publication date: Jul. 17, 2020
Conversation with The Cancer Letter
Giuseppe Curigliano: The COVID-19 curve in the U.S. will never decrease, like in Italy
Giuseppe Curigliano, MD, PhD
Associate professor of medical oncology, University of Milano;
Head, Division of Early Drug Development, European Institute of Oncology, Italy
This story is part of The Cancer Letter’s ongoing coverage of COVID-19’s impact on oncology. Our full coverage of SARS-CoV2 is available here.
In early March, when Giuseppe Curigliano, an oncologist in Milan, first spoke with The Cancer Letter about COVID-19, the situation in Italy was “like being in a war zone” (The Cancer Letter, March 11, 2020).
At the time, it seemed unfathomable that the U.S. could face a catastrophic event of a similar magnitude.
Today, the tables have turned.
Italy, which locked down entirely, has had 244,000 confirmed cases of coronavirus and 35,017 deaths as of July 15. The United States has had 3.53 million confirmed cases and 138,000 deaths.
At this writing, just the state of Florida has 72,000 more cases than all of Italy.
And Curigliano, associate professor of medical oncology at University of Milano and head of the Division of Early Drug Development at the European Institute of Oncology Italy, has some sobering words for the U.S.
“The risk is that the number of cases will increase, and you will never reduce or flatten the curve until you use the vaccine,” he said to The Cancer Letter. “In some states, you will never have a decrease of the curve. Maybe you will have it plateau in a few months, but the virus will survive, together with the people. You were not so restricted in terms of lockdown. So, maybe it will flatten the curve, but the curve will never decrease, like in Italy.”
Curigliano predicts that a second wave of the coronavirus will hit Italy this fall.
“Even if the virus will come back, I don’t believe we will be a mess. I believe we will control this,” Curigliano said. “We will be very careful, because, actually, I must tell you that everybody in Italy is respecting social distancing. And also wearing the mask. When I go around in Milan during the weekend, there is no more lockdown. Ninety-five percent of people I met are wearing a mask, nobody’s shaking your hands. So, there is a lot of respect for the rules.”
Worldwide, Curigliano predicts a second wave by the end of the year. How do we avoid devastating impact in the U.S.?
“My message is to be more responsible, and listen to people like Anthony Fauci, rather than listening to the president of the United States of America,” Curigliano said. “Wear your mask, wash your hands, maintain social distancing. Don’t go party, now, in Florida, in Texas. Just understand that you have to be more socially isolated. Nothing else.”
Curigliano spoke with Alexandria Carolan, a reporter with The Cancer Letter.
How are things there now?
I believe, actually, in Italy, the COVID-19 situation is almost normal. There is absolutely no problem.
We have less than 200 new cases per day. And the mortality rate is less than 10 cases per day.
So, actually, we are really in a condition to tell you that we are living normal, with the exception of wearing a mask and maintaining social distancing. There is absolutely no problem.
Are restaurants and things like that open now in Italy?
Yes, they’re open. They all are open—of course there are specific restrictions. Every time you go in a restaurant, you have to take the body temperature, the reason being distancing between people. And it’s almost normal, the situation.
And does the government mandate that restaurants take your temperature?
Yes. Not only restaurants, but also in the hospital, in public offices, in schools, in universities, any place. The supermarket—any place, yes.
I’d like to get back to that in a minute, but in the meantime, I’d like to start with maybe now that there’s more room to breathe. What has your cancer center been doing in regard to COVID-19?
The situation in my cancer center came back to normal. We are doing exactly the same routine that we did before COVID.
In the morning, when we enter the hospital, there is a triage for us and for the patients. It’s exactly the same. Body temperature, if it is normal, you go in the hospital. If not, you stay out.
And are you continuing with telehealth?
The only thing we are doing, for specific patients, we do the SARS-CoV-2 testing in order to be sure that even if they’re symptomatic, they are not positive.
In the case of positive RT-PCR patients, they are quarantined. If negative, they receive their surgery or chemotherapy.
I remember you previously said that you had some cancer patients with COVID-19. One was a lung cancer patient. How are they doing?
Actually, there is no more. I don’t have any new patients. So, the patient who had the COVID-19 recovered.
And they are now with only the problem—that is the cancer. No more COVID-19.
So, the message I would like to give to you is that in Italy, actually, COVID-19 is no longer a problem.
Italy, and it seems the rest of Europe, has successfully solved the problem. And the U.S. is just a big mess, to be frank. There are failures on a lot of levels. Why is that? What have Italy and Europe done right that the U.S. is doing wrong?
As I said before, in Italy, when we decided to do a lockdown and to apply very restrictive rules on social isolation, the decision was for all the country.
And if you remember, in one article, we say that in the United States, you will have restrictions that are different from state to state. And so, that’s why, actually, in Florida, in Texas, in Arizona, that’s the reason for dramatic increase of new cases.
Because you stopped at the lockdown, you gave no more restrictions. And so, people are going around without masks.
They are not respecting the social isolation. They go around to parties. And that’s why the median age of people affected in the United States is younger.
You have a younger population, maybe less access to intensive care, because they can also have the infection, and not have the very dramatic symptoms. You have, now, a wave of new infected people that are younger people, in most of the cases.
Because after you stop at the lockdown, there was no respect for wearing your mask and social distancing.
This is my explanation. And the risk is that the number of cases will increase, and you will never reduce or flatten the curve until you use the vaccine.
It’s very important to let the people understand that even if there is no lockdown, you should be careful in social distancing, in wearing your mask, and washing your hands.
Do you think it would help to enforce a lockdown in the U.S.? Is it too late?
I don’t know now if you can stop the country again. Because, you know, you did this already. What you can do is to increase the awareness against the virus and to instruct the people, to wear a mask, to do social distancing, and to wash their hands.
If you see the median age of people infected, it’s between 40 and 50 in the United States. It’s a younger population.
What was the median age in Italy, again?
The median age in Italy when we really had the peak of the COVID-19 pandemic was 69 years old.
The cases we have now are all asymptomatic subjects, positive for RT-PCR, but with no symptoms. We have younger patients.
What about the future of COVID-19 in Italy? Will the country have the second wave under control?
You know, I believe that we are ready for a new wave in October. Let’s say September, October.
But we reorganized the National Health System. We will be very careful, because, actually, I must tell you that everybody in Italy is respecting social distancing. And also wearing the mask.
When I go around in Milan during the weekend, there is no more lockdown. Ninety-five percent of people I met are wearing a mask, nobody’s shaking your hands.
So, there is a lot of respect for the rules. Even if the virus will come back, I don’t believe we will be a mess. I believe we will control this.
You’re more prepared this time and people know what to do. This second wave, for September, October—is this your prediction for the second wave worldwide?
No, I believe the prediction worldwide would be for the end of the year. Of course, you saw with the SARS and MERS, also in November, December—there was a new wave, but since people were ready, it had a really limited impact.
So, I do not expect in countries where we experienced it before—the pandemics—will have the same scenario. The problem will be for other countries in Asia, where they did not experience any scenario like us.
Why is that, do you think?
It was exactly for the reasons that you wrote the first article with me in The Cancer Letter, saying “If Italy is a mess, be prepared to have many patients.”
And despite this, the experience of New York City was exactly the same as Milan two months after. Because nobody believes that this is a virus.
Think about Brazil, what is going on in Brazil.
Based on what the curve is looking like in the U.S., what are your predictions for what’s going to happen here?
I believe that in the United States, in some states, you will never have a decrease of the curve.
Maybe you will have it plateau in a few months, but the virus will survive, together with the people. You were not so restricted in terms of lockdown. So, maybe it will flatten the curve, but the curve will never decrease, like in Italy. You see now the curve of Italy is completely different.
I remember you previously said that the government basically needs to prioritize people over the economy.
Yes, yes. This was the decision, yes.
Is there anything else you’d like to add?
I believe your president should be more convincing to explain to people that this is a serious problem.
And until that, your president is so clear with the population of the United States of America, I believe people will do everything they believe is normal to do: not wearing a mask, not maintaining social distancing.
This is the best way to disseminate the virus. Even if now there are younger people affected, there is a risk also for the older population.
My message is to be more responsible, and listen to people like Anthony Fauci, rather than listening to the president of the United States of America.
Health care in the U.S. is expensive. How do you think this might affect COVID-19 here versus how it’s spreading in Europe?
Now, the problem is to solve the dissemination of the infection. It’s very low cost, because you don’t need to go to the hospital to stop with the dissemination.
In order to reduce healthcare costs, the best way and the best thing to do is to avoid going to the hospital, and to stop the spreading of the virus.
So, wear your mask, wash your hands, maintain social distancing. Don’t go party now in Florida, in Texas. Just understand that you have to be more socially isolated. Nothing else.
Would you like to see the screen, now, of our situation?
That’d be great.
Data on COVID-19 in Italy as of the morning of July 17.
Look at the curve here. There are no more cases. Those are the number of people that now are out of the hospital. And there were all situations, the country is completely different. Look, now it’s all yellow. We don’t have any more red spots.
The total number of people who died—the final number is 35,000. In the U.S., more than 100,000 unfortunately died.