the North). At least half of the ordinary beds were given to the emergency by 41.7% of centres nationwide, 68.4% in the North, and 23–25% in the rest of Italy. Overall, 45.8% of the Departments maintained their own endocrine beds.

Regarding the specialty physicians (endocrinologists of the NHS), in 15.8% of northern Italy the entire staff was dedicated to handle COVID-19 patients, whereas it dropped to 6.3% nationwide. However, in 66.2% of sites of North and Middle, at least half of specialists have been used for the emergency. This means that 168 endocrinologists (out of 502) have dedicated most of their working hours to COVID-19 related activities (141 in North, 31 in Middle and 9 in South Italy). Similarly occurred for nurses usually working in Endocrinology or Diabetology. Overall 192 nurses have dedicated most of their time to COVID-19 healthcare. The reorganization resulted in a reduction or suspension of the Endocrine Day-Hospital admissions for 89.6% of sites, but outpatient activities, limited to urgent and non-deferrable outpatients, was almost universally guaranteed.

Coming to the contribution of the residents in Endocrinology, a remarkable help was given to crisis handling. A third of the Schools have made available more than half of their own trainees (31.2%), and an additional 16.7% to a lower proportion. Translated into numbers, it corresponds to a "small army" of at least 190 young in-training endocrinologists who are helping COVID-19 wards. The involvement, was much higher in the North (in 68.4% more than half of the trainees were used), smaller in the Middle (12.6%), not requested in the South of Italy. The latter finding must be interpreted in light of the different geographical impact that the pandemic. An important aspect is that adhesion to the COVID-19 emergency was voluntary in 41.7% of cases of medical doctors.

In summary, this survey demonstrates the ability and readiness of endocrinology—in all its subspecialties diabetes, metabolism and andrology—to support our NHS bringing competence, dedication and sense of responsibility. Our response to COVID-19 is not only the best handling of endocrine patients [1-5] but also a large scale human resources mobilization that should be a source of pride for all Endocrinology Programs, Directors, Coordinators and all physicians and trainees who dedicate their lives to science and healthcare of our country.