CONCLUSIONS
The Italian COVID-19 outbreak strained the National Health System of Northern Italy, especially in Lombardy. The hub-and-spoke system was an effective way to face the pandemic and to guarantee efficient treatment and implementation of cardiac and vascular procedures.
As can happen during a war, the pandemic caused by COVID-19 totally changed our habits and lifestyle, reducing self-confidence. Contrary to a war scenario, we had to fight against an invisible and totally unknown enemy, more dangerous and more lethal. After experiencing feelings of surprise, discomfort and unpreparedness, we rearranged the hospital system, sharing technological tools and ideas. Like a real war cabinet, we held daily and weekly briefings. A THT was set up through digital platforms. While respecting privacy, we shared a huge amount of on-line imaging and clinical data. The on-duty and on-call shifts were completely rearranged, creating a mixed team including spoke and hub surgeons. The newly nominated hub-and-spoke committee urgently approved new temporary guidelines, flow charts, new serological and diagnostic tests and pharmacological and surgical treatments. To prevent a system failure, a ‘COVID-19 backup shift’ was created: A spare shift, in case of a sick surgeon, according to military reservists, is always ‘ready for action’.
In a pandemic, the hub-and-spoke system is an effective way to guarantee access to cardiac and vascular surgical procedures. Further studies are needed to quantify the number of cardiovascular patients who died of SARS-CoV-2. At the end of the pandemic, with the resumption of elective procedures and a daily increase in surgical activities, further reorganization will be required.