Coronavirus, Update April 15th, Day 55

Coronavirus, Update April 15th, Day 55

Wednesday again confirms to be the day in which the number of cases rises.  It might be related to the resumed testing activity that scales back later in the week.

As we expected yesterday’s decline, we had to expect a decent increase in new cases today, especially after the Easter holidays.
We are accustomed to the abstruse relationship between tests and cases, more understood thru common sense and sheer hunch rather mathematics.

Key concepts to know

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Charts are much better for that as they give us a perspective over time and help us see fluctuations for what they are. We are only interested in seeing the decline continue, at the end of the day.

Today’s numbers in Lombardy are definitely good. 827 new cases out of more than 7.000 tests.

Both hospitalizations and ICU admissions drop. Deaths are still 235 but a slow downtrend can been seen here as well. It’s too bad we don’t see positive signs from the province of Milan, which continues to struggle.  

It is quite clear now that the end of the lockdown is in sight, with masks and sanitizers accompanying us for the foreseeable future. We will get used to an endemic that will keep hanging around for some time. Experts are discussing possible options for reopening. We hope that in the meantime most areas will reach such a low rare of contagion that containment and, possibly, further declines will still be achievable despite a cautious resumption of business activities.  It does not seem unrealistic and most of all, we do not have any other alternatives.

This period has been important in educating all of us on social-distancing. We all know quite well that May the 4th will not be the “national hugging day”.

 

From the rest of Italy: the number of deaths is still concerning but a we also have to report a significant decline in new cases despite the high number of tests. The average increase drops to 1.6 with many regions showing positive improvement and fewer cases for alert in the “traffic lights table”. Some regions are still lagging behind (Piemonte, we know) but the trend is overall quite good.

In the analysis and projections I added a few tables with some figures and dates of the peaks for each curve. It makes it easier to navigate the data and spot the regions that have a “cumulative approach” to grouping patients in self-isolation at home and other regions, that fortunately are more and more numerous each day, that are witnessing a downtrend of the green curves, proving the existence of a follow-up process for the self-isolating patients that includes the migration of “currently positive patients” to “recovered” once that the negativity is confirmed through two consecutive tests.

The recovery time is quite long, for this reason it is crucial to have an active approach towards infected patients and relatives that self-isolate at home, in order to make the decision to interrupt the isolation less arbitrary and more dependant on the guidelines provided by experts.         

As we have recently flagged, a small difference in the curves might reflect the quality of the monitoring process put in place by each region. It is quite sad to acknowledge that Lombardy is not among the most virtuous regions when it comes to thoroughly monitorizing the several types of existing cases.  

 

We do not want to insist too much on that. Maybe someone will listen to us, sooner or later.

Maybe some daring journalist will ask Mr. Borrelli the reason why the number of “currently positive” never declines despite the continuous drop in the new cases and the lowering pressure on hospitals. Tonight someone brought up the aspect of recoveries (Spain vs Italy) but no convincing answers to the question were provided, yet once again.

Enjoy a wonderful evening

Dr. Paolo Spada
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He is a vascular surgeon at the Humanitas Institute in Milan: this article, also published on his Facebook profile, is a daily update regarding the trend of COVID-19 in Italy based on official data published after 6 pm by the Ministry of Health.

The reports I publish here are based on official information. I am a doctor, and I report the numbers that the Ministry of Health issues every evening after 6pm. My job was to automate a system of graphs that show the same data over time, and divided by areas, a few minutes later the dissemination of raw data. It is a useful job, first for me, to understand the progress of the epidemic, but that many websites, and newspapers, do better than me, with interactive and much more complete graphics (as well as all over the world, not Italy only). What I add, taking advantage of some years of experience in the development of algorithms applied to medicine, is a series of projections, that is, attempts to predict the epidemic in the following weeks. It is not a question of wanting to see in the crystal ball, but only of getting an idea of ​​the possible scenario, which day by day you can glimpse on the basis of the real data available. The algorithms were initially designed on the basis of the data of the experience of the epidemic in China, the only available benchmark, against which our numbers, which can be almost superimposed in the first few weeks, vary significantly over the course of days. The projections therefore change, as data is acquired, and are also subject to “assumptions” which presuppose a certain degree of arbitrariness. Among the various hypotheses, I try to represent the “minimum” scenario, that is, the one that will probably happen even in the best of cases, or for good that the contagion goes from here on. Compared to this “little but safe” (which however is never safe) I prefer to contemplate more severe scenarios only if supported by further evidence. Finally, it should be added that the same official data are often incomplete, discontinuous, and discordant in the method of collection between one area and another in the country. An example is that of the number of infections, widely and variously underestimated, but it is not the only one, unfortunately. Although with many limitations, and lacking in the representation of the spread spread in the asymptomatic or paucisymptomatic population, these reports still provide a reading of the health burden, the effort required of hospitals, intensive care, and the number of deaths. The emergency is here, and this remains my focus, with the sole purpose of being somehow useful, and in absolute good faith. I therefore distrust anyone from the improper use, or in any case not previously authorized, of the images and comments. The content of these posts is the result of an initiative carried out in a personal capacity, in no way related to my professional activities and the institutions to which I belong. On the other hand, I have an obligation to mention, with pride, the commitment and the high social and human profile shown by doctors, nurses, and by all the staff and management of Humanitas Research Hospital in coping, at the forefront of this dramatic emergency.