Coronavirus, Update April 20th, Day 60

Coronavirus, Update April 20th, Day 60

Today 735 new cases in Lombardy out of 6.300 tests (the ratio has risen by 0.1%ish: let’s not get too fixated on that number).

Good news on hospitalizations as well ICU admissions which both showed a decline.

163 new deaths, in line with yesterday although down compared to the past few days. 454 overall in Italy.

Data at a national  level were provided by Mr. Borrelli (Civil Protection department) who finally is not giving the number of “new positive cases”.

Key concepts to know

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As we have already remarked several times, this definition makes little sense, as the new patients being counted are the new confirmed cases (2.256 today) while the difference between yesterday and today of the  “currently positive” does not identify the new patients, but rather a difference that today is negative for the first time: -20.

As we can see today, that value does not tells us about the strength of the contagion, yet it is the result of three different forces (contagion, recovery, and deaths).

Seeing a negative number is definitely encouraging, as it indicates that the curve symbolizing the still actively positive patients pressure is declining. It’s too bad that

self-isolations are not properly monitored and added to the recovered patients, if this was the case we would have had a negative result days ago, consistently with the real epidemics’ trend.
In short, a useless data.

Again, Borrelli and the news services do better to focus more on the contagions, that are anyway more important.

By the way, the 2.256 new confirmed cases have to be correlated with slightly more than 40.000 tests, thus the proportion is quite good, and the chart of the % increases benefits nicely. Overall we are at 1.3%.

The National Center for Health, coordinated by Prof. Ricciardi, has published some estimates on the contagion trend in the next few weeks, providing each region with a minimum date before which he expects new contagions to go to zero. The estimates seem reasonable overall with some surprising exceptions from my standpoint.

For instance, in Lombardy, the total absence of new cases cannot be expected before end of June (quite reasonable), same in the Marche region, that was actually doing quite well thus I do not really have an explanation for such estimate.

The first regions expected to be COVID-19 free are Basilicata and Umbria (April the 21th, i.e. tomorrow!), then Molise April the 24th, Sicilia and Sardinia, April the 30th and 29th respectively, Calabria May the 1st. We have Puglia and Abruzzo on May the 7th, Campania May the 9th, Lazio May the 12th, Valle d’Aosta May the 13th, Liguria May the 14th, Trento-Bolzano My the 16th-26th, Friuli May the 19th, Veneto and Piemonte May the 21st, Emilia-Romagna May the 29th, Toscana May the 30th and last but not least March, June the 27th and Lombardy the 28th.

This is brings a smile to my face (don’t get me wrong, this report is well done).

The Center warns that statistical models used are not epidemiological as they are not based on the overall exposed population, the more susceptible people, or the R0 but  rather on the approximate the trend of new cases observed over time.

I feel less lonely. The Center also adds that the projections consider lockdown measures and clearly warns that in case such measures were no longer in places, these projections will lose credibility. It finally underlines that the precision of such projections is related to the correct detection of new cases, it is quite obvious that such cases can be underestimated due to the presence of asymptomatic infected as well as the number of tests carried out.

 

I totally agree with that. This is why when answering some questions on why I don’t extend my projections to May I explained that such projections would be too arbitrary. 

I would end up extending my projections, with smaller and smaller numbers without considering possible reactions to the easing of lockdown measures which is exactly what we should expect in the future, right?

For the moment, let’s just live day by day with updated estimates but the same time horizon. The Center will stimulate our imagination.

Have a good evening,

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.