COVID-19: What actually IS happening in Italy and WHY?

[DSeid]

First a link. Some numbers and facts in this post are pulled from there.

Per the Hopkins site - current “confirmed cases” in Italy (which I think all can agree is likely a huge undercount) 21,157. Deaths 1441. Most concentrated in the northern regions of Lombardy, Veneto and Emilia-Romagna.

Average influenza season deaths in Italy about 17,000. Influenza season is still in progress in Italy, not at peak but still “elevated.” Across the EU of those with symptoms of fever, cough, so on (the way both influenza and COVID-19 presents) 38% test positive for influenza in most recent numbers. What is happening in Italy is happening overlapping with influenza. And guessing here from the numbers we have above, for the northern region could be adding maybe a 40ish% more of a seasonal influenza’s morbidity and mortality for the region* added to an influenza demand in progress, albeit past peak, and concentrated in one month rather than spread out over five.

The region’s healthcare system is more than strained handling that. Once capacity is exceeded it is a disaster zone. Each drop over the top of a wine glass spills on the table. And so far it is not killing many times more people there than a season of influenza does. That can change. Or not.

So why is it so much worse there than anywhere else? (And to relative population scale we can include Hubei even.)

Well, ideas in the linked article -

The virus was likely already spreading there well before the first case was officially diagnosed, from early February likely. (In which case the number of infections is much much higher than reported and there is some number of deaths that occurred caused by COVID-19 never diagnosed as such.)

Italy has an exceptionally old population.

Pollution is bad there.
My WAG includes the above and expands on the second. As I’ve mentioned in other threads all the current information we have shows that COVID-19 is very different in the dynamics of its spread than influenza and many other germs in that children do NOT seem to be highly significant drivers of contagion. They may be catching it from adults in big numbers (and if so getting very mild and mostly undiagnosed disease) but unlike influenza they are not spreading it. Functionally they behave almost like non-susceptibles in any epidemiological model. If it is true then more kids means less spread instead of the usual kids as amplifiers of the spread into adults.

Italy does not just have lots more over 80 than many other countries, they have had a low and shrinking birth ratefor years. For this bug it may be less kids means more spread faster, and higher death rates per infection. Really very different than influenza.

Northern Italy may represent a confluence of worst case circumstances for this particular disease. Overlapping with a reasonably bad flu season, unrecognized for over a month before social distancing of any sort was implemented, fewer children and many more high risk elderly citizens than many other regions.

And it is bad. Very bad. But if we assume that the true number of deaths so far is twice the current number (those before missed) and that we will get twice that number before it is over, then the total mortality may still roughly be in the range of a bad flu season, 50ish% worse than an average one there.

That is bad. Adding a bad flu season to even a not bad flu season would exceed our country’s health systems capacities. Having relatively more kids around and overall being a less elderly population helps us, and its coming on as flu is dropping further helps us too. Knowing early on to minimally protect the higher risk population as it travels through and to take actions to reduce the speed of its spread (which actions have the most return and which might cause more harm than good a fair debate to have), should help us more.

*I’m using a wild-assed assumption the northern region generally gets about a fourth of Italy’s influenza cases, so 4.25Kish deaths each year, so 1.7/4.25.

[monstro]

Coronavirus: More young patients being admitted to hospital, Italian doctor warns

“The type of patient is changing,” Luca Lorini, the head of anaesthesia and intensive care at a northern Italian hospital, has said.

“They are a bit younger, between 40 to 45 years old and the cases are more complicated.”

Dr Lorini, who works at a hospital in Bergamo, told radio programme RaiNews24: ”People are arriving who got ill six or seven days ago and treated themselves at home – and then their conditions became more and more critical.”

Twelve per cent of those who have been treated in intensive care are aged between 19 and 50, according to official figures released last week. Around 52 per cent are between 51 and 70 years old, with the rest all over 70.

[monstro]

Italy isn’t alone in seeing a higher than expected number of younger patients with severe symptoms.

Most French ICU patients with virus are under 60

[MandaJo]

Is it that kids don’t get it, or is it that their symptoms are so mild they don’t get tested? And if the latter, does that mean that they are less contagious?

I agree that the was kids respond to the virus is weird. But absence of evidence is not evidence of absence, and it seems like the worldwide pattern of not testing people that aren’t super sick means we really don’t know.

[Mangosteen]

Northern Italy is a hotbed of illegal immigrants from China who were brought in to work in the garment industry. The factory owners are able to stamp “Made in Italy” on their products as opposed to the less desirable “Made in China” label. The vast majority of these Chinese are from the Wuhan area.

CORONA VIRUS EXCLUSIVE: WHY ITALY? - AltNewsMedia

[DSeid]

@monstro

Coronavirus: More young patients being admitted to hospital, Italian doctor warns

@monstro

Italy isn’t alone in seeing a higher than expected number of younger patients with severe symptoms.

Most French ICU patients with virus are under 60

Of course this depends on how you read it. In France, at this point, is a bit more than 150 under 60 a bigger than expected number, or is it that a bit less than 150 in ICU over 60 a significantly smaller than expected number, a result of social distancing done by that group beginning two to three weeks ago?

These numbers may reflect who changed behaviors when. The alarms of increased case number started to go off in France about two to three weeks ago. It is perhaps reasonable to assume that highest risk elderly adults started social distancing themselves in greater numbers and in greater degrees at the first alarm bell, when they were specifically advised to stay home as much as possible, and now two to three weeks later are catching it much less often? While younger citizens, even those with chronic conditions, engaged in few behavior changes at all and now represent a much bigger n?

Italy started to have its awareness of its numbers of cases a week or so earlier than France, and also likely started to have differential behavior changes beginning then, before the regional lockdown. If modest social distancing by the highest risk in particular is effective at protecting them as much disease swirls around, then the elderly should be making up a decreasing fraction of the total diagnosed cases and of the total in ICU or dead, the rate of rise in death rates should begin to become less steep, and the mortality rate of diagnosed cases drop.
Mangosteen good point but more broadly put, air travel connections with China historically overall.

The high number of coronavirus infection cases in Italy may be explained by the expanding air travel with China.

Italy is the European nation with the highest number of air connections with China after the air connections between the two countries tripled earlier this year.

From the first Time link -

Italy was the first European Union country to ban flights to and from China.

The travel ban, however, may have encouraged travellers to come in on connecting flights without disclosing their country of departure. Some experts also believe the virus could have entered the country before the government took action, spreading undetected throughout the country.

Manda JO, what we “know” is that diagnosed cases are low, significantly ill is rare (non-zero), and that in South Korea’s testing and other contact tracing activities kids get it as often from household close contact as adults do, but are not, in those studies, apparently spreading it to others. Numbers not big enough to say that child to child or child to adult spread does not occur to some degree, but big enough to know that kids are not a very significant driver of spread in the way that they are for influenza. I cannot imagine that they do not spread it at all. LIKELY that means they get it but in far fewer numbers than they do for influenza AND that they have milder symptoms.

[monstro]

@DSeid

Of course this depends on how you read it.

Everything depends on how you read it. Including everything in your OP.

There is a hypothesis floating around that the Europeans are grappling with a different strain than the Asians. Both this hypothesis and yours are quite interesting and I’m sure we will nail down what’s happening when we can get to a point where we can mine the data thoughtfully. But we don’t have enough information to do that now. All we do know for sure is that everyone–not just the elderly–should be practicing social distancing and staying home as much as possible. I don’t think this message has really sunk in because the focus has been so much on “DO IT FOR NANA!” and not enough on “DO IT FOR YOURSELF!” Unlike in Italy, a lot of younger Americans do not live under the same roof as their parents and grandparents and thus may not be persuaded to rein in their social behavior for their sake. I’m worried if we don’t make it more about them and their safety, they just aren’t going to care.

So I wish there were PSAs about this thing on billboards, radio, TV, cable, social media, and streaming services. There are a lot of heavy-smoking obese, diabetic, asthmatic, 20-somethings who are club-hopping and spring-breaking right now who have not been properly educated about the risks they are taking. And it’s not just 20-somethings. I have a 59-year-old friend who just flew out to Florida for a spontaneous beach vacation, and I have a 50-year-old sister who is fixin’ to do the same. Some people are foolish and wouldn’t change their behavior unless someone threatened to throw them in jail. But I think a lot have been misled by all the “wisdom” floating around on social media. We don’t know a lot about the age structure for ICU patients suffering from COVID-19. Maybe those are the kind of statistics people need to be see instead of the average age of fatalities.

[DSeid]

@monstro

Everything depends on how you read it. Including everything in your OP.

There is a hypothesis floating around that the Europeans are grappling with a different strain than the Asians. Both this hypothesis and yours are quite interesting and I’m sure we will nail down what’s happening when we can get to a point where we can mine the data thoughtfully. …

Agreed that we should, in our discussion, be careful to state what we know as fact and what is one interpretation, inclusive of those who make statements about how many more times deadly this is than influenza based on the very limited data we have.

The OP itself hopefully does that, stating clearly what we DO know specific to Italy and COVID-19, and what is speculation as to why that might be and what it might mean for everyone else.
Meanwhile some links about mutations that have occurred and what they might mean about different strains for those interested.

This tool has tracked various point mutations to create family trees and thereby the virus’s migration patterns. You can click play to see how they deduce it has travelled. More of their main page to explore in more detail.

In this report, we show that the virus is widely circulating across the globe, with evidence of local transmission on multiple continents. At this time, we urge focus on efforts to slow the spread within communities; travel bans are less likely to be effective.

In this week’s updates, we report:

COVID-19 is circulating widely across Europe, with significant movement between countries.

We identify at least 4 introductions to the UK, some with onward community transmission.

There have been a number of travel-related cases linking Iran with other parts of the world.

There have been many introductions into the U.S. to date, resulting in local transmission chains in multiple states.

The outbreak continues to grow in Washington state; some cases are closely related to those from the Grand Princess cruise ship.

There is local circulation of COVID-19 in California.

Social distancing measures should be enacted swiftly to ease the burden on healthcare systems and protect the vulnerable.

The two strain bit comes from the study discussed here.

The new coronavirus, like all other viruses, mutates, or undergoes small changes in its genome. A recently published study suggested that the new coronavirus, SARS-CoV-2, had already mutated into one more and one less aggressive strain. But experts aren’t convinced.

In the study, a group of researchers in China analyzed the genomes of coronaviruses taken from 103 patients with COVID-19, the disease caused by SARS-CoV-2, in Wuhan, China, the epicenter of the outbreak. The team found differences in the genomes, which they said could be categorized into two “strains” of the coronavirus: the “L” type and the “S” type, the researchers wrote in the study, which was published Tuesday (March 3) in the journal National Science Review.

The researchers found the “L” type, which they deemed the more aggressive type, in 70% of the virus samples. They also found that the prevalence of this strain decreased after early January. The more commonly found type today is the older, “S” type, because “human intervention” such as quarantines may have reduced the ability of the “L” type to spread, researchers wrote in the paper. …

The article goes on the review why some/many are very skeptical.

Note: there is no information one way or the other as to whether or not any of the mutations identified in the first two links impact virulence at all either way. Nor at what point one designates any as different strains.

[Gatopescado]

Someone suggested to me, it’s because the Italians are a little ‘handsy’. Far from a scientific answer.

[Deeg]

DSeid, just wanted to say thanks for continuing to post stats and info about the situation and keeping us sane. You’re doing a good job walking the line between “It’s just the flu” and “PANIC!”.

[PookahMacPhellimey]

The pollution element is actually interesting and something I hadn’t heard before. I live in Veneto (so much fun right now) and it’s one of the most polluted regions of Europe. In fact, whenever I’ve had a “normal” cough it has taken ages - or a trip to the beach - to clear up. Obviously, this is way into the anecdotal, but it’s something I’ve noticed before The Big Mess, but I hadn’t made the connection. It might be worth looking into at least.