New coronavirus: Italy at war

Posted: March 7, 2020 in Uncategorized

There are scary lessons to be learned from the terrible threat Italy is facing. The US and other nations better listen. Time to get ready is running out much quicker than you think.

Italy

Covid-19 hospital admissions in Italy, including those in intensive care (see Figure above), are doubling every sixty hours and before the end of the month they risk being 10 times what they are now.

This is the same dynamic observed in Wuhan in January and February.

The outbreak does not start harmoniously diluted in an entire country: it hits certain territories first. In the small town of Codogno, two weeks ago Italy’s presumed “patient 1” went to the hospital emergency room twice in 24 hours and infected a host of fellow citizens and medical staff.

Because of that, the surrounding region was the first to get hit. And now the health-care system of Italy’s Lombardy region, one of the most efficient in the world, risks being destroyed in four weeks unless the Government takes draconian measures.

Direct fatality from Covid-19, a small percentage of people infected, is not the biggest problem now.

The biggest challenge is how to protect the public health system and avoid that multitudes end up dying from all other reasons in numbers much greater than the normal.

If that challenge is not won, then

  • the Lombardy health system will kneel at the end of March, with beds in sports halls and schools, and personnel exhausted and largely insufficient;
  • deaths of non-Covid patients deprived of access to treatment (heart attacks, strokes, trauma) will explode within a month;
  • the Italian national intensive-care (IC) capacity will be exceeded by a factor of 10 by mid-April;
  • in two months the entire Italian health system will be destroyed and very few people will have access to medical treatment of any kind anymore.

There are several types of fronts on which to fight to avoid that fate. They are all known and already pursued. But it is being recognized that the scale of the effort must be multiplied:

  1. First and foremost, circulation and even small gatherings of people must be kept close to zero for several weeks in order to minimize the ‘survival’ of the virus. An extremely difficult undertaking in open, democratic societies. Furthermore, a few simple personal hygiene rules must be communicated obsessively to the public.
  2. Health-care personnel, from family physicians to workers in any hospital ward, must be carefully protected from infection.
  3. Public health capacity, both material and human, must be expanded as quickly as it is being abused by Covid-19. Remember Wuhan building hospitals by the week? Italian hospitals have already had masons work overnight to tear down walls and expand IC areas, and military and para-military field hospitals have been built in outside parking lots.

Improving on (1)…(3) above entails a formidable logistic, industrial and political task.

As an example, there is an ongoing breathless redesign of the whole hospital system in Northern Italy, affecting 20 million people and 140,000 medical staff. Patients are being relocated tens of miles away. This happens only two weeks after the first outbreak was discovered, with a mere five thousand people infected in a country of 60 million.

As another example, French and German authorities have asked their industries that they turn down Italian – and other countries – purchase orders to procure ventilators, FFP3 masks, and some of the drugs most-needed for the Covid-19 disease.

This could force Italy into a spiral of twisted autarky measures, damaging the European Union stability and creating a dangerous ripple effect worldwide with unimaginable consequences

So what?

Let’s hope Italians manage to get out of this nightmare. Clearly, a decisive help will come if measures adopted thus far turn out useful to reduce the spread of the virus.

The US and other countries must begin immediately to leverage Italy’s experience to get ready right now for when they will have to tackle the same challenges. Which could be very soon. It is better to be roughly right than exactly wrong.

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