Starting from the first official case of coronavirus disease 2019 (COVID-19) recorded in Italy on February 21, 2020 in Codogno, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) quickly spread in Northern Italy, bringing Lombardy to be the second world epicenter after China and the first European outbreak of the COVID-19 pandemic. The number of COVID-19 patients in need of hospitalization and treatment in a sub-intensive and intensive regime has rapidly increased, leading to a sudden and unexpected oversaturation of hospitals and healthcare network. Currently, on April 27th, 199.414 COVID-19 cases have been confirmed in Italy, with 26.977 deaths [1]. Starting from March 2020, in order to contain the transmission of the infection, the Italian Government approved a series of decrees (the latest issued on April 10), declaring the lockdown and quarantine status.

Hospitals quickly overburdened with COVID-19 patients. Given the situation of imminent collapse, Lombard Regional Government issued on March 8, 2020 Decree No. XI / 2906 [2], redefining the Lombard Regional Health System in a new Hub and Spoke system. Hub Hospitals have been assigned to the treatment of time-dependent emergencies, in order to concentrate the management of COVID-19 patients in Spoke hospitals. Five emergency categories have been defined [3]. Our Institution, Di Circolo and Fondazione Macchi Hospital in Varese, takes on the role of Hub center for traumatological, neurosurgical, and neurointerventional emergencies.

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