Record number of fatalities.
475 dead in a single day, nearly 8% fatality rate. Twice China’ss rate and approaching the 2003 SARS rate.
Why is it so bad in Italy and does this bode poorly for the rest of us?
Italy has the per capita oldest population in Europe (nearly a quarter of the population is above 65 years old) and actually the second to Japan in terms of retirees with the ranking of sixth in life expectancy in the world. It also has a social environment in which intimate contact (hugging, kissing, and the sharing of food) is socially reinforced. The health care system is well-ranked among industrialized nations (by many measures it is ranked second or third in Europe) but even before the current COVID-19 pandemic hospitals were often understaffed and at the limits, with non-emergency planned surgeries often having a waitlist of months although emergency surgeries such as post-infarction angioplasty often being scheduled within a few days in the wealthier northern part of the country.
However, it is quite apparent that Italy, like nearly every other industrialized nation, was not prepared in its health care system nor public health authority to deal with an epidemic such as this, and failed to take rapid action when the SARS-CoV-2 virus was identified outside of Wuhan despite the fact that is a major center of international business and tourist travel. The subsequent lockdown and travel restrictions are an example of an extreme reaction at way too late of a time to substantially affect the immediate outcome, and although a total lockdown may avoid a small number of additional infections the virus has clearly spread throughout the population to the extent that vector transmission paths cannot even be identified. A public health information emphasizing the need for distancing for everyone and isolation for at-risk members of the population and reinforcing the need for this via indoctrination (versus just stating facts that the public conveniently ignored) could have gone a long way into at least blunting the peak of the outbreak and better allowing the health care system to provide care and acquire needed supplies.
The SARS-CoV-2 outbreak and the resulting COVID-19 epidemic were probably never completely avoidable given its apparent asymptomatic and aerosol transmission, but a more effective response invoking the responsibility of the public instead of just laying the effort exclusively at the feet of the health care system could have saved many lives. And CIVD-19 is comparatively mild compared to a bad influenza pandemic or viral hemorrhagic fever. This is a wakeup call to all of the governments and leaders who have been responsible for defunding and ignoring the serious threat posed by such contagions in a world deeply interconnected by global trade and travel.
Stranger
According to this page, Italy has tested ~150,000 people so far. Which is only 0.25% of the whole population. So it’s very possible there are tens of thousands of infected people who haven’t yet been tested. Maybe hundreds of thousands.
Millions. Maybe tens of millions. Ignore the case fatality rate as measured by deaths per detected infections; it will be months and the development of a serology test before we will actually know just how widespread the infection is, but a conservative assumption at this point is an R[SUB]0[/SUB] > 4 (e.g., four replications for every infected person) with most infected people having mild to no symptoms. The resulting case fatality rate may turn out to be significantly less than 1%, although obviously several times that for people in high at-risk demographics, e.g. the elderly, immunocompromised, or those with underlying medical issues and co-infections of other respiratory illnesses.
The answer to this is don’t panic, but also don’t blithely ignore the direction of public health authorities to maintain distance socially and isolate as best possible.
Stranger
And a general feeling in the U.S.: definitely a major tragedy for Italy, but the U.S. is so much better off.
But some of us feel the U.S. is only a few weeks behind what is happening in Italy–and what the U.S. is doing now is too little, too late.
Stranger when you talk about “nearly every other industrialized nation” who do you see as the exceptions? I don’t see any country outside east Asia (like Taiwan, Singapore, Hong Kong).
Fatalities do not have a linear relationship to the infection rate. Once the health care system is overwhelmed, whether because of shortage of beds, ventilators, or medical personnel, the fatality rate can spike sharply. China took some extreme measures like building new hospitals in days to avoid the worst of it. Italy was not able to.
The response by every nation in Europe has been too late, but at least some countries like Denmark are instituting complete lockdown of all non-essential travel and interaction, ordering schools, gyms, and other public gathering facilities closed, making provisions for childcare and education at a national level rather than leaving it up to municipalities and districts, and most importantly providing factual public health information and clear guidance rather than the stream-of-consciousness ramblings followed by multiple corrections which themselves are often contradictory of one another. How much of an impact that will have on lessening the peak of the epidemic remains to be seen, but it is clear that no government and health authority recognized the severity of the epidemic and managed to take effective action in a timely manner despite decades of warnings from epidemiologists.
Stranger
There’s also the lifestyle of the elderly in Italy which is different than in the US. It’s pretty common for seniors in Italy to walk everywhere, visit different food specialty stores, socialize with friends and neighbors, and so on. The typical American senior likely spends a lot more time in the house and makes many fewer trips outside. I would guess the number of people an older Italian interacts with on a weekly basis is 10x or 100x greater than that of a typical older American. It seems like that would give the older Italians many more opportunities to get infected right away, and they would have a big wave of critical cases from those older people hitting the hospitals right at the beginning.
The biggest thing that makes it look like Italy has it worse is that they are simply more connected to China. They have the most air routes to China in Europe and recently signed onto a Chinese global trade infrastructure program. There may be aggravating factors, but really they look bad because they got it first, and are further along in the process.
Welcome back
Even with more hospitals you still need more ventilators and trained personnel.
Supposedly there are efforts to 3D print most if not all of the parts needed for a ventilator.
I think in Italy it is still relatively common for three generations to live in the same house, or very nearby. Kids have a lot of chances to infect grandma.
This is “mild”.
Compared to the 1918-20 H1N1 “Spanish Flu”, a poliomyelitis epidemic, and especially to a potential widespread viral hemorrhagic fever pandemic, yes, it is “mild” by an order of magnitude of fatality. Imagine how bad the next global pandemic could be if not effectively contained. Next to an asteroid strike or global thermonuclear war, a viral pandemic is the most severe existential threat to industrial human civilization. This is a hiccup by comparison.
Stranger
I thought after the 2009 H1N1 outbreak the new wisdom was that it was the global circumstance of the 1918 pandemic which made it so bad, rather than it being inherently dangerous. Since the peaks were associated with mass movements (of American troops to France in 1918 and global demobilization in 1919)?
No argument there.
Seconded
NPR: “ 2009 Flu Pandemic Was 10 Times More Deadly Than Previously Thought”.
The real danger of influenza is that it can promote a cytokine release syndrome (sometimes referred to as a “cytokine storm”) in perfectly healthy patients in which an overstimulated immune system response produces a runaway systemic inflammation which does far more damage than the viral budding itself and with such rapid onset there is only a short window for effective treatment. Having experienced this myself even in a mild form (ironically, in a rare reaction to a flu inoculation)
I can attest that it is not fun. Immunologists don’t know why this occurs and the only effective treatments involved essentially shutting down the immune response leaving the patient vulnerable to secondary infections. Many stains of InfA(H1N1) seem particularly prone to this, but as far as I’ve seen the SARS-CoV-2 is not prone to causing a runaway cytokine response and the major concern is lower respiratory distress.
Stranger
It is generally now believed that this is why Spanish Flu was so deadly, and why it was so unusually ferocious in killing young, healthy adults.
There was a study from China that suggested a cytokine storm might be responsible for increased mortality from SARS-CoV-2, but I haven’t seen that confirmed in other studies.
Blog of someone in Italy:
https://boardgamegeek.com/geeklist/270443/our-life-lockdown
Brian