A Houston-trained Doctor's Advice from a COVID-19 Hotspot in Italy

An immunologist describes the epidemic he has been facing in Milan.

By Dianna Wray April 9, 2020

Shutterstock Viacheslav Lopatin and Aleksey Boyko

Things have been looking increasingly surreal in Houston due to the coronavirus pandemic, but we wanted to get some insight from someone who is in the thick of it, which is why we talked with Dr. Marco Folci, an immunologist who trained in Houston and has been on the front lines of the epidemic in Milan.

Italy was the first country outside of Asia to grapple with the full impact of this virulent disease when the outbreak started in Bergamo, a small town near Milan, back in February. Since then more than 140,000 Italians have contracted COVID-19 and more than 18,000 have died. While Houstonians have been making progress in blunting the curve since Harris County started its stay-home order in March, Folci has shared some insight about how this disease could play out, ways Houstonians can help slow its spread, and some tips on the best ways to deal with being at home and the continuing uncertainty of the moment we are all living in.


You’re a former Houstonian. What brought you to the city, and what did you think of your time here?

I went to Houston in 2017 to conduct some research about inducing immune system against cancer at Methodist Research Institute managed by Professor Mauro Ferrari.

I think Houston, with its huge medical center, is an amazing place to live for a person interested in applied medical research like me. During my period, I discovered a piece of the United States with uncommon energy and large spaces. I shared time with Texans, their ways to work, live, and spend free time. I enjoyed every detail of your culture, every behavior, and every reaction to little and big events, from a Rockets match to the 4th of July. It was amazing to live there in Houston especially for a person who comes from a such different and little country like Italy. Houston gave me the opportunity to grow from different points of view. I met hundreds of interesting people, and I also had the chance to achieve a childhood dream: shake the hand of an astronaut! 

I understand you’re an immunologist dealing with the coronavirus at Humanitas in Milan. When did you begin to realize how serious the epidemic, which had one of its hotspots in nearby Bergamo, actually was?

We have been facing off with coronavirus since the mid-end of February. Everything about our life has changed in those days, from our job routine to our chance to be with our loved ones.

My colleagues and I from Milan were constantly in contact with our friends and our former university classmates who were working in Bergamo and Lodi, where the outbreak struck firstly. We were trying to understand the situation, to be ready for [what] they were fighting, and to be of help for them discussing clinical cases. We immediately understood the situation. The virus wave spreads fast; indeed, very soon it flooded over us. Our institution, Humanitas Research Hospital, reacted promptly based on what was occurring in Bergamo, replanning all the spaces and activities. Teams of doctors and nurses were rapidly trained on all safety measures needed, even on therapeutic protocols, as well as noninvasive ventilation.

The hospital adopted a step-by-step approach, gradually increasing the number of wards to treat COVID-19 and involving more and more doctors in mixed teams (clinicians and surgeons) to treat as [many] patients as possible. 

How long have you been in the thick of this pandemic?

I have been facing directly this emergency from the end of February.

You have been working directly with COVID-19 patients. What has that been like? What have you seen?

I think working with COVID-19 patients is a unique opportunity for a medical doctor to evolve. Honestly, I felt a mix of curiosity for an unknown disease and fear because we have to assist patients and be exposed to biological hazard and could fall ill ourselves. After the first weeks, all of us understood how [it] was difficult to face something without many guidelines or on-field experience. Furthermore, we were not aware how much physical endurance was necessary to assist patients in a “p3” environment.

What are some things that people in Houston need to know and understand about this disease?

The importance to respect the rules. It’s of pivotal importance to obey to every measure the authority wants to set up to face the emergency. Every person['s] action are a small but essential part of the global result. Some simple hints must become part of everyday habits. All of us have to work hard to change our behaviors, because only with the effort of everyone can we face this threat and get through this.

Has anything about this genuinely surprised or shocked you about dealing with this pandemic?

Yes, almost everything.

At first, when coronavirus was only a Chinese problem, I looked at it as a remote threat. When the outbreak hit Europe and especially my nation, everything changed. I felt a mix of emotions: fear for something unknown, the inappropriateness to be at the level of this challenge, my duty to treat and assist sick people, and anxiety to put your own life at risk, even if it is to do what you love. After the first days I was facing the disease, my interior vortex—the mix of feelings—changed into a sense of powerlessness and sorrow. We were overwhelmed and smacked by something unprecedented in recent history. However, all this suddenly turned into fuel for our interior engines, and every person working in health reacted to the situation by giving their best at every level, helping each other with full collaboration. I think the most important gift this terrible outbreak has offered us is the opportunity to share our real feelings and help everyone you have nearby you without any preconception or hesitation. We have the chance to embrace the best of people, and to offer our talents to society by working together—that is a gift.

How have you dealt with the emotional and psychological strain of all of this?

I was able to deal with all this by putting in action what I acquired during my experience as a volunteer in Africa with NGO (COE). Spending a lot of weeks in difficult situations (Democratic Republic of Congo, Cameroon) and sharing time, feelings, ideas, and problems with people then helped me to develop a sort of inner path to face troubles. Most importantly, I was trained by fantastic people to be calm and ready to face one problem at a time and proceeding constantly day by day. I have acted in this way with patients and colleagues, step by step, [while] we were trying to solve the puzzle of this disease.

As a medical doctor, I always try to be compassionate. I usually work hard to be a good doctor for patients, treating and relieving physical distress as well as giving support. I am used to [sharing] fears and concerns of every human being in a critical condition, even just with my presence and silence. We must be there, near those who suffer; it’s our mission.

What are some things Houstonians are doing right to protect themselves from the virus spreading the way it has in Italy?

I think Houston is doing well with all the measures of social distancing and the hand-washing campaign; however, I strongly encourage the application of all the preventions we did in Italy, following the previous examples of China as well as South Korea. Some of these are simple but effective, such as the use of surgical masks during all movements outside the house with the aim to protect uninfected people from asymptomatic ones. Disposable gloves when [buying] groceries, cleaning every package with an alcoholic solution before putting in place, as well as cleaning home and workplace (keyboard and mouse) surfaces. All those are simple actions, but effective ways to limit the spreading of the virus. (It is proved the virus can be infectious on plastic and metal surface till two and respectively three days).

When do you think we will be able to say that this is officially over?

This is a very difficult question. I am not able to estimate some terms because this pandemic event involves different areas of the world in different timeframes. Moreover, we haven’t yet understood the clues of this disease's pathological process. We have a lot of questions and we have hardly started working on answering them. However, I think we have a big chance: the chance to collaborate. The great hope is in the hands of the entire (scientific and not) world. 

What are some ways Houstonians can help themselves stay sane and calm during this outbreak? What have you done to help you deal with it?

I think Houstonians can do a lot for themselves, and for their fantastic city.

First of all, follow the rules of the authorities. Be precise and correct. Don’t underestimate dangers or symptoms. Read and study official communications on the virus and COVID-19 to be aware and ready in case you begin showing signs. Knowledge is the most powerful instrument we have to be calm and rational. It’s important to be organized and act as one real community, the city of Houston!

The last, but not the least, is find a way to distract yourself from the outbreak during lockdown. Read a book, watch a movie or TV series, use social networks to virtually meet your friends and your loved ones, and strengthen your hobbies (but only the ones permitted). Everyone needs some time off to recover and gain energy.

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