Images from Italy are usually a window into the past. But recently, its empty canals, tourist sites, and streets provided a startling glimpse of the future.
"Probably we are learning things for the next pandemic," said anesthesiologist Marco Vergano, who was the lead author of recommendations designed to help Italian doctors prioritize ICU patients when there aren't adequate resources – a dilemma hospitals in the U.S. now face.
So, what should the U.S. be learning from Italy? "When I hear the news from colleagues and friends, for example, in New York City, I think that probably they wasted some of the advantage they had," Dr. Vergano said.
That advantage? Time to prepare. He said a few extra days of containment measures in communities can make an exponential difference in hospitals
Correspondent Seth Doane (himself in quarantine in Rome) asked, "What is the lag-time between the lockdown and when you really see it working?"
"At least ten days, but probably up to three weeks," Dr. Vergano replied.
Hospitals in Italy have been sources of infection since early cases were not recognized. The Italian government's evolving response has also been criticized. Initially, only Italy's north was locked down, and people fled south – likely carrying the infection.
Now, a national lockdown is in place.
And Italy has boosted surveillance, and fines. Despite its staggering more than 15,000 deaths, Italy has shown encouraging signs this past week, as the percentage increase of new infections has slowed.
But the country is prioritizing testing only the most severe cases. So, that means many others go undetected – and, Vergano said, calculations (including those in China) have been misleading: "Many epidemiologists say that probably the real number of deaths is 4-8 times more than the official numbers. And this is happening in Italy, too. So, those are catastrophic numbers."
"The issue of under-reporting is just a chronic one," said Jon Zelner, a professor of epidemiology at the University of Michigan. He told Doane that testing is key: "It's like fighting gravity, right? It's really hard to beat back the tide. When you have 1, 2, 3, 4, 5 cases in your community, and you know where they are, you can deal with them on a case-by-case basis. But as that number grows, the ability to chase down individual cases just completely goes out the window, and we're left with these more draconian measures."
So, what went so wrong in Italy?
"The problem is, we've been the first Western country where the disease was diagnosed," said Dr. Giacomo Grasselli. "So, we did not recognize cases of the disease that certainly were around at least four, five weeks before."
Dr. Grasselli is coordinating the response at hospitals in hard-hit Lombardy province. They've struggled with a demographic challenge: The age of the population. "Because Italy has one of the oldest populations in the world," said Dr. Grasselli.
The only way to slow infections is to change behavior, and that has not been easy. In late February – just days before he tested positive for COVID-19 – a top Italian politician, Nicola Zingaretti, tweeted about maintaining "normality" and rekindling the country's economy.
Dr. Grasselli said, "If we leave this disease go, we will have a number of deaths which is comparable to the Second World War. I don't see how having hundreds of thousands of deaths can help the economy. I would be draconian now – and then we will restart, as we restarted after the wars, you know?"
While lockdowns may buy time, ultimately widespread testing and contact tracing are essential to truly defeat this virus.
For more info:
- Anesthesiologist Marco Vergano (Academia.edu)
- Jon Zelner, assistant professor of epidemiology, University of Michigan School of Public Health
- Dr. Giacomo Grasselli, Università degli Studi di Milano
Story produced by Sari Aviv. Editor: Remington Korper.
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