Coronavirus, Update April 17th, Day 57

Coronavirus, Update April 17th, Day 57

The drop in both the number of new cases and in the ICU admissions continues, confirming the progressive slowdown of the contagion after the more acute phase.

The increase in the number of tests is also a phenomenon to look at positively as it gives a chance to extend the screening more and more to the self-isolated patients, finally described as the “final frontier” in fighting the epidemic.  

As we certainly know, this means increasing the chances of detecting new positive cases and to feed our anxiety thru our charts and projections.

Key concepts to know

Leggi l’articolo in Italiano

I did all I could in the last few weeks to make you more familiar with these charts, I see with much relief that you have learned to interpret them in a savvy manner, on both the good and the bad days. Today is an “average” day overall, as you will be able to see yourself.

Some inconsistencies between projections and actual data remain evident with respect to the trend of self-isolations at home which only very few regions have started migrating into the “recoveries” bucket.

The death toll remains quite remarkable.

This morning during the conference held by the ISS (Istituto Superiore di Sanità) we received confirmations on many of the issues and doubts raised by many of you in my posts and to which I tried to provide as many answers as possible during the past few weeks.

I am referring to the “identikit of the average infection” which would help us understand the mechanisms behind what really makes virus transmission happen.

At the moment the ISS does not have this information. They are planning to gather this data moving forward, following the virtuous example of Germany.

From the experiences accumulated thus far and the contribution provided by several health workers, it is now quite clear that the so-called “clusters”, households and small communities are the main driver of the contagion.

It appears there is an “extended time buffer”  that leads to subjects of the same cluster to contract the infection in subsequent periods, emerging clinically with significant delays also because of a lack of monitoring within the cluster itself, as well as the time needed to make the tests and carry out the analysis. Only in the last few weeks has a strong screening activity been implemented, starting with nursing homes and often resulting in the sporadic peaks in the number of cases, as reported in our charts. It is not surprising that, in the absence of an effective screening, the only macroscopic effect was the high number of deaths, growing slowly yet steadily compared to the number of new cases.

Equally disappointing, and I say this without the intent of causing controversy, is the analysis of the nursing homes carried out by the ISS starting from end of March thruquestionnaires.  The ISS managed to obtain feedbacks only from one third of these facilities across the country and added little insight to the general feeling that a silent slaughter is happening among these communities (due to age, pre-existing conditions of the patients, space sharing, lack of personnel).  As a result, the ISS has been unable to even provide solid and reliable estimates of COVID-19 related deaths.

We don’t even know the death rate of the past years or even the number of patients populating these facilities.

It is not my goal to point my finger either at the ISS or at the Nursing homes, and will do my best to arrive at an fair, rational view without prejudice, as the authorities are currently attempting to do with some of the situations in Lombardy.  

 

For the moment I will focus on the delays and lack of clarity of the information provided, and this is a serious problem to address. It has tremendous impact on the decisions as well as the actions that will be undertaken, with enormous consequences, only downsized by our perception that they cannot be fully explained and understood.

This epidemic is showing much about us: our great strength and willingness to resist and react. It is also telling a lot about the structural issues affecting this Country, namely the inability to prevent problems even more so than sorting them out. And both of them will be tested in the next days.

 

Dr. Paolo Spada
Link to my Facebook page

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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.