Coronavirus, Update April 11th, Day 51

Coronavirus, Update April 11th, Day 51

Lombardy on the rise, again. 1.544 new cases, on  fewer than 10,000 tests.
A good chunk of them come from Milan.
ICU admissions are still a touch lower, while hospitalizations are back up again.
This applies to Lombardy though and not the rest of the country.
On a positive note, on average, the cases requiring hospitalization are less serious than seen in the past.
We would like to know a little bit more about the new cases in order to have a better idea of the contagion mechanisms that have so far eluded the lockdown measures.
But as of today, we do not have it.

Key concepts to know

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Data are up also at national level, back to 4.694 new cases which is only partly explained by the higher number of tests.
Also, another 619 deaths.
No comment on that in today’s press conference.
There is focus on pediatrics: generally speaking the questions had a pre-Easter tone.

Lots of focus on the declining number of hospitalizations, which is really great news, but sadly the only one.

On the basis of such data, our algo has updated its estimates, revising them upwards but without losing its positivity. Still, it’s definitely not an Easter present.

From the charts, Piemonte is notably higher in many statistics, something we have seen in the past, when it always retraced. Hopefully it will be the case this time as well.  A few regions improve, others get worse, the overall Italian overall data back to 3.2.

Tomorrow I will take an Easter break. I will update the numbers but I will be back with my commentary on Monday. Maybe we will all find some benefit from the short break.  If not a real resurrection at least some relief from what is otherwise an anxious atmosphere.

I would like to add a new aspect related to the data of recoveries released by the Ministry of Health, that is getting more and more pressing every day. The different way the charts look these days depends on the way such data are laid out. I will try to give you an explanation for this, also because many important aspects lie behind the data issues and are worth consideration even for those who are not experts..

A few days back, as you might recall, I brought up an issue, as did others, with the official repository of the Ministry of Health that releases the data coming from each region. We had flagged that Region of Lombardy, in their press release communicated to the Ministry of Health, only includes patients that had been hospitalized. Self-isolating patients were not included.

Note well: I am not referring to people in voluntary self-isolation never registered as positive cases despite having had symptoms and never reported in the official data. I am only considering the “currently positive people” that are left at home in self-isolation, many of whom can assumed to be healed.

We had made clear that not only does Regione Lombardia consider patients dismissed from hospital as totally recovered (a technical error because according to official sources, a recovered patient is the one that has tested negative twice in a row but  in reality such good practice is rarely applied before dismissal) but it also reports only these cases while putting all the others in a  “voluntary self-isolation” bucket as if they were cured BUT without including them in the official ministerial data.

It might now be quite evident why the number of recoveries in Spain is twice as large: if Lombardy, the epicenter of the contagion, does not include such numbers, the comparison makes little to no sense.

The head of the civil protection, Borrelli is communicating every evening the updated “actually positive” numbers, waiting for it to go zero, as one would expect in this period of the epidemic BUT the data (or non-data) of Lombardy weighs on this difference more and more!

Looking at the In/Out data, it is obvious to wonder how many and which other regions will adopt the criteria used by Lombardy. My idea is that it will be the majority (perhaps except for Marche and Umbria).
We asked the data providers about that and today we were told that we will receive an answer soon.

This aspect does not change the whole picture that we look at every night in order to appreciate the residual strength of the contagion: the number of new cases is still the most appropriate gauge.

But my opinion is that all this confusion around the number of recoveries casts further doubts over the reliability of the overall reported figures in a period when the data is pivotal in order to understand where we are in the outbreak. This will be even more important when the lockdown is scaled back.

I am not looking to be controversial.
I want to stay positive.
But every epidemiologist knows that the recovery rate is a game changer: we need more clarity on this data. Also, as a clinical doctor, I would like to add that if we stop following up on the relatively few patients that were reported in the data – maybe one twentieth of the total – we miss out on the opportunity to control the contagion by tracking relatives, contacts, colleagues, etc.
This is a job that needs to be done.
I totally understand that the emergency has put the entire system under severe pressure, at all levels.
But now it is important to step up and do what is needed.  (By the way,  we also publish the LOM Alert App which the region is using to map the infection, not house by house but by zip code. If you have not downloaded it yet, it is time to do so).

Regarding our graphs, for the ones with the projections, I have further dividend the yellow bars (those currently positive) in to three catagories: Intensive care, hospitalized, and home isolation trying to overlap the color of the last group with the one representing people healed, which, at least for a good part, is more correct.

In short, it’s an optical effect which tries to take in to account every possibility. In fact, it’s very likely, as I have said, that the criteria differ between various regions, so please be patient. It is the best we can do with what we have

Have Easter to everyone and we’ll be back in touch Monday evening!

Dott. Paolo Spada
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