As was internationally announced, the Prime Minister of the Italian Government Giuseppe Conte has extended the deadline of the lockdown from April 13th to May 3rd for the whole nation. In the meantime, he is organising a task force comprising managers, economists and the like with the important job of bringing the country out of economic hibernation, with some non primary facilities having pilot openings based on the strategic importance and safety that each of these working activities can guarantee, starting from April 20th. In this way we’ll get a general feel for what is being called Phase 2, in other words what will be the process after the extensive quarantine and the beginning of a new period of safety at work. The worst enemy in this second phase has been named the “second wave”, or the risk to regress back into a period of heightened infections resulting in new red zones emerging, and even being forced to shut things down again. In this case, it would mean a nightmarish new spike in positive cases, with a lot of critical patients overcrowding the ICU areas again and the toll of daily deceased back on steady growth; all prices that Italy already paid, right up to late March. As with all previous measures, the new phase two strategy will be based on the data that is given every evening by Angelo Borelli, the Chief of Civil Protection, as he announces the toll during his evening press conference. Data everyone will need to take full advantage of, now especially when phase two is starting, and with which the future of Italy dangles. This data gives us three important figures. The first is the “confirmed positive cases”, those who have tested positive and are still infected at the days end. The next is the “newly infected cases”, which helps us study the virus’ spread through the population and who it is affecting, an essential statistic for us to understand to help stop it, but this statistic has a major flaw, as the new daily cases are based on the number of tests done, averaging at fourty thousand tests per day. Considering the relatively few tests done till now, Borrelli has admitted that the total number of coronavirus positive patients – comprising sick, mildly symptomatic and asymptomatic people – could be a much higher number, even thirty times higher than the official one at some estimates. With the limited reach of the tests, thousands of potentially positive cases go unchecked and unreported every day. The final figure that provides us with crucial information comes from the scientific committee of the Superior Health Institute, the organization has been supporting the Government in its policy making, and its figures consist of the number of serious patients hospitalized in ICU rooms. Thankfully this number is decreasing each day, albeit slightly; but with fewer patients who need special breathing equipment in the ICU, fewer will die from multiple organ and system failure due to prior health issues and the coronavirus induced breathing difficulties from pulmonitus, meaning patients who were at risk to suffer heart attacks and strokes because of lung inflammation have more of a fighting chance. It depends on the organ affected by the possible embolisms. The flattening of the lethality curve is also connected with another important and difficult figure, the number of people we have lost. In other words, the pressure on the ICU also flattens because many of its occupants die. We know that the rate of deceased will be the last to decrease in any significant way, and we know that the official data (20465 deaths the April 13) doesn’t represent all of the deaths for Covid-19. For example, it doesn’t take into account the thousands of old people who are dying in many elderly facilities, especially in Lombardy, where in its retirement homes the worst case scenario has already occurred, the cohabitation between unaffected elderly and mildly positive patients dismissed by the general hospital to lighten the load on hospital beds at the beginning of the epidemic. It is estimated that of the elderly deceased only a small part, less than ten percent, received the test and appear among Covid-19 deaths. The same thing has happened for those patients who started with mild symptoms and are being looked after at home by the family doctor with a phone-call diagnosis or the emergency services of Civil Protection, who are trained to provide emergency support in times of crisis. Based on recorded data, the witness accounts of many family doctors, and of relatives using social media, a significant number of “stay-at-home patients” suffer from worsening of their condition and then die at home without hospital access or even testing to officially confirm them. For this reason aren’t accounted for among the deceased Covid-19 victims. For this reason, it’s estimated that the real number of deaths for Covid-19 is so much higher than the official one. If these are the approximations on which Italy is betting it’s future, then it brings to mind the film from Italian director, Federico Fellini, “E la nave va” (and the ship sails on) which metaphorically displays the chaos that ensues when order is taken away, and depicts people sailing into the open sea despite the storm that obscures the horizon. But let’s take a look at how Italian authorities are preparing the end of the lockdown in the upcoming first week of May. We know through the media that the experts are talking about what they think should be ready at the beginning of the second phase. They claim 50 million face masks will be ready on a daily basis, predicting that 25 million people will be back at work every day. In addition to that, the number of primary tests will be distributed as widely as possible, enough to test all the people that have been in contact with the infected. The aim is to flush out the new positive cases in advance and put them in quarantine as soon as possible, thus reducing the infectivity rate (how many people are newly infected from a single person). On that subject, science tells us that “fourteen days of isolation aren’t enough anymore” reported Roberto Burioni, an Italian virologist from San Raffaele hospital in Milan, when he appeared on the Italian television broadcast “Che tempo che fa” on Sunday evening, the twelfth of April. He pointed out that, “According with new scientific data, the coronavirus is able to stay alive inside of a patient 30-40 days after the disappearance of all symptoms. In the meantime, serological antibody tests are ready to be validated by the Istituto Superiore di Sanità (Superior Institute of Health) but only tests with a high rate of reliability are expected to pass. To help flatten the peak number of infections, another measure is to considerably increase the distribution of the normal flu vaccine that elderly people often take every year typically during Autumn. It’s thought that if people are inoculated against the flu, it will reduce misdiagnosis, help prevent patients from needing to go to the hospital for regular flu health complications and though the flu vaccine hasn’t proven effective against coronavirus, it is true that this vaccine helps strengthen the immune response, giving people a better fighting chance should they contract the coronavirus.
Written by Alberto Ferrari