Massimo Galli had thought that retirement was going to arrive quietly within a couple of years. In January, 2020, Galli, who is head of the Infectious Diseases Unit at the University of Milan-affiliated Luigi Sacco Hospital in Milan, Italy, had just recovered from a pulmonary thromboembolism. But the next few months would be the most challenging of his career as the COVID-19 pandemic exploded in Italy.
He has spent his entire career in Milan, working between the Sacco Hospital and the University of Milan where he is a full professor of infectious diseases. “When I was a young doctor, I wanted to go to America and study immunology”, Galli tells The Lancet Infectious Diseases. “This was the early 1980s, and then the HIV epidemic arrived. My boss told, Massimo, you should stay here. This will need to be your America now”.
Having studied medicine at the University of Milan, he specialised in clinical immunology and allergology and later in infectious diseases and internal medicine. His earliest research interest, in 1976, had been on cryoglobulinaemia, a condition in which cold sensitive antibodies precipitate from the blood. For some years this condition had been thought to be driven by hepatitis B virus, but Galli's studies in the early eighties helped to downsize the role of that virus, and in the 1990s he helped identify hepatitis C virus as a predominant cause of this disorder.
As HIV tightened its deadly grip in the 1980s, Galli researched clinical epidemiology, therapeutics, prevention, focusing in particular on the epidemic among the key risk group of heroin users in Italy. He was an expert on the toxic effects of antiretroviral therapy, and his group was among the first to highlight the lipotrophic effects of nucleoside reverse transcriptase inhibitors. This work led to his position on the Italian National Commission on HIV and AIDS, a role he held from more than 10 years. He also contributed to Italy's latest national plan for the fight against HIV/AIDS, launched in 2017. And in the 1990s and 2000s, Galli coordinated various programmes to combat AIDS in Africa, Latin America, and eastern Europe, promoted by the Italian National Association for the Fight Against AIDS (ANLAIDS), of which he is one of the founders.
As President of the Italian Society of Infectious and Tropical Diseases from 2017 to 2019, he passed a resolution endorsing the HIV undetectable=untransmittable concept. “One of my main concerns is that young Italians today do not sufficiently recognise HIV or its effects. And that PrEP is not yet widely available in Italy”, he says. He also advocated for mass testing for hepatitis C so that Italy can eliminate its remaining cases, having successfully treated some 200 000 so far.
Since 2000, Galli has been a full professor at the University of Milan, and in 2018 he became director of the University's Department of Biomedical and Clinical Science L. Sacco, overseeing some 70 medical professors. He also teaches and still works in the hospital clinic. He will step down from his directorship in November 2020, and do another year of research before retiring completely in 2021. “I already have many investigations into COVID-19 in progress. But I also want to return to other projects I have left in the desk drawer!”, he says.
Dealing with the severe acute respiratory syndrome coronavirus 2 outbreak has been an enormous challenge for all doctors in Italy. Galli's hospital is the reference centre for epidemic emergencies and bioterrorism in northern Italy, so his team is all fully trained in the use of personal protective equipment and the use of negative pressure rooms to stop transmission. They have also tripled their ICU capacity. “While no colleagues in my hospital have been infected, others across Italy have sadly lost their lives”, he says.
His team has quickly produced several research papers on the coronavirus outbreak, including a phylogenetic analysis of the origin of the Italian epidemic published in the Journal of Medical Virology, showing Italy's index case to have travelled from Munich in late January. “It's very clear that the virus arrived in Italy in January and spread for 3 or 4 weeks undetected”, explains Galli. At the time of writing, daily deaths from COVID-19 in Italy are declining from their peak. While we finish our interview, Galli takes a call from a member of Italian Government to discuss how to ease their lockdown.
After he retires, Galli will pursue his interest in much older pandemics, including the plague. “I am analysing the register of deaths in Milan that goes from as far back as 1452 to early 19th century, and using it to establish the cause of death. The quality of information in this register is amazing, despite its age”, he says.
“Beyond any professional achievement Massimo is one of the few remaining men in the world with a true encyclopaedic knowledge. One of his preferred dinner questions is to ask around if any of the guests know who were the six wives of Henry VIII!” says Giovanni Di Perri, Professor of Infectious Diseases at the University of Torino, Italy. “In this recent COVID-19 outbreak he played as a giant the role of the independent as well as brilliant spokesman on behalf of all doctors and nurses involved in the epidemic. I would like to have him as the next Prime Minister of Italy!”