What the F**k is going on with Italy’s coronavirus nightmare?

Although the Covid-19 coronavirus started in Wuhan, China, and ran rampant through the entire Hubei province, it is quickly becoming obvious that Italy has overtaken China as the current viral hotspot of this outbreak. Why is this? What happened in Italy that caused this historical tourist destination full of vibrancy and joie de vivre to see a such a virulent outbreak that is decimating their country?

When a 38-year-old man with severe flu symptoms and respiratory problems walked into the emergency room at a hospital in Codogno, a small town in the Lombardy province of northern Italy on February 18th, medical professionals were not too concerned. Despite the well-documented and dangerous spread of what was then called the Wuhan Coronavirus in China, this man reported that he had not recently traveled nor had any direct contact with anybody who had recently traveled to China, with the exception of one friend who had returned from China but had already tested negative for the coronavirus.

Unfortunately, despite not traveling out of the country in recent weeks, this patient had had an incredibly busy month.

In the last couple of weeks, he’d attended at least three very social and busy dinners with numerous guests. He’d played soccer a few times and traveled with his team to different matches. In between, he had maintained an active and full social life full of meetings with friends for drinks, coffee, and lunch. When, on February 14th, he finally began developing symptoms and feeling unwell, he visited a local doctor where he was prescribed standard treatments for influenza. He resumed his lifestyle on a slightly muted level. It was later discovered that during all of this time and through all of his social contacts, he’d been Covid-19 positive and asymptomatic.

Even after his initial visit to the emergency room on February 18th, he didn’t isolate himself, perhaps lulled by the false sense of security in doctors telling him he just had the flu. He declined hospitalization and decided to get better at home. Later that same day, he was much sicker and returned to the hospital where he was admitted into a general medical ward. He was kept in close proximity to other patients and had a constant stream of nurses and doctors checking on him. Two days later, on February 20th, he was finally transferred to the intensive care unit where he finally received a positive test for the coronavirus and was put into isolation.

His wasn’t the first case of the coronavirus in Italy. On January 31st, two Chinese tourists in Rome tested positive, and a week later, an Italian who had been repatriated from Wuhan also tested positive. The Italian government had already suspended all flights to and from China, and there had been an uneasy silence as the health ministry waited to see if the virus had been contained. The case in Codogno squashed those dreams quickly.

Because of his very active lifestyle, specialists began calling this man a Super Spreader. It’s estimated that he personally infected scores, if not hundreds of people prior to his diagnosis. Although identifying Patient Zero in Italy has been impossible due to open borders in the European Union, Italian authorities have determined that this man is probably Patient One in the spread chart, having likely contracted the virus from another unknown European.

Without a traceable source of the contagion, and with the incredibly high number of contacts from this patient, Italy had no chance of containing the virus.

Doctor Walter Ricciardi, the scientific adviser to Italy’s Minister of Health, said that it was incredibly bad luck that this man, the Super Spreader, lived such an active lifestyle in one of the most densely populated and dynamic areas in all of Italy, and that he went to the hospital in Codogno not once, but twice, infecting hundreds of people including many doctors and nurses. “He was incredibly active,” Ricciardi said.

On Sunday, February 23rd, just a few days after the Super Spreader was officially diagnosed, Italians watched as the number of infected clicked stealthily into triple digits and authorities began to get worried. Eleven municipalities in Lombardy province were identified as coronavirus clusters and were placed under quarantine, locked down by police and military roadblocks. Prime Minister Giuseppe Conte canceled all sporting events in Lombardy Province.

Police man a roadblock in a sealed off town in northern Italy. credit…Piero Cruciatti Agence France-Presse

The next day, infections climbed over 200, seven deaths attributed to the virus had been recorded, the Italian stock market was in freefall, and PM Conte was looking for a scapegoat. He blamed the hospital in Codogno for contributing to the spread by not isolating the Super Spreader immediately, and also blamed them for instituting aggressive testing of even those patients without symptoms, something he claimed was exaggerating the severity of the problem by falsely bloating the case numbers. His concern? The economic damage to the country through what he thought was an unfair representation of the severity of the problem.

Sound familiar, Americans?

On February 27th in Milan, the largest city in the Lombardo region, only about forty miles from the center of the outbreak in Codogno, the mayor, Beppe Sala, began publicizing a campaign with the slogan, “Milan Does Not Stop.” He shared a Milan promotional video he’d had created that contained images of people hugging each other, eating in restaurants, walking in parks and waiting at train stations. The most famous square in Milan, Duomo Square, anchored by the landmark cathedral that is a major tourist destination, had been closed since the February 23rd lockdown instituted by PM Conte. Sala reopened it, declaring that the Milanese people would not let the virus interfere with their way of life. People came out of their homes and resumed their lives.

Duomo square in Milan credit Flavio Lo Scalzo/Reuters

Additionally, Nicola Zingaretti, the leader of the co-ruling democratic party in Italy began his own campaign of disinformation. On February 27th, he traveled to Milan where he posted pictures to his Instagram account that showed him eating and drinking with people in Milan with the following translated slogan, “Let’s not lose our habits, we can’t stop Milan and Italy. Our economy is stronger than fear: we go out to drink an aperitif, a coffee or to eat a pizza.” On the 28th of February, he returned to Rome where he met for hours with party leaders, jammed together in a close room, shaking hands and quite possibly discussing the overreaction of the Prime Minister. On March 6th, he held a press conference about the virus in a crowded room with associates and reporters.

On March 7th, he announced he had tested positive for Covid-19.

Drink and be merry, for tomorrow you may be dead.
Hmmm…why does my throat feel so scratchy?

By March 8th, it was readily apparent that Italy had a huge problem on its hands. Total confirmed cases had blossomed to almost 6000. Deaths grew in a 24- hour period from 233 to 366, an increase of more than 50%. Prime Minister Conte ordered the entirety of Lombardy province and 14 other provinces in the heavily infected northern Italy to be quarantined. The news of the imminent quarantine leaked before it could be fully implemented, and thousands of southern Italians who were on holiday in the north fled in a panicked rush to their homes in the south, jamming onto trains and furthering the spread of the infection throughout the country. Holding an impromptu press conference at 2 a.m., Conte urged the population not to panic. He was optimistic about the future and the success they would have in defeating the virus. He warned them to isolate and practice good social distancing. He urged them not to be clever and look for loopholes, but to do what they must to protect their aging population.

The quarantine was instituted and the 25% of Italians were completely locked down.

Police check travel documents and enforce quarantines at a train station in Italy credit Alessandro Grassani for The New York Times

It didn’t work. A day later, Italians were basically ignoring the orders and going about their business, huddled up in coffee shops and restaurants for their daily breakfast and lunch meetings, packing public squares, and hugging and kissing each other in greetings on the streets.

On March 10th, fatalities had nearly doubled from two days prior, hitting a total of 631, and Conte put the entire country into a national lockdown. A few days later, bars, restaurants, theaters, and all other non-essential businesses were finally ordered closed across the country. Conte addressed the nation and thanked them for their sacrifices in a very somber tone, far different from the earlier optimism he’d exhibited.

All the steps he’d taken had been reactionary, and those measures had lagged behind the lethal explosion of the infection rate. Italy was in a lot of trouble and Conte knew it.

“It is not easy in a liberal democracy,” said Doctor Ricciardi, at a press conference. He argued that the Italian government acted on the scientific evidence made available to it, and that they took the appropriate steps. Italy’s efforts to contain the virus were piecemeal though, shutting down first small towns, then provinces, then finally the entire country, while slowly closing businesses in the same lackadaisical manner, leaving enough loopholes to make the U.S. tax code look as sound as the vaults of Fort Knox.

All of their efforts just seemed to constantly lag slightly behind the virus’s lethal trajectory.

Sandra Zampa, the undersecretary of health in Italy admitted as much. “Now we are running after it. We closed gradually, as Europe is doing. France, Spain, Germany, the U.S. are doing the same. Every day you close a bit, you give up on a bit of normal life. Because the virus does not allow normal life.” Although she admitted they’d been constantly chasing the virus and had gotten caught in a complacency rut, she said she didn’t know what steps they could have taken differently given the difficulties faced by a democratic republic in instituting drastic and draconian measures.

Other Italian officials agreed, responding defensively to criticism, stating that they had done as much or more than any other democratic state to attempt to stop the coronavirus from spreading. They claimed they immediately acted on the advice of scientists and specialists and implemented unprecedented steps sooner than anyone. They’re only partially right of course, as the examples from earlier have shown. And the fact is, most of their drastic steps were reactive instead of proactive, and they missed many opportunities out of complacency.

And this coronavirus thrives on complacency.

In the United States, the population has much the same problem abiding by shelter-in-place and quarantine orders as Italy. In fact, it’s possible we have an even bigger problem. We’re far less family-centric than Italy, where grandparents live in generational family units and are revered. Much of the youthful population of the U.S. seems decidedly unconcerned with the effect of the coronavirus on the elderly of our community. They also seem to resent the authority of government to enforce stay-at-home orders, flauntingly ignoring the isolation pleas of governors by congregating on beaches, parks, and underground clubs. The complacency seen here in the United States seems to top that seen in Italy at the beginning of their growing struggle, and, as mentioned earlier, the coronavirus thrives on complacency.

The steps taken in Italy are arguably much more stringent than those taken in the United States. Here, we have only instituted shelter-in-place or stay-at-home type lockdowns in sixteen of our fifty states, with Washington State instituting that policy as I type this. Italy locked down their entire country. In the U.S., enforcement of the lock downs is sparse or non-existent. In Italy, travel authorizations are being checked by police at train and bus stations, and the military has been called in to support police with quarantine roadblocks around cities and towns. Will those militaristic and oppressive steps be implemented here in the U.S.? It seems really likely that our near future lies on exactly that path.

The inability of our leadership to present a unified front doesn’t help, much like it didn’t help in Italy with the Prime Minister telling people to isolate while the democratic leadership and the mayor at the epicenter of the outbreak declared, “We Won’t Stop.” President Trump tweeted the following on March 9th, just two weeks ago today, comparing the coronavirus to the flu in an insinuation that the flu was worse:

Just TODAY in a press conference to the nation, he made mention again of the death rate of the flu and even threw in the death rate of automobile accidents in order to minimize the fatality rate of the coronavirus. He also has been hinting that this lockdown will not last more than another week or so, the magical “fifteen-day” mark when he will reevaluate the impact on the economy and decide how best to proceed, hinting that he will probably choose to end the lockdown and restore the status quo. This is incredibly dangerous as studies like the one in one of my previous blogs shows. This lockdown will need to last for months, not a couple of weeks in order to be successful.

So, the real question is, what is the likelihood that we’re going to see a coronavirus path similar to the one seen in Italy? It’s a little difficult to make a true comparison because of a number of differences in our population:

  1. The median age in Italy is 47.3 years, where in the U.S. it is 38.3. Since the virus infects older people at a higher rate and more severely, it is less likely the U.S. will see the same fatality rate. On the other hand, people in Italy are generally healthier than in America, with obesity and heart disease issues significantly higher here. The coronavirus feeds on the unhealthy at an even greater disparity than it feeds on the elderly. That may mitigate the age spread factor, however, it’s impossible to do more than speculate as to how much.
  2. The population of Italy is 60.5 million while in the U.S. it is 331 million. The U.S. has about 5.5 times as many people, which means when comparing numbers, it’s necessary to multiply Italy’s numbers by 5.5 to get comparable numbers for the U.S.
  3. Although the population is significantly lower in Italy, the population density is higher. The virus spreads more merrily through a dense population, so while the results of cities like New York and L.A. may mimic the numbers of the population centers of Italy, taken as a whole for the country, it’s not likely the United States will see comparable fatality figures, especially away from the coastal population centers.

Let’s take a look at a weekly chart of cases and fatalities in both Italy and in the United States. Keep in mind that Italy was way ahead of the U.S. with regard to testing. As the U.S. finally ramps up testing, we can expect to see our confirmed case numbers explode in a way that’s difficult to compare. They’re still listed here for information, but mainly we should focus on the deaths as opposed to the cases.

 

Weekly growth of cases and fatalities in ITALY Weekly growth of cases and fatalities in the U.S.A.
February 23rd 157 cases and 3 deaths February 23rd 35 cases and 0 deaths
March 1st 1701 cases and 41 deaths March 1st 75 cases and 1 death
March 8th 7375 cases and 366 deaths March 8th 531 cases and 22 deaths
March 15th 24747 cases and 1809 deaths March 15th 3680 cases and 68 deaths
March 22nd 59138 cases and 5476 deaths March 22nd 33566 cases and 413 deaths
March 23rd 63927 cases and 6077 deaths March 23rd 43718 cases and 552 deaths

 

It’s somewhat difficult to see here on a weekly scale, but the fatality doubling rate in Italy has an average time span of about four days. The United States has about the same doubling rate. If you multiply Italy’s fatalities by a factor of 5.5 to account for total population difference, you can see that at the current number as of the time of this writing, the U.S. at 552 deaths would be equal to Italy at 100 deaths, which (not on this chart) was reached on March 4th, putting us 19 days behind them. Our death total yesterday, March 22nd, was 413, which would equal Italy’s 75 deaths which occurred on March 3rd, again, exactly 19 days behind them. Going back further, the U.S. had 68 deaths on March 15th which would equal Italy’s 12 deaths, and that occurred on February 26th, exactly 19 days earlier.

It’s impossible to say if this 19-day trend is going to continue, as there just aren’t enough data points to be certain, but the fatality rate sure seems to be following the exact path with the few data points that we have. In fact, if you look at a graph of fatality rates on a logarithmic scale, you can see that they look very similar, as you can see in this not-very-well-constructed overlay. In fact, though the comparison is not quite to the exact scale, the U.S. log track actually appears steeper, and that’s pretty terrifying.

If this rate remains identical, Italy’s 6077 deaths today, March 23rd, will mean 33,423 U.S. deaths 19 days from now, on April 11th, a number that is significantly higher than the number expected through the 4-day doubling average I observed and recorded in earlier blogs. 33,423 would represent a doubling average of about every three days instead, and the rapidly exploding numbers we’ve seen in the last five days or so would seem to support that rate.

If this holds true, it puts us on track to hit 1 million deaths here in the U.S. on April 26th, a good two weeks earlier than the mid-May timeframe I predicted for that ghastly number just two weeks ago.

This is not a prediction, it’s just simply an overview of the mathematical rate of expected fatalities, and a warning of what we might expect after analyzing what’s happening in Italy right now. It’s what we can look forward to if it is indeed true that the actions of the Italian people seem to mimic very closely what has taken place here in America. In Italy they are stacking up bodies because the morgue can’t handle the number of dead. There are reports of bodies lying in apartments for days, with nobody to pick them up to even take them to the morgue. There are reports of hospitals running out of supplies and instituting triage efforts to try to care for those they can still save. Doctors and nurses are catching the virus and dying, leading to even more desperation. It’s not a pretty picture and it’s been really bad there for at least the last 7 days.

If our infection rate and mortality path mimics theirs, it’s going to start getting really bad here about the middle of next week. That’s going to be right around the time Donald Trump is trying to get restrictions eased and isolation orders lifted. If he’s successful in that endeavor, things will be even worse.

It’s not going to be a great time to be anywhere in a major metropolitan center in America.

Let’s hope the numbers flatten out and don’t continue along this hellish and alarming path.

 

 

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