Coronavirus, Update April 23rd, Day 63

Coronavirus, Update April 23rd, Day 63

For the Lombardy region:  500 people were discharged from Covid treatment units while another 27 patients left ICUs.

Total ICU patients being treated has dropped from 1381 to 790 in just twenty days.

These are the only “true” data whose significance can’t be called in to question, especially given the consistency of the drop over the last days.

Key concepts to know

Leggi l’articolo in Italiano

Total new cases in the region were 1073, on a total of 12,000 tests. Deaths amounted to 200.  A large number of recovered patients recorded in hospitals while new cases showed up in the home isolation total (we had the first and only drop there a few days ago).  Are these numbers true?  They are, but in some way only partial data which can lead to confusion.

Are the new cases actually new infections?  Or are they pre-existing cases, by now asymptomatic which have been carrying traces of the virus in the mucus for last weeks?  The number of tests is highly variable and includes many control tests. From tomorrow we will start to report the actual number of people tested which may be more insightful but let’s not delude ourselves.   We are always doing limited sampling. The number of people infected is far greater and our ability to identify them, to understand if they are still contagious, is limited.

The deaths themselves are something which tell us more about what has happened, and less about what is happening.  As we said yesterday, we would like  more information, further details about the deaths. In the absence of this, we only hope we will begin to see a drop in these numbers soon. Overall the number in Italy was 464 in Italy. It is improving but VERY slowly.

Today Dr. Borrelli cited what we will call the inverted In/Out rapport, due to the prevalence of people healed versus new cases. Unfortunately the healed data is not always healed: for instance in Lombardy it’s the people discharged. The positive cases are not always positive cases. Many of the home isolation cases are likely healed but we have no real idea of these numbers.  The actual R0 is somewhere between 0.5 and 0.7 and it continues to move lower.

Even the serological test, which was launched in four provinces of lombardy today, are raising a lot of questions.  The official validation has not been given. We do not know if the antibodies give immunity and if so, for how long. Everyone is asking for the test but to do what exactly? Beyond the noble and useful epidemiological scope, much remains to be understood.

Yet in this sea of uncertainty, the only sure data is telling us that the epidemic is passing, that the containment measurs are working and that things are getting better. For now let’s be satisfied with this. Tomorrow is another day.

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.