The Impact of the SARS-CoV-2 Pandemic on Healthcare Provision in Italy to non-COVID Patients: a Systematic Review 

Gianmarco Lugli1,10,*, Matteo Maria Ottaviani2,10,*, Annarita Botta1,10,*, Guido Ascione3,10, Alessandro Bruschi4,10, Federico Cagnazzo5, Lorenzo Zammarchi1,6, Paola Romagnani7,8 and Tommaso Portaluri9,10.

Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
2 Department of Neurosurgery, University Politecnica delle Marche, Ancona, Italy.
3 Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy.
4 Rizzoli Orthopaedic Institute, University of Bologna, Bologna, Italy.
5 Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier University Medical Center, 80, Avenue Augustin Fliche, Montpellier, France.
6 Unit of Infectious and Tropical Disease, University Hospital Careggi, Florence, Italy.
7 Nephrology and Dialysis Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy.
8 Department of Biomedical Experimental and Clinical Sciences "Mario Serio," University of Florence, Florence, Italy.
9 IN Srl, Udine, Italy.
10 CEST Centre for Excellence and Transdisciplinary Studies, Turin, Italy.  
* These authors contributed equally to this work.

Correspondence to: Annarita Botta. Department of Experimental and Clinical Medicine, Infectious and Tropical Disease Unit, Careggi University Hospital, University of Florence. E-mail:      

Published: January 1, 2022
Received: October 18, 2021
Accepted: December 16, 2021
Mediterr J Hematol Infect Dis 2022, 14(1): e2022012 DOI 10.4084/MJHID.2022.012

This is an Open Access article distributed under the terms of the Creative Commons Attribution License
(, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background: Italy has been one of the countries most affected by the SARS-CoV-2 pandemic, and the regional healthcare system has had to quickly adapt its organization to meet the needs of infected patients. This has led to a drastic change in the routine management of non-communicable diseases with a potential long-term impact on patient health care. Therefore, we investigated the management of non-COVID-19 patients across all medical specialities in Italy.
Methods: A PRISMA guideline-based systematic review of the literature was performed using PubMed, Embase, and Scopus, restricting the search to the main outbreak period in Italy (from February 20 to June 25 2020). We selected articles in English or Italian that detailed changes in the Italian hospital care for non-COVID-19 patients due to the pandemic. Our keywords included all medical specialities combined with our geographical focus (Italy) and COVID-19.
Results: Of the 4643 potentially eligible studies identified by the search, 247 were included. A decrease in the management of emergencies in non-COVID patients was found together with an increase in mortality. Similarly, non-deferrable conditions met a tendency toward decreased diagnosis. All specialities have been affected by the re-organization of healthcare provision in the hub-and-spoke system and have benefited from telemedicine.
Conclusions: Our work highlights the changes in the Italian public healthcare system to tackle the developing health crisis due to the COVID-19 pandemic.The findings of our review may be useful to analyse future directions for the healthcare system in the case of new pandemic scenarios.


Since the first case of the novel coronavirus (COVID-19) was reported in Wuhan, China, in December 2019, a viral infection spread at an alarming rate worldwide. On January 30, 2020, the World Health Organization (WHO) described COVID-19 as a Public Health Emergency of International Concern, and by March 11, 2020, it was officially declared a pandemic.[1] Italy was the first European country to be affected by COVID-19, with the first case being diagnosed on February 20 in a man living in the province of Lodi (NorthWest Italy).[2] The epidemic went on to affect all regions in Italy, with higher incidence rates in the north. The peak of the COVID-19 epidemic in Italy was reached in the last week of March, with over 5500 new cases per day.
Since then, there has been a gradual decline due to strict containment measures that shaped the Italian lockdown phase. However, especially during the first phase of the epidemic, the outbreak put the Italian National Health System (Servizio Sanitario Nazionale, SSN) under unprecedented pressure.
In an attempt to direct the available resources at counteracting and limiting the effects of the pandemic, deferrable and non-urgent medical activities were suspended. On the other hand, patients with life-threatening conditions, such as myocardial infarction and stroke, or chronic conditions, such as diabetes, retained the right to their medical needs being met.
In these circumstances, several medical domains have been constrained by different resource allocations with unpredictable long-term consequences on patient health care.[3-5]
Here, we present a systematic review of the literature, which illustrates the direct and indirect effects of the COVID-19 pandemic on the management of non-COVID patients across all medical specialities.


This systematic review was performed in accordance with PRISMA guidelines.[6] The search was conducted on June 25 2020, on three databases: PubMed, Embase, and Scopus, without any date restriction. All the keywords were investigated within the title and abstract in both "AND" and "OR" combinations. Our keywords included all medical specialities (and potential synonyms) combined with our geographical focus (Italy or Italian) and COVID-19. The full search strategy is reported in Supplementary Material Table 1. Patients or the public were not involved in the design, or conduct, or reporting, or dissemination plans of our research.
Selection of the Studies. The literature search returned original papers published between 1979 and 2020 – especially for the keyword "coronavirus". Since our focus was the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the first positive case in Italy was detected on February 20, the literature search was restricted to the period from February 20 to June 25 2020. The databases were queried via an R script on their respective APIs, checked and cleaned for duplicates (via title, DOI and/or database id), and exported into Excel.
In the second stage, studies were selected based on their titles and abstracts: each study was independently evaluated by three different raters (AnB, GA, GL). When there was a lack of agreement among the screeners, ensemble majority voting was used for the final decision. The full texts of the selected papers were thus analyzed by two reviewers in terms of relevance and inclusion/exclusion criteria (MMO and GA). When these reviewers disagreed over the inclusion or exclusion of a paper, a third reviewer was responsible for the final decision (GL). In addition, the reference lists of selected papers were reviewed in order to find pertinent studies not identified during the initial search.
Inclusion and Exclusion Criteria. The simultaneous co-occurrence of the following characteristics was considered for the inclusion of articles: (i) articles focusing on the SARS-CoV-2 infection/COVID-19 disease; (ii) articles focusing on the impact on patients based in Italy or on the Italian hospital organization; (iii) articles detailing COVID-19-associated changes in the Italian hospital care for non-COVID-19 patients. All the investigated articles were published in English or Italian.
Type of Studies. Original papers, editorials, comments, research letters, case series, and studies focusing on non-COVID patients in Italy were included.
Data Extraction and Quality Assessment. Data were extracted from the papers by one of the investigators (TP) and were subsequently checked for accuracy by other reviewers (GL, AnB). Disagreements regarding data extraction among reviewers were solved by consensus. Extracted data included: type of medical specialty involved (surgical, medical, or public health), geographical location (north, south, centre or nationwide), type of patients (COVID/non-COVID), type of study (article or research letter/comment/editorial). Unfortunately, no quality assessment was possible as over 32% of entries were not articles but consisted of comments, research letters, opinions or editorials – for which no quality guidelines are available.
Investigated Outcomes. This systematic review investigated the impact of the COVID-19 pandemic on patients' healthcare provision and hospital organization in Italy since the day the country was put in lockdown.[7] Our primary goal was to identify potential short-term and long-term effects on the health of non-COVID patients. Our secondary goals were to identify: (i) organizational and/or clinical settings and decisions that were particularly effective (or counterproductive) during the pandemic; and (ii) similarities and differences across medical specialities and regional areas.


The results are shown in Figure 1. After searching the databases, we identified 4643 papers from three different databases. Database merges and the removal of duplicates resulted in 1262 records, of which 100 were immediately removed as they were not related to COVID-19 (articles published before the pandemic in Italy). A total of 1162 records were then screened: 166 were removed as not relevant to Italy; 534 were removed as they referred to COVID-19 patients rather than non-COVID-19 patients. A total of 247 were deemed eligible, of which 81 consisted of comments/letters/opinions/editorials.
Oncology and radiotherapy were the most represented category (47 papers), followed by surgery (24 for general surgery, 9 for neurosurgery, 2 for cardio-surgery, 2 for vascular surgery, and 3 other types), cardiology (19), and dermatology 14. There was one paper each for rheumatology and microbiology.

Figure 1 Figure 1

Overall, 133 papers were related to clinical disciplines, 89 to surgery, and 24 to services. In terms of geographical distribution, many papers provided general recommendations without a specific geographical identification (75). Lombardy was the most represented region (72), followed by Lazio (21) and Emilia Romagna (15). In the south, Campania was the most represented region (11), followed by Puglia (4). Marche, Piedmont and Friuli Venezia Giulia  had 7 papers each, Tuscany and Veneto 9 each. Overall, 73 were general/nationwide, 105 pertained to northern regions, 54 to central regions, and 15 to southern regions and islands. The studies included are reported in Supplementary Material Table 2.
Management of Emergencies. In general, non-COVID patients admitted to emergency departments (ED) decreased and remained well below the standard levels.[8-11] The youngest age classes declined dramatically, while the oldest age classes progressively increased, remaining considerably above the standard rate of the local ED.[12]
Table 1 shows the most relevant data regarding cardiovascular emergencies, including stroke. In northern Italy, the emergency gradually took over most cardiology intensive care units (ICUs).[13] As expected, the net effect of this re-organization was a significant reduction in sites and staff committed to the treatment of cardiovascular diseases. [14-18] Comparing out-of-hospital cardiac arrests in the same period of the previous year, Baldi et al. found that the median arrival time of the emergency medical service was three minutes longer in 2020, and the proportion of patients who received cardiopulmonary resuscitation from bystanders was 15.6% lower. Among patients in whom resuscitation was attempted by emergency medical services, the incidence of out-of-hospital death was 14.9% higher in 2020 than in 2019.[9] This finding was confirmed by additional studies highlighting an unpredictable decrease in acute coronary syndrome-related hospitalization in high-volume centres[10,19,20-21] and pacemaker implantation during the weeks following the COVID-19 outbreak.[21-25]

Table 1.1 Table 1. Management of deferrable conditions and telemedicine during COVID-19 pandemic in Italy. 
Table 1.2

Of note, one study showed a 49% reduction in acute heart failure admission to the hospital.[26] The patients admitted had longer door-to-balloon and symptoms to PCI times, higher hs-cTnI levels at presentation, lower residual left ventricular function at discharge, and higher predicted late cardiovascular mortality on the GRACE score.19
Two studies[11,27] also reported fewer patients with minor strokes and transient ischemic attacks (TIAs), longer onset-to-door and door-to-treatment times for major strokes, and reduced transfers from spokes centres. As a result, the number of patients who underwent intravenous thrombolysis or bridging therapy (combined intravenous and thrombectomy) decreased by − 26% and −30%, respectively.
In addition, as a consequence of the reduction in the patient eligibility for bridging therapy, the number of primary thrombectomies (performed with all the necessary personal protective equipment owing to the risk of infection)[28] increased by 41%. Most of these patients had very serious strokes that would have benefited from early diagnoses.[11]
The decrease in hospital admissions, confirmed by a survey across multiple countries, including Italy,[29,30] resulted in increased door-to-needle times and missed therapeutic windows for patients suffering from severe strokes.[31]
The reduction in available Intensive Care Units (ICU) beds, massively dedicated to COVID-19 patients with acute respiratory failure, and the fear of infection resulted in the shrinkage of surgical activities in all fields[32-36] and a reduction in urgent endoscopic procedures in COVID-free hospitals.[37]
Each sub-speciality defined various non- deferrable surgical procedures that had to be guaranteed, causing a drop in consultations requested by emergency departments, as in the case of urgent urology.[38] The surgical community also faced a shortage of blood components derived from fewer donations due to lockdown and fear of infection.[39] To compensate for the initial fall (−10%) in blood donations in the first week of March, the government promoted a national media campaign on the importance and safety of blood donation as a priority to maintain basic healthcare services for non-COVID patients.[40] No blood-transmitted SARS-CoV-2 infection has been reported to date.[41]
Children's emergency departments also showed a substantial decrease in visits,[42] and that might reflect the scarcity of resources or the reluctance of parents and health care workers to expose children to the risk of viral infection in a healthcare setting, in addition to lower rates of acute infections and trauma.[43] However, this phenomenon has been detrimental to the health of non-COVID child patients: 12 cases of delayed access to hospital care were reported during the week of March 23–27 across five hospitals of an Italian Children's Hospital Research Network. Half of the children were admitted to an ICU, and four died, highlighting the high risk of delaying access to hospital care.[44] As a result, life-threatening conditions (i.e. abdominal pain, severe ketoacidosis) seemed to be more frequent, requiring, in some cases, an aggressive approach.[43]
The same phenomenon affected dermatology.[45] Tartari et al. compared two different weeks, before and after the outbreak of the COVID-19 pandemic in Italy, showing a decrease in unjustified referrals (93% reduction) in dermatological emergency services.[46]
Despite medical care for emergencies and urgent treatments being continuously provided throughout the pandemic, the lack of personnel, resources, and ICUs beds and the patients' fear of being infected in hospital affected patient management and substantially delayed the provision of ordinary medical activities. These initial data seem to show a decrease in emergencies and an increase in mortality.
Management of Non-Deferrable Conditions: the Hub-and-Spoke System. To tackle the massive impact of the overflow of SARS-CoV-2 infected patients, hospitals in Italy had to undergo a significant re-organization.[47-52] In order to manage conditions needing non-deferrable treatment while avoiding the risk of infection, hub-and-spoke centres were created and widely used throughout the country.[48,53-56] In the hub-and-spoke model, the main campus or hub supplies the most intensive medical services, while satellite campuses or spokes offer more limited services at sites distributed across the neighbouring area.[57]
Neurological surgery was particularly affected by the ICU re-organization, as it often requires a period of intensive monitoring in ICUs.[22,58-60] All the cases of elective neurological surgery were deferred, while urgent neurosurgical pathologies (above all traumas) and non-deferrable tumour cases were transferred to hubs.[27,29-33,61-63]
Some minimal activities were still performed at spoke centres, only for critical cases or when specific tools were required (i.e. gamma knife treatment of neoplastic lesions).[64-67]
This provided an unprecedented opportunity for transversal collaboration among different teams, representing real innovation in such a competitive setting.[56,62]
A hub-and-spoke system was also organized for vascular surgery and cardiac surgery units. All elective surgery was reduced, and urgent surgery (including aortic aneurysms, valvular diseases or severe coronary diseases) was performed only in hub centres, preferring the endovascular to the open surgical approach whenever possible.[68-70] A transcatheter approach was generally preferred, as it usually does not require an ICU bed or a ventilator.[69]
The limitation of all non-urgent surgical activities also applied to general surgery[71-76] and obstetrics.[76,77] In highly-infected areas (such as Lombardy), hub centres were created[78] to treat only advanced symptomatic tumours,[78-80] while elective oncological surgery procedures continued to be performed in less-affected regions.[78,81] This was an important issue for oncological patients, especially the older ones.[82-85]
Many possible ways of minimizing the risks were proposed: to postpone treatments or elective surgery for stable cancer in endemic areas, provide patients with greater personal protection, and offer more intensive surveillance or treatment.[86-88] For example, neoadjuvant treatments were recommended or increased to defer surgical admission for as long as possible.[78,81,89-90] For other medical conditions requiring surgery under particular circumstances, such as relapse of inflammatory bowel disease, dedicated hubs were identified.[91-93]
Interestingly, a tendency toward treatments to reduce hospitalization was also found in medical oncology.[94,95]
Some regions such as Tuscany created home care protocols to avoid exposure to hospital settings.[96] Oncological care delivery and cancer diagnosis[97-99] were dramatically reduced by the SARS-CoV-2 outbreak, even though suboptimal care and treatments may result in worse cancer‐related outcomes. Oncologists were thus asked to preserve patients' continuum of care while adopting mitigation strategies to reduce the likelihood of infection in all cancer patients.[100-109]
Arduino et al. described a worrying delay in diagnosing oral cancer in northwest Italy during the Covid pandemic.[110] Moreover, the cessation of elective activities, screening programs,[111] and the drastic reduction in services regarding breast cancer restricted evaluations to only clinical observations of palpable lesions with the elevated risk of missing new diagnoses.[112] Although not requiring a structural re-organization, palliative care was forced to find a new balance between family member visits and patients' needs.[113-116]
In orthopaedics, the re-organization led to the identification of poly-specialist major trauma centres and specialistic referral centres for minor trauma or non-deferrable orthopaedic surgeries (i.e. septic arthritis or malignant tumours).[117-124] There was a reduction in the number of proximal femur fractures in two centres, as well as a reduction in hip and knee arthroplasties.[125,126]
A similar re-organization was also carried out for plastic surgery: only post-traumatic, oncological and burn treatments were guaranteed.[127-129] A new approach based on enzymatic debridement was proposed for burns to reduce the need for burn surgery.[130]
In urology, only urgent, non-deferrable procedures (colicky flank pain, gross hematuria and acute urinary retention) were authorized after careful multidisciplinary evaluation, which led to a drop in urological surgical activities.[131-136] Whenever possible, alternative treatments not requiring general anaesthesia (i.e. radiotherapy for genitourinary cancers) were suggested as preferable.[131,133,137]
Oral and maxillofacial surgery, otolaryngology, and ophthalmology also suspended all non-urgent treatments, especially considering healthcare workers' high risk of infection while manipulating the upper airways and eyes.[138-145] Only the treatment of trauma, malignant neoplasms, and severe infections was guaranteed.[139,146-149]
In the context of radiotherapy, all follow-up visits involved a phone call in advance in order to postpone non-urgent cases.[150-153] The initial consultations of patients needing treatment for malignant tumours were conducted as normal, as were certain treatments such as bone metastases radiotherapy.[154-157] Specific approaches, such as short fractionated radiotherapy, were suggested.[158]
All non-urgent and deferrable radiation treatments were delayed, while therapies for patients with better prognoses (benign and functional diseases) were postponed.[159,160]
Dermatology departments were also involved in an extensive re-organization.[161-162] Dermatological anti-neoplastic treatments were provided in the dermatology clinics of many centres, such as Bologna, Naples, Modena and Ancona, which also maintained urgent dermatological procedures and consultations required by other hospital wards.[163-166] As awareness of the severity of the COVID-19 increased, some patients were concerned about continuing their medications; however, all centres followed specific recommendations and advised patients not to suspend these drugs without consultation.[167-170]
Lastly, microbiology labs underwent unprecedentedly high workloads with the increasing number of samples (swabs or serological tests) to analyze for the identification of Sar-Cov-2 infection. An extensive re-organization of the microbiology lab activities thus also occurred. In a large teaching hospital in Rome, the introduction of night shifts and the creation of a dedicated team significantly improved the number of samples processed without interfering with the daily laboratory routines.[171]
Replacement Therapies: Dialysis and Transplantation. Dialysis units experienced a profound change in their management with the introduction of COVID-19 isolation rooms and the identification of dedicated healthcare professionals.[172,173] Rombolà et al. proposed three actions to be taken in order to dialyze non-COVID patients safely: hygiene measures, the use of PPE to protect patients and the healthcare team, and the protection of the dialysis ward with an isolated area for testing patients suspected of infection.[174]
In general, all transplant programs were profoundly affected by the pandemic.[175-177] First of all, the wall-to-wall screening of donors and recipients was established to identify positive patients who would not be able to donate or receive blood, in view of the high mortality rates COVID-19 in immunocompromised patients.[177-180] Secondly, the widespread reduction in available ICU beds led to an estimated 15% drop in transplants compared with the last five years' average, such as liver transplantations.[177,181] transplantation was thus suggested only in true end-stage organ failure, preferring conservative treatments (maximizing pharmacological therapy) in all other patients.[181-184]
Management of Deferrable Conditions and Telemedicine. The management of chronic conditions also suffered.[185] Cesari et al. found that the integration of care services collapsed: admissions to post-acute/long-term care facilities were reduced, and several person-tailored interventions were suspended – e.g., physical therapists for mobilization.[183] Lasevoli et al. reinforced the view that the current pandemic has had dramatic consequences for the mental health of serious psychiatric patients.[186] All this inevitably led to a drastic reduction and a substantial re-organization of the clinical activity in many specialities (Table 1), postponing elective treatments and switching to telemedicine (TM) for consultation or not to leave vulnerable high-need patients without proper follow-up.[187-188]
The implementation of TM occurred in different ways and to varying degrees depending on the specific centre and specialty. An online questionnaire administered to the 176 Directors of Italian Radiation Oncology Departments revealed that to guarantee the continuity of care, in 78 centres (62.4%) activated telematic consultations for RT treatments.[152] A similar survey for RT centres in the Lombardy region revealed that 84% of RT facilities cancelled out-patient follow-up visits, 68% activated telematic consultation and 30% adopted working from home solutions.[153] Another survey administered to 122 medical oncology departments homogeneously distributed on the national territory revealed that in 72% of cases, alternative ways to get in touch with patients had been used, like telephonic interviews with the interpretation of laboratory and radiologic examination reports. According to Pietrantonio et al., WhatsApp turned out to be adequate to give a rapid answer to most queries from oncologic patients.[105] Brunasso et al. started a teledermatology service in smart working using phone calls and e-mails by which they could monitor almost 94% of their patients.[189] In a Department of Urology in Northern Italy, 55% of cases were screened undergoing telephone consultation.[190]
TM has been shown to have beneficial impacts on heart failure outcomes in a comparative analysis between 2020 and 2019 by Salzano et al.[191] Finally, TM positively impacted patients' life as documented by a survey in which 85% of patients were satisfied with the remote interview modality and the reduction of economic and time costs related to going to the clinic. Most of those subjects (90%) expressed their willingness to continue to be included in remote evaluation programs.[192] Almost all specialities benefited from TM during the pandemic. The results are summarized in Table 1


On March 11 2020, the World Health Organisation (WHO) declared the COVID-19 pandemic.[1] However, Italy was already in lockdown, with decrees limiting mobility and strengthening the National Health System. On March 9, 2020, most outpatient services were temporarily suspended, except for a few treatments that were considered urgent and non-deferrable.[7] Clinical support for early isolation, treatment, and, where needed, intensive care of COVID-19 patients (or suspect cases) became the priority, with a massive allocation of dedicated resources.
A large increase in all-cause mortality was revealed during the epidemic, greater than the number of deaths attributed to COVID-19 cases. The possible causes of this increase include a large number of severe undiagnosed COVID-19 cases, reduced access to health services due to the disruption of normal working processes, or the fear of contamination of sick patients affected by other diseases and possibly other factors.[8]
We provided a snapshot, across all medical specialities, of how the provision of treatments to non-COVID patients in Italy has been impacted by the shortage of resources imposed by the pandemic.
Measures put in place to mitigate the outbreak, such as social distancing and confinement, contributed to discouraging access to the emergency department (E.D.) all over the country and those conditions requiring urgent care. As a result, there was a significant decrease in overall E.D. admissions and a substantial reduction in all-speciality surgical consultations.[9-11] More studies are needed to confirm these data and to evaluate the impact on death rates; however, recent reports from other countries seem to confirm this trend.[193,194] Cardiovascular emergencies paid significant tolls with a significant delay in time-sensitive emergency operations.[9-19] More recent evidence, consistent with our results, showed a significant decrease in the mean number of endovascular therapies per hospital performed before and after COVID-19 confinement along with a significant increase in mean stroke onset-to groin puncture time.[195] A delayed presentation of STEMI patients that may lead to worsened prognosis and unnecessary deaths has also been observed.[196] Moreover, an additional study confirmed that more in-hospital cardiovascular deaths occurred in March 2020 compared with March 2019, a finding due to late hospital presentations and consequent greater disease severity that affected eligibility and outcome of cardiovascular procedures[197]
As stated before, the hospitalisation system was remodelled to allocate appropriate resources to manage patients with COVID-19; consequently, hubs were identified for specialised medical activities. Hub-and-spoke centres represented an important change in care provision, especially in the most affected regions, involving almost all specialities. However, data on the efficacy of this reorganisation, measured in terms of health outcomes (such as mortality), are lacking. To date, only a few reports suggest a tendency toward a decrease in diagnosis for non-deferrable conditions despite the hub-and-spoke organisation.[98,100,111] Cautious and evidence-based studies are needed to properly assess the overall impact of this model on measurable outcomes. Nevertheless, the hub-and-spoke system seems to be a valid model, at least, in the management of ischemic emergencies.[198]
A pandemic is a dynamic scenario, requiring reorganisation and flexibility of healthcare delivery. T.M., which consists of distributing health-related services and information via telecommunication technologies, proved a pragmatic approach to managing deferrable conditions during the COVID-19 pandemic in Italy. Moreover, TM allows for more flexibility on the side of both the clinician and the patient, as consultations can easily be rescheduled, and meetings can be held from home.[199] Notably, when looking at the world scenario, T.M. is thought to play an important role in delivering digital health to the general population.[200]
Almost all specialities benefited from T.M. during the pandemic, with short-term results particularly encouraging in some cases. The pandemic has generally demonstrated that information technologies should be more promoted independently from this specific context.[153] However, a longer follow-up is needed to assess the efficacy of these measures on common health outcomes.[199-201] Avoiding face-to-face contact via T.M. has been one of the most effective measures to limit the spread of SARS-Cov-2 infection, although many issues have been raised, such as privacy management and the lack of clear guidelines.[202-206] We strongly encourage overcoming these limitations to promote further the multiple opportunities of T.M. in tune with its pivotal role during the second phase of the COVID-19 pandemic in Italy.[207] T.M. has deeply influenced non-COVID patient care, enabling the remote diagnosis and monitoring of patients and allowing clinical data sharing between patients and physicians.[208,209]
One limitation of this systematic review is the heterogeneity in publication type, which prevented the execution of a meta-analysis to summarise the findings together with a quality assessment. Another important issue is the potential underreporting, although the studies covered the whole country's experiences. Finally, while also providing a snapshot of the first modification during the pandemic, this work does not include more recent Italian studies.
Our work thus suggests that a public health crisis has resulted from the pandemic, a concern raised in other countries too, such as France and Denmark; indeed, a danish study demonstrated that mortality rates for patients admitted to hospitals with non-covid-19 diseases (such as respiratory disease, cancer, pneumonia and sepsis) were higher.[210,211] More detailed, nationwide population-based cohort studies are needed to assess whether emergency management benefited from the reorganisation adopted and evaluate hospital admissions and mortality rates for non-covid patients. Nevertheless, the system and telemedicine undoubtedly played – and continue to play – a crucial role in dealing with non-deferrable and deferrable conditions, respectively.


T.P. and G.L. conceived and designed the study. T.P. collected the data. G.L, M.M.O, An.B, G.A., Al.B. analysed and selected the data. F.C. and T.P. supervised data analysis. G.L, M.M.O., An.B, G.A., Al.B., T.P., wrote the manuscript. M.M.O. and An.B. revised and edited the manuscript. L.Z. and P.R. revised the final version of the manuscript.


All authors have completed the ICMJE uniform disclosure form at and declare: the work was supported by the Center for Excellence and Transdisciplinary Studies (CEST) and C.R.T. Foundation, Turin. The funder of the study had no role in the study design, data collection, data analysis, data interpretation, or writing the report; no financial relationships with any organisations that might have an interest in the submitted work; no other relationships or activities that could appear to have influenced the submitted work. All authors had full access to all study data and had final responsibility for the decision to submit for publication. The authors are thankful to Professor Paolo Vineis for his critical assistance in writing the paper.


  1. WHO Director-General’s opening remarks at the media briefing on COVID-19 - 11 March 2020.  (accessed June 20, 2020).
  2. Livingston E, Bucher K. Coronavirus Disease 2019 (COVID-19) in Italy. JAMA 2020; 323: 1335.
  3. Portnoy J, Waller M, Elliott T. Telemedicine in the Era of COVID-19. J allergy Clin Immunol Pract 2020; 8: 1489–91.
  4. Acheson RM. The definition and identification of need for health care. J Epidemiol Community Health 1978; 32: 10–5.
  5. Remuzzi A, Remuzzi G. COVID-19 and Italy: what next? Lancet 2020; 395: 1225–8.
  6. Moher D, Liberati A, Tetzlaff J, Altman DG, Group TP. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLOS Med 2009; 6: e1000097.
  7. *** ATTO COMPLETO ***.  (accessed June 20, 2020).
  8. Magnani C, Azzolina D, Gallo E, Ferrante D, Gregori D. How Large Was the Mortality Increase Directly and Indirectly Caused by the COVID-19  Epidemic? An Analysis on All-Causes Mortality Data in Italy. Int J Environ Res Public Health 2020; 17. HTTP://DX.DOI.ORG/10.3390/ijerph17103452
  9. Baldi E, Sechi GM, Mare C, et al. Out-of-Hospital Cardiac Arrest during the Covid-19 Outbreak in Italy. N Engl J Med 2020; published online April. HTTP://DX.DOI.ORG/10.1056/NEJMc2010418
  10. De Filippo O, D’Ascenzo F, Angelini F, et al. Reduced Rate of Hospital Admissions for ACS during Covid-19 Outbreak in Northern Italy. N Engl J Med 2020; NEJMc2009166.
  11. Baracchini C, Pieroni A, Viaro F, et al. Acute stroke management pathway during Coronavirus-19 pandemic. Neurol Sci 2020; 41: 1003–5.
  12. Comelli I, Scioscioli F, Cervellin G. Impact of the COVID-19 epidemic on census, organization and activity of a large urban Emergency Department. Acta Biomed 2020; 91: 45–9.
  13. Senni M. COVID-19 experience in Bergamo, Italy. Eur Heart J 2020; 41: 1783–4.
  14. Cosentino N, Assanelli E, Merlino L, Mazza M, Bartorelli AL, Marenzi G. An In-hospital Pathway for Acute Coronary Syndrome Patients During the COVID-19  Outbreak: Initial Experience Under Real-World Suboptimal Conditions. Can J Cardiol 2020; 36: 961–4.
  15. Stefanini GG, Azzolini E, Condorelli G. Critical Organizational Issues for Cardiologists in the COVID-19 Outbreak: A Frontline Experience from Milan, Italy. Circulation 2020; 1597–9.
  16. Agostoni P, Mapelli M, Conte E, et al. Cardiac patient care during a pandemic: how to reorganise a heart failure unit at  the time of COVID-19. Eur J Prev Cardiol 2020; 2047487320925632.
  17. Piepoli MF, Emdin M. A dialogue between the editor-in-chief and a deputy editor of a cardiology journal during the coronavirus outbreak: Take-home messages from the Italian experience. Eur J Prev Cardiol 2020; 27: 790–2.
  18. Mazzone P, Peretto G, Radinovic A, et al. The COVID-19 challenge to cardiac electrophysiologists: optimizing resources at a  referral center. J Interv Card Electrophysiol  an Int J  Arrhythm pacing 2020; : 1–7.
  19. Secco GG, Zocchi C, Parisi R, et al. Decrease and Delay in Hospitalization for Acute Coronary Syndromes During the 2020  SARS-CoV-2 Pandemic. Can J Cardiol 2020; published online May. HTTP://DX.DOI.ORG/10.1016/j.cjca.2020.05.023
  20. Franco F, Alessandro Z, Carlo C, et al. Impact of COVID-19 epidemic on coronary care unit accesses for acute coronary syndrome in Veneto region, Italy. Am Heart J 2020; 226: 26–8.
  21. Mauro T, Francesco N, Marco A, Marco M, Domenico F. Unpredictable Fall of Severe Emergent Cardiovascular Diseases Hospital Admissions During the COVID‐19 Pandemic: Experience of a Single Large Center in Northern Italy. J Am Heart Assoc 2020; 0: e017122.
  22. Cenzato M, DiMeco F, Fontanella M, Locatelli D, Servadei F. Editorial. Neurosurgery in the storm of COVID-19: suggestions from the Lombardy region, Italy (ex malo bonum). J. Neurosurg. 2020; 1–2.
  23. Federico M, Alessandro Z, Dario G, et al. Urgent Pacemaker Implantation Rates in the Veneto Region of Italy After the COVID-19 Outbreak. Circ Arrhythmia Electrophysiol 2020; 13: e008722.
  24. Migliore F, Zorzi A, Gregori D, et al. Urgent Pacemaker Implantation Rates in the Veneto Region of Italy After the COVID-19  Outbreak. Circ. Arrhythm. Electrophysiol. 2020; 13: e008722.
  25. De Rosa S, Spaccarotella C, Basso C, et al. Reduction of hospitalizations for myocardial infarction in Italy in the COVID-19 era. Eur Heart J 2020; 41. HTTP://DX.DOI.ORG/10.1093/eurheartj/ehaa409
  26. Colivicchi F, Di Fusco SA, Magnanti M, Cipriani M, Imperoli G. The Impact of the Coronavirus Disease-2019 Pandemic and Italian Lockdown Measures on  Clinical Presentation and Management of Acute Heart Failure. J. Card. Fail. 2020; published online May. HTTP://DX.DOI.ORG/10.1016/j.cardfail.2020.05.007
  27. Naccarato M, Scali I, Olivo S, et al. Has COVID-19 played an unexpected “stroke” on the chain of survival? J Neurol Sci 2020; 414: 116889.
  28. Nguyen TN, Abdalkader M, Jovin TG, et al. Mechanical Thrombectomy in the Era of the COVID-19 Pandemic: Emergency Preparedness for Neuroscience Teams: A Guidance Statement from the Society of Vascular and Interventional Neurology. Stroke 2020; 1896–901.
  29. Bersano A, Kraemer M, Touzé E, et al. Stroke care during the Covid-19 pandemic: Experience from three large European countries. Eur J Neurol 2020; n/a. HTTP://DX.DOI.ORG/10.1111/ene.14375
  30. Cofano F, Tartara F, Zenga F, Penner F, Lanotte M, Garbossa D. Letter: Back Pain and Accesses to Emergency Departments During COVID-19 Lockdown in  Italy. Neurosurgery 2020; published online May. HTTP://DX.DOI.ORG/10.1093/neuros/nyaa174
  31. Markus HS, Brainin M. COVID-19 and stroke—A global World Stroke Organization perspective. Int J Stroke 2020; 15: 361–4.
  32. Patriti A, Eugeni E, Guerra F. What happened to surgical emergencies in the era of COVID-19 outbreak?  Considerations of surgeons working in an Italian COVID-19 red zone. Updates Surg. 2020; 1–2.
  33. Lauro A, Pagano N, Impellizzeri G, Cervellera M, Tonini V. Emergency Endoscopy During the SARS-CoV-2 Pandemic in the North of Italy: Experience  from St. Orsola University Hospital-Bologna. Dig Dis Sci 2020; 65: 1559–61.
  34. Zheng MH, Boni L, Fingerhut A. Minimally Invasive Surgery and the Novel Coronavirus Outbreak: Lessons Learned in  China and Italy. Ann Surg 2020; 272: e5–6.
  35. Leva E, Morandi A, Sartori A, Macchini F, Berrettini A, Manzoni G. Correspondence from Northern Italy about our experience with COVID-19. J Pediatr Surg 2020; 55: 985–6.
  36. Patriti A, Baiocchi GL, Catena F, Marini P, Catarci M, FACS on behalf of the Associazione Chirurghi Ospedalieri Italiani (ACOI). Emergency general surgery in Italy during the COVID-19 outbreak: first survey from the real life. World J Emerg Surg 2020; 15: 36.
  37. D’Ovidio V, Lucidi C, Bruno G, Miglioresi L, Lisi D, Bazuro ME. A snapshot of urgent upper gastrointestinal endoscopy care during the Covid-19  outbreak in Italy. J Gastroenterol Hepatol 2020; published online June. HTTP://DX.DOI.ORG/10.1111/jgh.15132
  38. Motterle G, Morlacco A, Iafrate M, et al. The impact of COVID-19 pandemic on urological emergencies: a single-center  experience. World J Urol 2020; : 1–5.
  39. Grandone E, Mastroianno M, Caroli A, Ostuni A. Blood supply and transfusion support in southern Italy: findings during the first  four weeks of the SARS-CoV-2 pandemic. Blood Transfus 2020; 18: 230–2.
  40. Mascaretti L, De Angelis V, Berti P. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and Transfusion Medicine: reflections from Italy. Blood Transfus. 2020; 18: 77–8.
  41. Franchini M, Farrugia A, Velati C, et al. The impact of the SARS-CoV-2 outbreak on the safety and availability of blood transfusions in Italy. Vox Sang 2020; published online April. HTTP://DX.DOI.ORG/10.1111/vox.12928
  42. Pata D, Gatto A, Buonsenso D, Chiaretti A. A COVID-19 outbreak’s lesson: Best use of the paediatric emergency department. Acta Paediatr; n/a. HTTP://DX.DOI.ORG/10.1111/apa.15386
  43. Cognigni M. An Italian paediatric department at the time of Coronavirus: a resident’s point of view. Arch. Dis. Child. 2020; published online April. HTTP://DX.DOI.ORG/10.1136/archdischild-2020-319299
  44. Lazzerini M, Barbi E, Apicella A, Marchetti F, Cardinale F, Trobia G. Delayed access or provision of care in Italy resulting from fear of COVID-19. Lancet. Child Adolesc. Heal. 2020; 4: e10--e11.
  45. Giacalone S, Bortoluzzi P, Nazzaro G. Which are the “emergent” dermatologic practices during COVID-19 pandemic? Report from the lockdown in Milan, Italy. Int J Dermatol; n/a. HTTP://DX.DOI.ORG/10.1111/ijd.15005
  46. Tartari F, Guglielmo A, Fuligni F, Pileri A. Changes in emergency service access after spread of COVID-19 across Italy. J. Eur. Acad. Dermatol. Venereol. 2020; published online April. HTTP://DX.DOI.ORG/10.1111/jdv.16553
  47. Gagliano A, Villani PG, Cò FM, et al. 2019-ncov’s epidemic in middle province of northern Italy: Impact, logistic & strategy in the first line hospital. Disaster Med Public Health Prep 2020; 1–5.
  48. Ferrazzi EM, Frigerio L, Cetin I, et al. COVID-19 Obstetrics Task Force, Lombardy, Italy: Executive management summary and  short report of outcome. Int J Gynaecol Obstet Off organ  Int Fed Gynaecol Obstet 2020; 149: 377–8.
  49. Baggiani A, Briani S, Luchini G, et al. Management of healthcare areas for the prevention of COVID-19 emergency in an  Italian teaching hospital (Pisa, Tuscany): A hospital renovation plan. Infect Control Hosp Epidemiol 2020; 1–6.
  50. Carenzo L, Costantini E, Greco M, et al. Hospital surge capacity in a tertiary emergency referral centre during the COVID-19  outbreak in Italy. Anaesthesia 2020; 75: 928–34.
  51. Meschi T, Rossi S, Volpi A, et al. Reorganization of a large academic hospital to face COVID-19 outbreak: The model of  Parma, Emilia-Romagna region, Italy. Eur. J. Clin. Invest. 2020; 50: e13250.
  52. Mariani NM, Pisani Ceretti A, Fedele V, et al. Surgical Strategy During the COVID-19 Pandemic in a University Metropolitan Hospital  in Milan, Italy. World J Surg 2020; 1–6.
  53. Ghio S, Ferlini M, Scelsi L, et al. La pandemia COVID-19: Riorganizzazione della Cardiologia in un ospedale della Regione Lombardia. G Ital Cardiol 2020; 21: 358–9.
  54. Villa E, Saccocci M, Messina A, et al. COVID-19 e coronaropatia: Uso selettivo e collaborativo delle risorse durante le crisi sanitarie. G Ital Cardiol 2020; 21: 360–3.
  55. Chisci E, Masciello F, Michelagnoli S. The Italian USL Toscana Centro model of a vascular hub responding to the COVID-19 emergency. J Vasc Surg 2020; 72: 8–11.
  56. Zangrillo A, Beretta L, Silvani P, et al. Fast reshaping of intensive care unit facilities in a large metropolitan hospital in Milan, Italy: facing the COVID-19 pandemic emergency. Crit Care Resusc 2020; published online April.
  57. Elrod JK, Fortenberry JLJ. The hub-and-spoke organization design revisited: a lifeline for rural hospitals. BMC Health Serv Res 2017; 17: 795.
  58. Zoia C, Bongetta D, Veiceschi P, et al. Neurosurgery during the COVID-19 pandemic: update from Lombardy, northern Italy. Acta Neurochir (Wien) 2020; 162: 1221–2.
  59. Fontanella MM, Maria L De, Zanin L, et al. Neurosurgical Practice During the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Pandemic: A Worldwide Survey. World Neurosurg 2020; 2: 1–9.
  60. Fontanella MM, Saraceno G, Lei T, et al. Neurosurgical activity during COVID-19 pandemic: an expert opinion from China, South Korea, Italy, United Stated of America, Colombia and United Kingdom. J Neurosurg Sci 2020. HTTP://DX.DOI.ORG/10.23736/S0390-5616.20.04994-2
  61. Bernucci C, Brembilla C, Veiceschi P. Effects of the COVID-19 Outbreak in Northern Italy: Perspectives from the Bergamo Neurosurgery Department. World Neurosurg 2020; 137: 465--468.e1.
  62. Dobran M, Paracino R, Iacoangeli M. Letter to the editor by Dobran Mauro, Paracino Riccardo, and Iacoangeli Maurizio regarding ‘Neurosurgery during the COVID-19 pandemic: update from Lombardy, northern Italy.’ Zoia C, Bongetta D, Veiceschi P, Cenzato M, Di Meco F, Locatelli D, Boeris D, Fo. Acta Neurochir. (Wien). 2020; 162: 1223–4.
  63. Giorgi PD, Villa F, Gallazzi E, et al. The management of emergency spinal surgery during the COVID-19 pandemic in Italy. Bone Joint J 2020; 102-B: 671–6.
  64. Levi V, Risso A, Egidi M. Letter : The Resiliency of the Neurosurgeon in the Midst of COVID-19 Pandemic Storm : The Italian Experience From the Frontline. 2020; 0: 2019–20.
  65. Castelnuovo P, Turri-Zanoni M, Karligkiotis A, et al. Skull-base surgery during the COVID-19 pandemic: the Italian Skull Base Society  recommendations. Int Forum Allergy Rhinol 2020; published online April. HTTP://DX.DOI.ORG/10.1002/alr.22596
  66. Mazzatenta D, Zoli M, Cavallo MA, et al. Remodulation of neurosurgical activities in an Italian region (Emilia-Romagna) under COVID- 19 emergency: maintaining the standard of care during the crisis. J Neurosurg Sci 2020. HTTP://DX.DOI.ORG/10.23736/s0390-5616.20.05018-3
  67. Franzin A, Spatola G, Giudice L, Migliorati K, Vivaldi O, Giorgi C. Maintaining stereotactic radiosurgical treatments during Covid-19 outbreak: the case of the Gamma Knife Unit in Brescia - Italy. Br. J. Neurosurg. 2020; 1–2.
  68. Mangialardi ML, Orrico M, Mangialardi N. Routine in an Italian High-Volume Vascular Surgery Unit during the COVID-19 Era: How  the Pandemic Changed the Vascular Daily Practice. Ann. Vasc. Surg. 2020; 66: 6–7.
  69. Bonalumi G, di Mauro M, Garatti A, et al. The COVID-19 outbreak and its impact on hospitals in Italy: the model of cardiac surgery. Eur J Cardiothorac Surg 2020; 57: 1025–8.
  70. Bonalumi G, Di Mauro M, Garatti A, Barili F, Parolari A, Gerosa G. [COVID-19 outbreak and Cardiac Surgery: position paper from the COVID-SICCH Task  Force of the Italian Society for Cardiac Surgery]. G Ital Cardiol (Rome) 2020; 21: 396–400.
  71. Kurihara H, Bisagni P, Faccincani R, Zago M. COVID-19 outbreak in Northern Italy: Viewpoint of the Milan area surgical community. J Trauma Acute Care Surg 2020; 88: 719–24.
  72. Duci M, Antoniello LM, Trovalusci E, Tognon C, Gamba P. Pediatric endoscopic procedures during the COVID-19 pandemic: an Italian center experience. Pediatr Surg Int 2020; 36: 853–4.
  73. Torzilli G, Vigano L, Galvanin J, et al. A Snapshot of Elective Oncological Surgery in Italy During COVID-19 Emergency:  Pearls, Pitfalls, and Perspectives. Ann Surg 2020; published online May. HTTP://DX.DOI.ORG/10.1097/SLA.0000000000004081
  74. Navarra G, Komaei I, Currò G, et al. Bariatric surgery and the COVID-19 pandemic: SICOB recommendations on how to perform  surgery during the outbreak and when to resume the activities in phase 2 of lockdown. Updates Surg 2020; : 1–10.
  75. Repici A, Maselli R, Colombo M, et al. Coronavirus (COVID-19) outbreak: what the department of endoscopy should know. Gastrointest Endosc 2020; 1–6.
  76. Capanna F, Haydar A, McCarey C, et al. Preparing an obstetric unit in the heart of the epidemic strike of COVID-19: quick  reorganization tips. J Matern neonatal Med  Off J  Eur Assoc Perinat Med Fed Asia Ocean Perinat Soc Int Soc Perinat Obstet 2020; 1–7.
  77. Giannubilo SR, Giannella L, Delli Carpini G, Carnielli VP, Ciavattini A. Obstetric network reorganization during the COVID-19 pandemic: Suggestions from an  Italian regional model. Eur. J. Obstet. Gynecol. Reprod. Biol. 2020; 249: 103–5.
  78. Di Saverio S, Pata F, Gallo G, et al. Coronavirus pandemic and colorectal surgery: practical advice based on the Italian experience. Colorectal Dis 2020; 22: 625–34.
  79. Di Saverio S, Khan M, Pata F, et al. Laparoscopy at all costs? Not now during COVID-19 outbreak and not for acute care surgery and emergency colorectal surgery: A practical algorithm from a hub tertiary teaching hospital in Northern Lombardy, Italy. J Trauma Acute Care Surg 2020; 88: 715–8.
  80. Vicini E, Galimberti V, Naninato P, Vento AR, Ribeiro Fontana SK, Veronesi P. COVID-19: The European institute of oncology as a ‘hub’ centre for breast cancer  surgery during the pandemic in Milan (Lombardy region, northern Italy) - A screenshot of the first month. Eur. J. Surg. Oncol.  J. Eur. Soc.  Surg. Oncol. Br. Assoc. Surg. Oncol. 2020; 46: 1180–1.
  81. Gallo G, La Torre M, Pietroletti R, et al. Italian society of colorectal surgery recommendations for good clinical practice in colorectal surgery during the novel coronavirus pandemic. Tech Coloproctol 2020; 24: 501–5.
  82. Ingenito C, Buonerba L, Ferrara C, et al. Coronavirus Disease 2019 Emergency and Cancer in the South of Italy: What’s New for the Oncologist? Front Med 2020; 7: 189.
  83. Fratino L, Procopio G, Di Maio M, Cinieri S, Leo S, Beretta G. Coronavirus: Older Persons With Cancer in Italy in the COVID-19 Pandemic. Front Oncol 2020; 10: 648.
  84. Marano L, Marrelli D, Roviello F. Cancer care under the outbreak of COVID-19: A perspective from Italian tertiary  referral center for surgical oncology. Eur. J. Surg. Oncol.  J. Eur. Soc.  Surg. Oncol. Br. Assoc. Surg. Oncol. 2020; 46: 1184–5.
  85. Lombardi CP, D’Amore A, Grani G, et al. Endocrine surgery during COVID-19 pandemic: do we need an update of indications in Italy? Endocrine 2020; 68: 485–8.
  86. Lambertini M, Toss A, Passaro A, et al. Cancer care during the spread of coronavirus disease 2019 (COVID-19) in Italy: Young oncologists’ perspective. ESMO Open 2020; 5. HTTP://DX.DOI.ORG/10.1136/esmoopen-2020-000759
  87. Quaglino P, Fava P, Brizio M, et al. Metastatic melanoma treatment with checkpoint inhibitors in the COVID-19 era:  experience from an Italian Skin Cancer Unit. J Eur Acad Dermatol Venereol 2020; published online May. HTTP://DX.DOI.ORG/10.1111/jdv.16586
  88. Pietrantonio F, Garassino MC. Caring for Patients With Cancer During the COVID-19 Outbreak in Italy. JAMA Oncol 2020; 6: 821–2.
  89. Mandato VD, Aguzzoli L. Management of ovarian cancer during the COVID-19 pandemic. Int J Gynecol Obstet 2020; 149: 382–3.
  90. Perrone A, Palma A, De Iaco P. COVID-19 global pandemic: options for management of gynecologic cancers. The experience in surgical management of ovarian cancer in the second highest affected Italian region. Int J Gynecol Cancer 2020; 30: ijgc-2020.
  91. Allocca M, Fiorino G, Furfaro F, et al. Maintaining the Quality Standards of Care for Inflammatory Bowel Disease Patients  During the COVID-19 Pandemic. Clin Gastroenterol Hepatol  Off Clin Pract J  Am Gastroenterol Assoc 2020; 18: 1882–3.
  92. Occhipinti V, Pastorelli L. Challenges in the Care of IBD Patients During the CoViD-19 Pandemic: Report From a “Red Zone” Area in Northern Italy. Inflamm Bowel Dis 2020; 26: 793–6.
  93. Maida M, Sferrazza S, Savarino E, et al. ‘Impact of the COVID-19 pandemic on Gastroenterology Divisions in Italy: a national  survey’. Dig liver Dis  Off J Ital Soc  Gastroenterol Ital Assoc Study Liver 2020; published online May. HTTP://DX.DOI.ORG/10.1016/j.dld.2020.05.017
  94. Rossi D. Metronomic oral vinorelbine and lung cancer therapy during the COVID 19 pandemic: A  single-center experience. Lung Cancer 2020; 145: 83–4.
  95. de Marinis F, Attili I, Morganti S, et al. Results of Multilevel Containment Measures to Better Protect Lung Cancer Patients  From COVID-19: The IEO Model. Front Oncol 2020; 10: 665.
  96. Porzio G, Cortellini A, Bruera E, et al. Home Care for Cancer Patients During COVID-19 Pandemic: The Double Triage Protocol. J Pain Symptom Manage 2020; 60: e5-7.
  97. De Vincentiis L, Carr RA, Mariani MP, Ferrara G. Cancer diagnostic rates during the 2020 ‘lockdown’, due to COVID-19 pandemic, compared with the 2018-2019: an audit study from cellular pathology. J Clin Pathol 2020; published online June. HTTP://DX.DOI.ORG/10.1136/jclinpath-2020-206833
  98. Cuneo A, Scarfo L, Reda G, et al. CHRONIC LYMPHOCYTIC LEUKEMIA MANAGEMENT IN ITALY DURING THE COVID-19 PANDEMIC. A CAMPUS CLL REPORT. Blood 2020; published online June 19. HTTP://DX.DOI.ORG/10.1182/blood.2020006854
  99. Ferrari A, Zecca M, Rizzari C, et al. Children with cancer in the time of COVID-19: An 8-week report from the six  pediatric onco-hematology centers in Lombardia, Italy. Pediatr. Blood Cancer. 2020; e28410.
  100. Bongiovanni A, Mercatali L, Fausti V, Ibrahim T. Comment on ‘Reorganisation of medical oncology departments during the novel  coronavirus disease-19 pandemic: A nationwide Italian survey’ by Alice Indini et al. Eur. J. Cancer. 2020; 134: 3–5.
  101. Brandes AA, Ardizzoni A, Artioli F, et al. Fighting cancer in coronavirus disease era: organization of work in medical oncology  departments in Emilia Romagna region of Italy. Future Oncol 2020; published online May. HTTP://DX.DOI.ORG/10.2217/fon-2020-0358
  102. Tagliamento M, Spagnolo F, Poggio F, et al. Italian survey on managing immune checkpoint inhibitors in oncology during COVID-19 outbreak. Eur J Clin Invest 2020; n/a: e13315.
  103. Mistretta FA, Luzzago S, Molendini LO, et al. A Guide for Oncologic Patient Management during Covid-19 Pandemic: The Initial  Experience of an Italian Oncologic Hub with Exemplificative Focus on Uro-Oncologic Patients. Cancers (Basel) 2020; 12. HTTP://DX.DOI.ORG/10.3390/cancers12061513
  104. Omarini C, Maur M, Luppi G, et al. Cancer treatment during the coronavirus disease 2019 pandemic: Do not postpone, do  it! Eur J Cancer 2020; 133: 29–32.
  105. Pietrantonio F, Morano F, Niger M, et al. Systemic Treatment of Patients With Gastrointestinal Cancers During the COVID-19 Outbreak: COVID-19-adapted Recommendations of the National Cancer Institute of Milan. Clin Colorectal Cancer 2020. HTTP://DX.DOI.ORG/10.1016/j.clcc.2020.05.004
  106. Pellino G, Spinelli A. How coronavirus disease 2019 outbreak is impacting colorectal cancer patients in Italy: A long shadow beyond infection. Dis Colon Rectum 2020; 63: 720–2.
  107. Marandino L, Di Maio M, Procopio G, Cinieri S, Beretta GD, Necchi A. The Shifting Landscape of Genitourinary Oncology During the COVID-19 Pandemic and  how Italian Oncologists Reacted: Results from a National Survey. Eur. Urol. 2020; published online April. HTTP://DX.DOI.ORG/10.1016/j.eururo.2020.04.004
  108. Indini A, Aschele C, Cavanna L, et al. Reorganisation of medical oncology departments during the novel coronavirus disease-19 pandemic: a nationwide Italian survey. Eur J Cancer 2020; 132: 17–23.
  109. Silvestris N, Moschetta A, Paradiso A, Delvino A. COVID-19 Pandemic and the Crisis of Health Systems: The Experience of the Apulia  Cancer Network and of the Comprehensive Cancer Center Istituto Tumori ‘Giovanni Paolo II’ of Bari. Int J Environ Res Public Health 2020; 17. HTTP://DX.DOI.ORG/10.3390/ijerph17082763
  110. Arduino PG, Conrotto D, Broccoletti R. The outbreak of Novel Coronavirus disease (COVID-19) caused a worrying delay in the  diagnosis of oral cancer in north-west Italy: The Turin Metropolitan Area experience. Oral Dis. 2020; published online April. HTTP://DX.DOI.ORG/10.1111/odi.13362
  111. Minucci A, Scambia G, Santonocito C, Concolino P, Urbani A. BRCA testing in a genomic diagnostics referral center during the COVID-19 pandemic. Mol Biol Rep 2020; 1–4.
  112. Vanni G, Pellicciaro M, Materazzo M, Palombi L, Buonomo OC. Breast Cancer Diagnosis in Coronavirus-Era: Alert From Italy. Front Oncol 2020; 10: 938.
  113. Mercadante S, Adile C, Ferrera P, Giuliana F. Palliative Care in the Time of COVID-19. J Pain Symptom Manage 2020; : 4–5.
  114. Etkind SN, Bone AE, Lovell N, et al. The Role and Response of Palliative Care and Hospice Services in Epidemics and  Pandemics: A Rapid Review to Inform Practice During the COVID-19 Pandemic. J Pain Symptom Manage 2020; 60: e31-40.
  115. Costantini M, Sleeman KE, Peruselli C, Higginson IJ. Response and role of palliative care during the COVID-19 pandemic: A national  telephone survey of hospices in Italy. Palliat Med 2020; 269216320920780.
  116. Lazzarin P, Avagnina I, Divisic A, Agosto C, Giacomelli L, Benini F. Management strategies adopted by a pediatric palliative care network in northern Italy during the COVID-19 pandemic. Acta Paediatr 2020; n/a. HTTP://DX.DOI.ORG/10.1111/apa.15411
  117. Zagra L, Faraldi M, Pregliasco F, et al. Changes of clinical activities in an orthopaedic institute in North Italy during the spread of COVID-19 pandemic: a seven-week observational analysis. Int Orthop 2020. HTTP://DX.DOI.ORG/10.1007/s00264-020-04590-1
  118. Randelli PS, Compagnoni R. Management of orthopaedic and traumatology patients during the Coronavirus disease (COVID-19) pandemic in northern Italy. Knee Surg Sports Traumatol Arthrosc 2020; 28: 1683–9.
  119. Casiraghi A, Domenicucci M, Cattaneo S, et al. Operational strategies of a trauma hub in early coronavirus disease 2019 pandemic. Int Orthop 2020. HTTP://DX.DOI.ORG/10.1007/s00264-020-04635-5.
  120. Placella G, Salvato D, Delmastro E, Bettinelli G, Salini V. CoViD-19 and ortho and trauma surgery: The Italian experience. Injury 2020; 51: 1403–5.
  121. Di Martino A, Faldini C. Trauma service reorganization in Bologna (Italy) during COVID-19 pandemic. Injury. 2020; 51: 1684.
  122. Maniscalco P, Poggiali E, Quattrini F, et al. The deep impact of novel CoVID-19 infection in an Orthopedics and Traumatology Department: the experience of the Piacenza Hospital. Acta Biomed 2020; 91: 97–105.
  123. Bettinelli G, Delmastro E, Salvato D, Salini V, Placella G. Orthopaedic patient work fl ow in CoViD-19 pandemic in Italy. J Orthop 2020; 22: 158–9.
  124. Grassi A, Pizza N, Tedesco D, Zaffagnini S. The COVID-19 outbreak in Italy: perspectives from an orthopaedic hospital. Int Orthop 2020; 1–5.
  125. Maniscalco P, Poggiali E, Quattrini F, et al. Proximal femur fractures in COVID-19 emergency: the experience of two Orthopedics  and Traumatology Departments in the first eight weeks of the Italian epidemic. Acta Biomed 2020; 91: 89–96.
  126. D’Apolito R, Faraldi M, Ottaiano I, Zagra L. Disruption of Arthroplasty Practice in an Orthopedic Center in Northern Italy During  the Coronavirus Disease 2019 Pandemic. J Arthroplasty 2020; 35: S6-9.
  127. Facchin F, Messana F, Sonda R, Faccio D, Tiengo C, Bassetto F. COVID-19: Initial experience of hand surgeons in Northern Italy. Hand Surg. Rehabil. 2020; published online May. HTTP://DX.DOI.ORG/10.1016/j.hansur.2020.04.007
  128. Scalise A, Torresetti M, Di Benedetto G. Wound Healing Center: Analysis of preventive measures and new indications in a teaching hospital in central Italy during the Covid-19 emergency. Int Wound J; n/a. HTTP://DX.DOI.ORG/10.1111/iwj.13430
  129. Pignatti M, Pinto V, Miralles MEL, Giorgini FA, Cannamela G, Cipriani R. How the COVID-19 pandemic changed the Plastic Surgery activity in a regional referral center in Northern Italy. J Plast Reconstr Aesthetic Surg 2020; : 1–9.
  130. Ranno R, Vestita M, Verrienti P, et al. The role of enzymatic debridement in burn care in the COVID-19 pandemic . Commentary by the Italian Society of Burn Surgery ( SIUST ). Burns 2020; : 2019–20.
  131. Ficarra V, Novara G, Abrate A, et al. Urology practice during COVID-19 pandemic. Minerva Urol Nefrol 2020; published online March. HTTP://DX.DOI.ORG/10.23736/S0393-2249.20.03846-1
  132. Novara G, Bartoletti R, Crestani A, et al. Impact of the COVID-19 pandemic on urological practice in emergency departments in  Italy. BJU Int 2020; published online May. HTTP://DX.DOI.ORG/10.1111/bju.15107
  133. Simonato A, Giannarini G, Abrate A, et al. Pathways for urology patients during the COVID-19 pandemic. Minerva Urol Nefrol 2020; published online March. HTTP://DX.DOI.ORG/10.23736/S0393-2249.20.03861-8
  134. Luciani LG, Mattevi D, Giusti G, et al. Guess Who’s Coming to Dinner: COVID-19 in a COVID-free Unit. Urology 2020; published online May. HTTP://DX.DOI.ORG/10.1016/j.urology.2020.05.011
  135. Cini C, Bortot G, Sforza S, et al. Paediatric urology practice during COVID-19 pandemic. J Pediatr Urol 2020; 16: 295–6.
  136. Rocco B, Sighinolfi MC, Sandri M, et al. The dramatic COVID-19 outbreak in italy is responsible of a huge drop in urological surgical activity: A multicenter observational study. BJU Int 2020; n/a. HTTP://DX.DOI.ORG/10.1111/bju.15149
  137. Campi RR, Amparore D. Letter to the Editor. Eur Urol 2020; 9–10.
  138. Allevi F, Dionisio A, Baciliero U, et al. Impact of COVID-19 epidemic on maxillofacial surgery in Italy. Br J Oral Maxillofac Surg 2020; published online May. HTTP://DX.DOI.ORG/10.1016/j.bjoms.2020.04.035
  139. De Bernardi F, Turri-Zanoni M, Battaglia P, Castelnuovo P. How to Reorganize an Ear, Nose, and Throat Outpatient Service During the COVID-19  Outbreak: Report From Northern Italy. Laryngoscope 2020; published online May. HTTP://DX.DOI.ORG/10.1002/lary.28716
  140. Ralli M, Minni A, Candelori F, Cialente F, Greco A, de Vincentiis M. Effects of COVID-19 Pandemic on Otolaryngology Surgery in Italy: The Experience of Our University Hospital. Otolaryngol Neck Surg 2020; 0194599820928970.
  141. Veritti D, Sarao V, Bandello F, Lanzetta P. Infection control measures in ophthalmology during the COVID-19 outbreak: A narrative review from an early experience in Italy. Eur J Ophthalmol 2020. HTTP://DX.DOI.ORG/10.1177/1120672120927865
  142. Arrigo A, Aragona E, Parodi MB, Loperfido F, Bandello F. Ophthalmology and SARS-CoV-2: Blind toward those who fight blindness? Eur J Ophthalmol 2020; 1120672120929961.
  143. Tognetto D, Pastore MR, De Giacinto C, et al. Managing ophthalmic practices in a referral emergency COVID-19 hospital in north-east Italy. Acta Ophthalmol 2020; n/a. HTTP://DX.DOI.ORG/10.1111/aos.14488
  144. Lanni V, Iuliano A, Laezza MP, Uccello G, Tranfa F, Strianese D. Oculoplastic management of patients in the Covid-19 era: experience from an Italian tertiary referral center. Orbit 2020; 1–3.
  145. Parravano M, Borrelli E, Costanzo E, Sacconi R, Varano M, Querques G. Protect Healthcare Workers and Patients from COVID-19: The Experience of Two  Tertiary Ophthalmology Care Referral Centers in Italy. Ophthalmol Ther 2020; 9: 231–4.
  146. Barca I, Cordaro R, Kallaverja E, Ferragina F, Cristofaro MG. Management in oral and maxillofacial surgery during the COVID-19 pandemic: Our experience. Br J Oral Maxillofac Surg 2020; S0266--4356(20)30177--7.
  147. Galli J, Settimi S, Tricarico L, Almadori G, Paludetti G. Clinical and surgical management of patients with head and neck cancer in a COVID-19  dedicated center in Italy. Head Neck 2020; published online June. HTTP://DX.DOI.ORG/10.1002/hed.26263
  148. Saibene AM, Allevi F, Biglioli F, Felisati G. Role and Management of a Head and Neck Department during the COVID-19 Outbreak in Lombardy. Otolaryngol Neck Surg 2020; 162: 795–6.
  149. Riva G, Pizzo C, Fassone E, Pecorari G. Head and neck cancer surgery in COVID-19 pandemic in Northern Italy. Oral Oncol 2020; 104835.
  150. Pezzulla D, Macchia G, Taccari F, Sticca G, Deodato F. Radiotherapy in Southern Italy at the time of COVID-19: options for radiation  oncology units. Int. J. Gynecol. cancer  Off. J.  Int. Gynecol. Cancer Soc. 2020; published online May. HTTP://DX.DOI.ORG/10.1136/ijgc-2020-001523
  151. Montesi G, Di Biase S, Chierchini S, et al. Radiotherapy during COVID-19 pandemic. How to create a No fly zone: a Northern Italy  experience. Radiol Med 2020; 125: 600–3.
  152. Jereczek-fossa BA, Pepa M, Marvaso G, et al. COVID-19 outbreak and cancer radiotherapy disruption in Italy: Survey endorsed by the Italian Association of Radiotherapy and Clinical Oncology (AIRO). 2020.
  153. Jereczek-Fossa BA, Palazzi MF, Soatti CP, et al. COVID-19 Outbreak and Cancer Radiotherapy Disruption in Lombardy, Northern Italy. Clin. Oncol. (R. Coll. Radiol). 2020; 32: e160–1.
  154. Filippi AR, Russi E, Magrini SM, Corvò R. Letter from Italy: First practical indications for radiation therapy departments during COVID-19 outbreak. Int J Radiat Oncol Biol Phys 2020. HTTP://DX.DOI.ORG/10.1016/j.ijrobp.2020.03.007
  155. Meattini I, Franco P, Belgioia L, et al. Radiation therapy during the coronavirus disease 2019 (covid-19) pandemic in Italy: A view of the nation’s young oncologists. ESMO Open 2020; 5: 2019–21.
  156. Alterio D, Volpe S, Marvaso G, et al. Head and neck cancer radiotherapy amid COVID-19 pandemic: Report from Milan, Italy. Head Neck; n/a. HTTP://DX.DOI.ORG/10.1002/hed.26319.
  157. Rinaldi CG, Ippolito E, Greco C, Matteucci P, D’Angelillo RM, Ramella S. Radiotherapy for pain relief from bone metastases during Coronavirus (COVID-19) pandemic. Eur J Pain (United Kingdom) 2020; 1211–2.
  158. Barra S, Guarnieri A, di Monale E Bastia MB, et al. Short fractionation radiotherapy for early prostate cancer in the time of COVID-19:  long-term excellent outcomes from a multicenter Italian trial suggest a larger adoption in clinical practice. Radiol Med 2020; : 1–5.
  159. Krengli M, Ferrara E, Mastroleo F, Brambilla M, Ricardi U. Running a Radiation Oncology Department at the time of coronavirus: an Italian  experience. Adv Radiat Oncol 2020; published online March. HTTP://DX.DOI.ORG/10.1016/j.adro.2020.03.003
  160. Portaluri M, Tramacere F, Portaluri T, Gianicolo EAL. Southern Italy: How the supply of radiation therapy, patient outcomes, and risk to  health care providers have changed during the COVID-19 Pandemic. Adv Radiat Oncol 2020; published online April. HTTP://DX.DOI.ORG/10.1016/j.adro.2020.03.016
  161. Valenti M, Gargiulo L, Pavia G, et al. Reorganization of a Northern Italy dermatology department during the COVID-19 pandemic: is it temporary or the beginning of a new era in dermatology? J Dermatolog Treat 2020; 1–2.
  162. Pacifico A, Ardigò M, Frascione P, Damiani G, Morrone A. Phototherapeutic approach to dermatological patients during the 2019 Coronavirus pandemic: Real-life Data from the Italian Red Zone. Br J Dermatol 2020; n/a. HTTP://DX.DOI.ORG/10.1111/bjd.19145
  163. Patrizi A, Bardazzi F, Filippi F, Abbenante D, Piraccini BM. The covid-19 outbreak in Italy: preventive and protective measures adopted by the dermatology unit of bologna university hospital. Dermatol Ther 2020; 1–2.
  164. Marasca C, Ruggiero A, Annunziata MC, Fabbrocini G, Megna M. Face the COVID-19 emergency: measures applied in an Italian Dermatologic Clinic. J Eur Acad Dermatology Venereol 2020; 0–3.
  165. Rossi E, Trakatelli M, Giacomelli L, et al. The COVID-19 outbreak in dermatologic surgery: resetting clinical priorities. J Eur Acad Dermatol Venereol 2020; published online May. HTTP://DX.DOI.ORG/10.1111/jdv.16672
  166. Radi G, Diotallevi F, Campanati A, Offidani A. Global coronavirus pandemic (2019-nCOV): implication for an Italian medium size dermatological clinic of a II level hospital. J Eur Acad Dermatology Venereol 2020; 34: e213–4.
  167. Micali G, Musumeci ML, Peris K. The Italian dermatologic community facing COVID-19 pandemic : recommendation from the Italian society of dermatology and venereology. 2020; 155: 123–5.
  168. Atzori L, Mugheddu C, Addis G, et al. Psoriasis health care in the time of the coronavirus pandemic: insights from dedicated centers in sardinia (Italy). J Eur Acad Dermatology Venereol 2020. HTTP://DX.DOI.ORG/10.1111/jdv.16473
  169. Gisondi P, Facheris P, Dapavo P, et al. The impact of the COVID-19 pandemic on patients with chronic plaque psoriasis being  treated with biological therapy: the Northern Italy experience. Br J Dermatol 2020; published online April. HTTP://DX.DOI.ORG/10.1111/bjd.19158
  170. COVID-19 and biologics for psoriasis: a high-epidemic area experience - Bergamo, 2 Lombardy, Italy. 2020.
  171. Posteraro B, Marchetti S, Romano L, et al. Clinical microbiology laboratory adaptation to COVID-19 emergency: experience at a large teaching hospital in Rome, Italy. Clin Microbiol Infect 2020; 2019–21.
  172. Manganaro M, Baldovino S, Besso L, et al. First considerations on the SARS-CoV-2 epidemic in the Dialysis Units of Piedmont and Aosta Valley, Northern Italy. J Nephrol 2020; 33: 393–5.
  173. Brioni E, Leopaldi D, Magnaghi C, et al. [Covid-19 in patients on dialysis: infection prevention and control strategies]. G Ital di Nefrol  organo Uff della Soc Ital di  Nefrol 2020; 37.
  174. Rombolà G, Heidempergher M, Pedrini L, et al. Practical indications for the prevention and management of SARS-CoV-2 in ambulatory dialysis patients: lessons from the first phase of the epidemics in Lombardy. J. Nephrol. 2020; 33: 193–6.
  175. Pascale MM, Bianco G, Ferri L, Agnes S. COVID-19 health restrictions in a transplanted Italian cohort. Transpl. Int.  Off. J. Eur. Soc. Organ  Transplant. 2020; published online May. HTTP://DX.DOI.ORG/10.1111/tri.13661
  176. De Simone P, Melandro F, Balzano E, et al. COVID 19 infection requires strengthening of the chronic care model: the impact on liver transplant practice at a high-volume center in Italy. Liver Transplant; n/a. HTTP://DX.DOI.ORG/10.1002/lt.25821
  177. Umberto M, Luciano DC, Daniel Y, et al. The impact of the COVID-19 outbreak on liver transplantation programs in Northern Italy. Am J Transplant 2020; n/a. HTTP://DX.DOI.ORG/10.1111/ajt.15948.
  178. Angelico R, Trapani S, Manzia TM, Lombardini L, Tisone G, Cardillo M. The COVID-19 outbreak in Italy: Initial implications for organ transplantation programs. Am J Transplant 2020; published online April. HTTP://DX.DOI.ORG/10.1111/ajt.15904
  179. Agnes S, Andorno E, Avolio AW, et al. Preliminary Analysis of the Impact of COVID-19 Outbreak on Italian Liver Transplant  Programs. Liver Transplant.  Off. Publ. Am. Assoc.  Study Liver Dis. Int. Liver Transplant. Soc. 2020; published online May. HTTP://DX.DOI.ORG/10.1002/lt.25790
  180. Vistoli F, Furian L, Maggiore U, et al. COVID-19 and kidney transplantation: an Italian Survey and Consensus. J Nephrol 2020. HTTP://DX.DOI.ORG/10.1007/s40620-020-00755-8
  181. Lauterio A, De Carlis R, Belli L, Fumagalli R, De Carlis L. How to guarantee liver transplantation in the north of Italy during the COVID-19 pandemic: A sound transplant protection strategy. Transpl. Int. 2020; published online April. HTTP://DX.DOI.ORG/10.1111/tri.13633
  182. Cacciola R. Response to ‘The COVID-19 outbreak in Italy: Initial implications for organ  transplantation programs’. Am. J. Transplant.  Off. J. Am. Soc.  Transplant. Am. Soc. Transpl. Surg. 2020; published online May. HTTP://DX.DOI.ORG/10.1111/ajt.15968
  183. Cesari M, Proietti M. Geriatric Medicine in Italy in the Time of COVID-19. J Nutr Heal Aging 2020; 24: 459–60.
  184. Berardi G, Colasanti M, Levi Sandri GB, et al. Continuing our work: transplant surgery and surgical oncology in a tertiary referral COVID-19 center. Updates Surg 2020. HTTP://DX.DOI.ORG/10.1007/s13304-020-00825-3
  185. Mauro V, Lorenzo M, Paolo C, Sergio H. Treat all COVID 19-positive patients, but do not forget those negative with chronic  diseases. Intern Emerg Med 2020; 1–4.
  186. Iasevoli F, Fornaro M, D’Urso G, et al. Psychological distress in patients with serious mental illness during the COVID-19  outbreak and one-month mass quarantine in Italy. Psychol Med 2020; 1–3.
  187. Costi S, Caporali R, Cimaz R. Dealing with COVID-19 in a Pediatric Rheumatology Unit in Italy. Pediatr Drugs 2020; 22: 263–4.
  188. Ohannessian R, Duong TA, Odone A. Global Telemedicine Implementation and Integration Within Health Systems to Fight the COVID-19 Pandemic: A Call to Action. JMIR Public Heal Surveill 2020; 6: e18810.
  189. Brunasso AMG, Massone C. Teledermatologic monitoring for chronic cutaneous autoimmune diseases with  smartworking during Covid-19 emergency in a tertiary center in Italy. Dermatol Ther 2020; : e13495
  190. Luciani LG, Mattevi D, Cai T, Giusti G, Proietti S, Malossini G. Teleurology in the Time of Covid-19 Pandemic: Here to Stay? Urology 2020; 140: 4–6.
  191. Salzano A, D’Assante R, Stagnaro FM, et al. Heart failure management during COVID-19 outbreak in Italy. Telemedicine experience  from a heart failure university tertiary referral centre. Eur. J. Heart Fail. 2020; published online May. HTTP://DX.DOI.ORG/10.1002/ejhf.1911
  192. Capozzo R, Zoccolella S, Musio M, Barone R, Accogli M, Logroscino G. Telemedicine is a useful tool to deliver care to patients with Amyotrophic Lateral Sclerosis during COVID-19 pandemic: results from Southern Italy. Amyotroph Lateral Scler Front Degener 2020; : 1–7.
  193. Hammad TA, Parikh M, Tashtish N, et al. Impact of COVID-19 pandemic on ST-elevation myocardial infarction in a non-COVID-19 epicenter. Catheter Cardiovasc Interv 2020; published online June. HTTP://DX.DOI.ORG/10.1002/ccd.28997
  194. Bres Bullrich M, Fridman S, Mandzia JL, et al. COVID-19: Stroke Admissions, Emergency Department Visits, and Prevention Clinic  Referrals. Can J Neurol Sci Le J Can des Sci  Neurol 2020; 1–10.
  195. Hajdu, Steven D et al. “Acute Stroke Management During the COVID-19 Pandemic: Does Confinement Impact Eligibility for Endovascular Therapy?.” Stroke vol. 51,8 (2020): 2593-2596.
  196. Di Liberto, Ilenia Alessandra, et al. "Impact on hospital admission of ST-elevation myocardial infarction patients during coronavirus disease 2019 pandemic in an Italian Hospital." Journal of Cardiovascular Medicine 21.9 (2020): 722-724.
  197. Del Pinto, Rita, et al. "Increased cardiovascular death rates in a COVID‐19 low prevalence area." The Journal of Clinical Hypertension (2020).
  198. Chiesa, Roberto, et al. "Emergency management of the COVID‐19 pandemic in a vascular surgery department of a large metropolitan hospital in Italy. Preparation, escalation, de‐escalation, and normal activity." Journal of cardiac surgery (2020).
  199. Brunasso AMG, Massone C. Teledermatologic monitoring for chronic cutaneous autoimmune diseases with  smartworking during Covid-19 emergency in a tertiary center in Italy. Dermatol Ther 2020; e13495.
  200. Pinto, F. J., Piñeiro, D., Banerjee, A., Perel, P., Pervan, B., & Eiselé, J. L. (2021). World Heart Day 2021: COVID-19, digital health, and tackling cardiovascular disease. The Lancet, 398(10310), 1467-1468
  201. Luciani LG, Mattevi D, Cai T, Giusti G, Proietti S, Malossini G. Teleurology in the Time of Covid-19 Pandemic: Here to Stay? Urology 2020; 140: 4–6.
  202. Caroppo E, Lega I, Cognetti D, Rotunno V. Community Mental Health Care in the COVID-19 Response: An Italian Example. Prim care companion CNS Disord 2020; 22. HTTP://DX.DOI.ORG/10.4088/PCC.20com02659
  203. Gambardella C, Pagliuca R, Pomilla G, Gambardella A. COVID-19 risk contagion: Organization and procedures in a South Italy geriatric  oncology ward. J Geriatr Oncol 2020; published online May. HTTP://DX.DOI.ORG/10.1016/j.jgo.2020.05.008
  204. Starace F, Ferrara M. COVID-19 disease emergency operational instructions for Mental Health Departments issued by the Italian Society of Epidemiological Psychiatry. Epidemiol Psychiatr Sci 2020; 29: e116.
  205. Omboni S. Telemedicine During The COVID-19 in Italy: A Missed Opportunity? Telemed J E Health 2020; 00: 19–21.
  206. Volpato S, Landi F, Incalzi RA. A Frail Health Care System for an Old Population: Lesson form the COVID-19 Outbreak  in Italy. J Gerontol A Biol Sci Med Sci 2020; published online April. HTTP://DX.DOI.ORG/10.1093/gerona/glaa087
  207. Giansanti D. The Italian Fight Against the COVID-19 Pandemic in the Second Phase: The Renewed Opportunity of Telemedicine. Telemed e-Health 2020;00:1–4.
  208. Perrone G, Zerbo S, Bilotta C, Malta G, Argo A. Telemedicine during Covid-19 pandemic: Advantage or critical issue? Med Leg J 2020; 002581722092692.
  209. Sossai P, Uguccioni S, Casagrande S. Telemedicine and the 2019 Coronavirus (SARS-CoV-2). Int J Clin Pract; n/a: e13592.
  210. Goulabchand R, Claret P-G, Lattuca B. What if the worst consequences of COVID-19 concerned non-COVID patients? J Infect Public Health 2020.
  211. Holler JG, Eriksson R, Jensen TØ, van Wijhe M, Fischer TK, Søgaard OS, Israelsen SB, Mohey R, Fabricius T, Jøhnk F, Wiese L, Johnsen S, Søborg C, Nielsen H, Kirk O, Madsen BL, Harboe ZB. First wave of COVID-19 hospital admissions in Denmark: a Nationwide population-based cohort study. BMC Infect Dis. 2021 Jan 9;21(1):39.  PMID: 33421989; PMCID: PMC7794638.
  212. Bignamini E, Cazzato S, Cutrera R, et al. Italian pediatric respiratory society recommendations on pediatric pulmonary  function testing during COVID-19 pandemic. Ital. J. Pediatr. 2020; 46: 68.
  213. Salzano A, D’Assante R, Stagnaro FM, et al. Heart failure management during COVID-19 outbreak in Italy. Telemedicine experience  from a heart failure university tertiary referral centre. Eur. J. Heart Fail. 2020; published online May. HTTP://DX.DOI.ORG/10.1002/ejhf.1911
  214. Mureddu GF, Ambrosetti M, Venturini E, et al. Cardiac rehabilitation activities during the COVID-19 pandemic in Italy. Position Paper of the AICPR (Italian Association of Clinical Cardiology, Prevention and Rehabilitation). Monaldi Arch Chest Dis 2020; 90. HTTP://DX.DOI.ORG/10.4081/monaldi.2020.1439
  215. Scaldaferri F, Pugliese D, Privitera G, et al. Impact of COVID-19 pandemic on the daily management of biotechnological therapy in inflammatory bowel disease patients: Reorganisational response in a high-volume Italian inflammatory bowel disease centre. United Eur Gastroenterol J 2020; 1–7.
  216. Danese S, Ran ZH, Repici A, et al. Gastroenterology department operational reorganisation at the time of covid-19 outbreak: An Italian and Chinese experience. Gut 2020; 1–3.
  217. Siniscalchi M, Zingone F, Savarino EV, D’Odorico A, Ciacci C. COVID-19 pandemic perception in adults with celiac disease: an impulse to implement  the use of telemedicine: COVID-19 and CeD. Dig liver Dis  Off J Ital Soc  Gastroenterol Ital Assoc Study Liver 2020; published online May. HTTP://DX.DOI.ORG/10.1016/j.dld.2020.05.014
  218. Catassi GN, Vallorani M, Cerioni F, Lionetti E, Catassi C. A negative fallout of COVID-19 lockdown in Italy: life-threatening delay in the  diagnosis of celiac disease. Dig liver Dis  Off J Ital Soc  Gastroenterol Ital Assoc Study Liver 2020; published online May.
  219. Rubin DT, Abreu MT, Rai V, Siegel CA. Management of Patients With Crohn’s Disease and Ulcerative Colitis During the  Coronavirus Disease-2019 Pandemic: Results of an International Meeting. Gastroenterology. 2020; published online April. HTTP://DX.DOI.ORG/10.1053/j.gastro.2020.04.002
  220. Curigliano G. How to Guarantee the Best of Care to Patients with Cancer During the COVID‐19 Epidemic: The Italian Experience. Oncologist 2020. HTTP://DX.DOI.ORG/10.1634/theoncologist.2020-0267
  221. Gebbia V, Piazza D, Valerio MR, Borsellino N, Firenze A. Patients With Cancer and COVID-19: A WhatsApp Messenger-Based Survey of Patients’  Queries, Needs, Fears, and Actions Taken. JCO Glob Oncol 2020; 6: 722–9.
  222. Buonomo OC, Materazzo M, Pellicciaro M, Caspi J, Piccione E, Vanni G. Tor Vergata University-Hospital in the Beginning of COVID-19-Era: Experience and Recommendation for Breast Cancer Patients. In Vivo 2020; 34: 1661–5.
  223. Viale G, Licata L, Sica L, et al. Personalized Risk-Benefit Ratio Adaptation of Breast Cancer Care at the Epicenter of  COVID-19 Outbreak. Oncologist 2020; published online May. HTTP://DX.DOI.ORG/10.1634/theoncologist.2020-0316
  224. Corsi F, Caruso A, Albasini S, et al. Management of breast cancer in an EUSOMA-accredited Breast Unit in Lombardy, Italy, during the COVID-19 pandemic. Breast J 2020; n/a. HTTP://DX.DOI.ORG/10.1111/tbj.13926
  225. Rossi B, Zoccali C, Baldi J, et al. Reorganization Tips from a Sarcoma Unit at Time of the COVID-19 Pandemic in Italy:  Early Experience from a Regional Referral Oncologic Center. J Clin Med 2020; 9. HTTP://DX.DOI.ORG/10.3390/jcm9061868.
  227. Tomelleri A, Sartorelli S, Campochiaro C, Baldissera EM, Dagna L. Impact of COVID-19 pandemic on patients with large-vessel vasculitis in Italy: a  monocentric survey. Ann. Rheum. Dis. 2020; published online April. HTTP://DX.DOI.ORG/10.1136/annrheumdis-2020-217600
  228. Minniti A, Maglione W, Pignataro F, Cappadona C, Caporali R, Del Papa N. Taking care of systemic sclerosis patients during COVID-19 pandemic: rethink the  clinical activity. Clin Rheumatol 2020; 39: 2063–5.
  229. Malipiero G, Paoletti G, Puggioni F, et al. An academic allergy unit during COVID-19 pandemic in Italy. J. Allergy Clin. Immunol. 2020; published online April. HTTP://DX.DOI.ORG/10.1016/j.jaci.2020.04.003
  230. Pulvirenti F, Cinetto F, Milito C, et al. Health-Related Quality of Life in Common Variable Immunodeficiency Italian Patients Switched to Remote Assistance During the COVID-19 Pandemic. J Allergy Clin Immunol Pract 2020; 8: 1894-1899.e2.
  231. Cocci A, Presicce F, Russo GI, Cacciamani G, Cimino S, Minervini A. How sexual medicine is facing the outbreak of COVID-19: experience of Italian  urological community and future perspectives. Int J Impot Res 2020; 1–3.
  232. Rizzo M, Liguori G, Verze P, Palumbo F, Cai T, Palmieri A. How the andrological sector suffered from the dramatic Covid 19 outbreak in Italy:  supportive initiatives of the Italian Association of Andrology (SIA). Int J Impot Res 2020; 1–2.
  233. La Marca A, Niederberger C, Pellicer A, Nelson SM. COVID-19: lessons from the Italian reproductive medical experience. Fertil. Steril. 2020; 113: 920–2.
  234. Requena A, Cruz M, Vergara V, Prados N, Galliano D, Pellicer A. A picture of the covid-19 impact on IVIRMA fertility treatment clinics in Spain and  Italy. Reprod Biomed Online 2020; 41: 1–5.
  235. De Santis L, Anastasi A, Cimadomo D, et al. COVID-19: the perspective of Italian embryologists managing the IVF laboratory in  pandemic emergency. Hum. Reprod. 2020; 35: 1004–5.
  236. Corona G, Baldi E, Isidori AM, et al. SARS-CoV-2 infection, male fertility and sperm cryopreservation: a position  statement of the Italian Society of Andrology and Sexual Medicine (SIAMS) (Società Italiana di Andrologia e Medicina della Sessualità). J Endocrinol Invest 2020; : 1–5.
  237. Vaiarelli A, Bulletti C, Cimadomo D, et al. COVID-19 and ART: the view of the Italian Society of Fertility and Sterility and Reproductive Medicine. 2020.
  238. Grazzi L, Rizzoli P. The Adaptation of Management of Chronic Migraine Patients With Medication Overuse to  the Suspension of Treatment Protocols During the COVID-19 Pandemic: Lessons From a Tertiary Headache Center in Milan, Italy. Headache 2020; published online April. HTTP://DX.DOI.ORG/10.1111/head.13825
  239. Sechi A, Macor D, Valent S, et al. Impact of COVID-19 related healthcare crisis on treatments for patients with  lysosomal storage disorders, the first Italian experience. Mol Genet Metab 2020; 130: 170–1.
  240. Dubbioso R, Nobile-Orazio E, Manganelli F, et al. Dealing with immune-mediated neuropathies during COVID-19 outbreak: practical  recommendations from the task force of the Italian Society of Neurology (SIN), the Italian Society of Clinical Neurophysiology (SINC) and the Italian Peripheral Nervous System . Neurol. Sci.  Off. J. Ital. Neurol. Soc.  Ital. Soc. Clin. Neurophysiol. 2020; 41: 1345–8.
  241. Capozzo R, Zoccolella S, Musio M, Barone R, Accogli M, Logroscino G. Telemedicine is a useful tool to deliver care to patients with Amyotrophic Lateral Sclerosis during COVID-19 pandemic: results from Southern Italy. Amyotroph Lateral Scler Front Degener 2020; : 1–7.
  242. Bersano A, Pantoni L. On being a neurologist in Italy at the time of the COVID-19 outbreak. Neurology 2020; 94: 905—906.
  243. Schirinzi T, Cerroni R, Di Lazzaro G, et al. Self-reported needs of patients with Parkinson’s disease during COVID-19 emergency  in Italy. Neurol Sci  Off J Ital Neurol Soc  Ital Soc Clin Neurophysiol 2020; 41: 1373–5
  244. Tornese G, Ceconi V, Monasta L, Carletti C, Faleschini E, Barbi E. Glycemic Control in Type 1 Diabetes Mellitus During COVID-19 Quarantine and the Role of In-Home Physical Activity. Diabetes Technol Ther 2020; 22. HTTP://DX.DOI.ORG/10.1089/dia.2020.0169
  245.  Maria B, Federico B, Angelo B. Glycaemic Control Among People with Type 1 Diabetes During Lockdown for the SARS-CoV-2 Outbreak in Italy. Diabetes Ther 2020. HTTP://DX.DOI.ORG/10.1007/s13300-020-00829-7
  246. Capaldo B, Annuzzi G, Creanza A, et al. Blood Glucose Control During Lockdown for COVID-19: CGM Metrics in Italian Adults With Type 1 Diabetes. Diabetes Care 2020. HTTP://DX.DOI.ORG/10.2337/dc20-1127
  247. Brunasso AMG, Massone C. Teledermatologic monitoring for chronic cutaneous autoimmune diseases with  smartworking during Covid-19 emergency in a tertiary center in Italy. Dermatol Ther 2020; : e13495.
  248. Marasca C, Ruggiero A, Megna M, Annunziata MC, Fabbrocini G. Biologics for patients affected by hidradenitis suppurativa in the COVID-19 era:  data from a referral center of Southern Italy. J. Dermatolog. Treat. 2020; : 1.
  249. Villani A, Megna M, Scalvenzi M, Fabbrocini G, Ruggiero A. Teledermatology and chronic skin diseases: real life experience in a Southern Italian Dermatologic Centre. Dermatol Ther 2020; n/a: e13839.
  250. de Girolamo G, Cerveri G, Clerici M, et al. Mental Health in the Coronavirus Disease 2019 Emergency-The Italian Response. JAMA psychiatry 2020; published online April. HTTP://DX.DOI.ORG/10.1001/jamapsychiatry.2020.1276
  251. D’Agostino A, Demartini B, Cavallotti S, Gambini O. Mental health services in Italy during the COVID-19 outbreak. The lancet. Psychiatry. 2020; 7: 385–7.
  252. Percudani M, Corradin M, Moreno M, Indelicato A, Vita A. Mental Health Services in Lombardy during COVID-19 outbreak. Psychiatry Res 2020; 288: 112980.
  253. Fagiolini A, Cuomo A, Frank E. COVID-19 Diary From a Psychiatry Department in Italy. J Clin Psychiatry 2020; 81. HTTP://DX.DOI.ORG/10.4088/JCP.20com13357
  254. Tullio V, Perrone G, Bilotta C, Lanzarone A, Argo A. Psychological support and psychotherapy via digital devices in Covid-19 emergency  time: Some critical issues. Med Leg J 2020; :5817220926942.
  255. Carpiniello B, Tusconi M, di Sciascio G, Zanalda E, di Giannantonio M, Psychiatry EC of the IS of. Mental health services in Italy during the Covid-19 Pandemic. Psychiatry Clin Neurosci 2020; 10.1111/pcn.13082.
  256. Zucchetti G, Bertolotti M, Fagioli F. How Paediatric Psycho-oncology is changing during the COVID-19 Epidemic in Italy: New approaches. Psychooncology; n/a. HTTP://DX.DOI.ORG/10.1002/pon.5444
  257. Balduzzi A, Brivio E, Rovelli A, et al. Lessons after the early management of the COVID-19 outbreak in a pediatric transplant and hemato-oncology center embedded within a COVID-19 dedicated hospital in Lombardia, Italy. Estote parati. Bone Marrow Transplant 2020. HTTP://DX.DOI.ORG/10.1038/s41409-020-0895-4
  258. Brunetti-pierri N, Fecarotta S, Staiano A, Strisciuglio P, Parenti G. Ensuring continuity of care for children with inherited metabolic diseases at the time of COVID-19 : the experience of a metabolic unit in Italy. Genet Med 2020; 0: 3–5.
  259. Cardinale F, Ciprandi G, Barberi S, et al. Consensus statement of the Italian society of pediatric allergy and immunology for the pragmatic management of children and adolescents with allergic or immunological diseases during the COVID-19 pandemic. Ital J Pediatr 2020; 46: 84.
  260. Mascagni D, Eberspacher C, Mascagni P, et al. From high volume to ‘zero’ proctology: Italian experience in the COVID era. Int J Colorectal Dis 2020; 1–4.
  261. SAGES and EAES Recommendations Regarding Surgical Response to COVID-19 Crisis - SAGES.  (accessed July 4, 2020).
  262. Usuelli FG, D’Ambrosi R. Being a foot and ankle surgeon in Italy in the era of COVID-19. Knee Surg. Sports Traumatol. Arthrosc. 2020; 28: 1679–82
  263. Angileri FF, Sabatino G, Cavallo LM, et al. Natura non facit saltus: a phase 2 proposal to manage brain tumors cases from the  neuro-oncology section of the Italian Society of Neurosurgery (SINch®). J Neurosurg Sci 2020; published online June. HTTP://DX.DOI.ORG/10.23736/S0390-5616.20.05054-7
  264. Ciavattini A, Delli Carpini G, Giannella L, et al. Expert consensus from the Italian Society for Colposcopy and Cervico-Vaginal Pathology (SICPCV) for colposcopy and outpatient surgery of the lower genital tract during the COVID-19 pandemic. Int J Gynecol Obstet 2020; 149: 269–72.
  265. Sciarra A, Salciccia S, Maggi M, et al. Elective procedures for prostate cancer in the time of Covid-19: a multidisciplinary  team experience. Prostate Cancer Prostatic Dis 2020; : 1–3.
  266. Luciani LG, Mattevi D, Cai T, Giusti G, Proietti S, Malossini G. Teleurology in the Time of Covid-19 Pandemic: Here to Stay? Urology 2020; 140: 4–6.
  267. Negrini S, Kiekens C, Bernetti A, et al. Telemedicine from research to practice during the pandemic. ‘Instant paper from the  field’ on rehabilitation answers to the Covid-19 emergency. Eur J Phys Rehabil Med 2020; published online April. HTTP://DX.DOI.ORG/10.23736/S1973-9087.20.06331-5
  268. Boldrini P, Bernetti A, Fiore P. Impact of COVID-19 outbreak on rehabilitation services and Physical and Rehabilitation Medicine (PRM) physicians’ activities in Italy. An official document of the Italian PRM Society (SIMFER). Eur J Phys Rehabil Med 2020. HTTP://DX.DOI.ORG/10.23736/S1973-9087.20.06256-5
  269. Boldrini P, Kiekens C, Bargellesi S, et al. First impact on services and their preparation. ‘Instant paper from the field’ on rehabilitation answers to the Covid-19 emergency. Eur J Phys Rehabil Med 2020. HTTP://DX.DOI.ORG/10.23736/S1973-9087.20.06303-0
  270. Pedersini P, Corbellini C, Villafañe JH. Italian Physical Therapists’ Response to the Novel COVID-19 Emergency. Phys Ther 2020; published online April 13. HTTP://DX.DOI.ORG/10.1093/ptj/pzaa060
  271. Iannaccone S, Castellazzi P, Tettamanti A, et al. Role of Rehabilitation Department for Adult Covid-19 Patients: the Experience of the San Raffaele Hospital of Milan. Arch Phys Med Rehabil 2020. HTTP://DX.DOI.ORG/10.1016/j.apmr.2020.05.015

Supplementary Material

Suppl Table 1.1 Table 1. Full search strategy adopted in three different databases.
Suppl Table 1.2

SupTable2.1 Table 2. Full search strategy adopted in three different databases.
SupTable 2.6
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