Probably the single most important headline this week:
- After just one week from the outbreak, Northern Italy is already considering expanding its hospital beds capacity because 1 in 11 patients goes in ICU
- After just one week from the outbreak, Northern Italy is already considering expanding its hospital beds capacity because 1 in 11 patients goes in ICU
The Lombardy equiv. of the minister of Health, 5 days ago:
"in Lombardy no problem with the number of hospital beds".
Today: "the hospital beds [in this hospital] are not enough anymore […] even the ICU beds are saturated […] we're working on expanding our capacity to react."
"in Lombardy no problem with the number of hospital beds".
Today: "the hospital beds [in this hospital] are not enough anymore […] even the ICU beds are saturated […] we're working on expanding our capacity to react."
In Lombardy they're delaying non-urgent surgeries and are re-hiring retired nurses and doctors.
Bergamo Lodi & Cremona are out of beds.
repubblica.it/cronaca/2020/0…
Bergamo Lodi & Cremona are out of beds.
repubblica.it/cronaca/2020/0…
(I see now that the picture chosen by twitter is misleading. That's not a hospital-in-a-tent. It's a pre-triage tent built at the entrance of hospitals in order to prevent suspected cases entering and contaminating the hospital without PPEs.)
One problem specific to Italy is its aging population.
Another is that it's re-hiring retired doctors and nurses, a needed move which comes with its dangers, as being retired and being an health-care worker are both risk factors.
Another possible nonlinearity raising mortality.
Another is that it's re-hiring retired doctors and nurses, a needed move which comes with its dangers, as being retired and being an health-care worker are both risk factors.
Another possible nonlinearity raising mortality.
6/ In Italy we have 3.2 hospital beds per 1k patients. Counting only the free ones (rule of thumb: 15%), it’s about 0.48/kp.
Better hope that only 0.5% of Italians get the virus (assuming 1 in 10 needs the hospital; very conservative).
Also situation is worse due to clustering.
Better hope that only 0.5% of Italians get the virus (assuming 1 in 10 needs the hospital; very conservative).
Also situation is worse due to clustering.
7/ Given the difference in population sizes, the chart below is not reassuring.
Thankfully Italy began reacting with school closings and other measures 3 days earlier than China, in the parallel timelines with the offset shown below. Hopefully we should see some effect soon.
Thankfully Italy began reacting with school closings and other measures 3 days earlier than China, in the parallel timelines with the offset shown below. Hopefully we should see some effect soon.
8/ I'm mostly worried for the Italian regions whose case count is still low, as it seems that too little is being done there to contain the spread.
I mean, the US is restricting travel from/to Lombardy but Abruzzo isn't? At least if not formally, by setting explicit warnings.
I mean, the US is restricting travel from/to Lombardy but Abruzzo isn't? At least if not formally, by setting explicit warnings.
9/ The anchoring that “the only borders along which travel can be restricted are those with customs” will be harmful.
10/ One in ten doctors in Lombardy cannot work because of the virus (he's ill or in preventive isolation).
11/ A member of the Lombardy council found positive to the coronavirus test.
12/ The major of an Italian quarantined city: "people keep dying and there are no doctors to treat the sick […] we had 5 GPs, 3 are in quarantine & 2 are sick; 1 GP volunteered [from outside but] no one gave him the tools to protect himself when he's visiting patients."
13/ Piedmont (Northern Italy) suspends all surgeries except life-threatening and oncological ones.
14/ A full ward of the 3rd largest hospital in Italy (in Turin) is being temporarily closed because a couple went there for “the flu” but didn’t think it was relevant to mention that their son works in Lodi (a city next to the epicenter) and visited them recently.
15/ Our healthcare system is being destroyed by our refusal to feel vulnerable.
16/ (I didn’t mention in tweet #14: the couple obviously tested positive)
17/ In Piedmont (my family's region):
- 108 cases
- 61 hospitalized
- 18 in ICU
Why so many in ICU?
- extremely old population
- undertesting
(anedoctally, my friend's coworker tested positive and she's simply in self-quarantine with no test unless she becomes symptomatic)
- 108 cases
- 61 hospitalized
- 18 in ICU
Why so many in ICU?
- extremely old population
- undertesting
(anedoctally, my friend's coworker tested positive and she's simply in self-quarantine with no test unless she becomes symptomatic)
18/ Lombardy's welfare minister: "every day we get 200 new people to the ER in critical conditions, which means every day we need to find 200 more hospital beds. […] the virus is spreading at an exceptional speed, faster than our predictions and than the data we got from China."
19/ Italian Senator admits having manufactured the fake audio impersonation the Minister of Education saying that the virus is transforming.
google.it/amp/s/m.huffin…
google.it/amp/s/m.huffin…
20/
21/ From today’s 🇮🇹 data:
- 778 new cases
- 12% of confirmed cases in ICU
- average age of death 81 years old
The last point would explain the high ICU %.
- 778 new cases
- 12% of confirmed cases in ICU
- average age of death 81 years old
The last point would explain the high ICU %.
22/ That said, the average age will go down as older people are not only more likely to die from the virus but also faster in doing so.
There might be younger people in terrible condition who didn’t die yet.
There might be younger people in terrible condition who didn’t die yet.
23/ It will be forbidden to enter / exit Lombardy and 11 provinces until the 3rd of April (except emergency situations).
12 million people affected.
12 million people affected.
24/ “It can become necessary to put soon an age limit to enter ICU […] to save scarse resources for who has the largest chances of survival”,
says a horrifying document from the Italian Society of anesthesiology, reanimation and intensive care.
google.it/amp/s/www.ilfa…
says a horrifying document from the Italian Society of anesthesiology, reanimation and intensive care.
google.it/amp/s/www.ilfa…
25/ The above corroborates a message I received from an anonymous and unverified source that similar tradeoffs (prioritizing ICU treatments to the younger) were already considered in Lombardy as of Friday.
26/ Regarding the closing of Lombardy: it’s not effective yet, which is terrible.
Announcing it in advance will cause “panic migration” thus spread.
🤦♂️ 🤦♂️ 🤦♂️
This indecisiveness causes Italy to reap minimum benefits at the maximum cost.
Announcing it in advance will cause “panic migration” thus spread.
🤦♂️ 🤦♂️ 🤦♂️
This indecisiveness causes Italy to reap minimum benefits at the maximum cost.
27/ Meanwhile: elderly couple exits from the quarantined epicenter to go on holiday in Trentino.
They then fall ill and test positive.
An epidemic of selfish behavior.
(via @RobertoBurioni)
They then fall ill and test positive.
An epidemic of selfish behavior.
(via @RobertoBurioni)
28/ The answer was "7 days" apparently.
I didn't expect it to be so fast, probably no one did. At least we know now, and it can be of learning for other countries.
I didn't expect it to be so fast, probably no one did. At least we know now, and it can be of learning for other countries.
29/
31/ Italy will close bars and restaurants who don’t force their customers to keep at least 1 meter between them (in Lombardy and in the 14 quarantined provinces).
32/ Apparently flights are still departing from Lombardy airport.
I understand those leaving Italy to let foreigners evacuate, but why are flights to Rome, Bari and Naples still on?
I understand those leaving Italy to let foreigners evacuate, but why are flights to Rome, Bari and Naples still on?
33/ Piedmont's president tested positive to the virus.
34/ According to CNN, it is Lombardy's press office that leaked the draft of yesterday's night quarantine's decree 🤦♂️.
Causing thousands to leave the quarantine and flee to the South, potentially bringing the virus with them.
Causing thousands to leave the quarantine and flee to the South, potentially bringing the virus with them.
35/ It's 11am, and trains are still running as usual in Italy despite the quarantine, helping people spreading the virus around.
It's unclear why they are still running despite the clear decree which is already in force since 2am.
It's unclear why they are still running despite the clear decree which is already in force since 2am.
36/ Hospitalizations due to the virus doubled today in Piedmont (Turin’s region, 🇮🇹). The Order of Doctors of Turin Province asks that the region is considered “red area” so that gatherings are further limited.
37/ Riots in at least 2 Italian jails after the suspensions of ourside visits.
“100 inmates occupied the second ward”
“We’re trying to bring back legality in a prison that, from what they tell us, is fully destroyed”.
“100 inmates occupied the second ward”
“We’re trying to bring back legality in a prison that, from what they tell us, is fully destroyed”.
38/ Planes are still flying in and out of Milan, without any check on passengers.
Airports should be the easiest point on where to enforce quarantine blocks.
That’s ridicule.
Airports should be the easiest point on where to enforce quarantine blocks.
That’s ridicule.
39/ Six people died in yesterday’s prison riots in Italy (of overdose after sacking the infirmary).
Some escaped but got caught.
Protests on the roof of a prison.
Some escaped but got caught.
Protests on the roof of a prison.
40/ In Cosenza 60 GPs in quarantine: they had been visited by a pharmaceutical sales rep who tested positive.
70000 people affected by the loss of GP.
70000 people affected by the loss of GP.
41/ Tuscany distributed 37000 face masks to 3700 doctors.
That’s 10 each.
To give a perspective, Singapore distributed 4 masks *per household* and that was about one week into the outbreak.
That’s 10 each.
To give a perspective, Singapore distributed 4 masks *per household* and that was about one week into the outbreak.
42/ All Italy like Lombardy: the protected area extends to the whole territory. Movement of people forbidden unless for proven need.
(waiting for more details)
(waiting for more details)
43/ Second run to the grocery stores in Italy.
Stuff that happens when people tell you not to panic, but then at some point you eventually must panic.
Hopefully other countries will begin panicking now, so that the impact on supply chains is staggered.
Stuff that happens when people tell you not to panic, but then at some point you eventually must panic.
Hopefully other countries will begin panicking now, so that the impact on supply chains is staggered.
44/ A boat full of people from Northern Italy, included from the previous red zones, just docked in Sardinia. People are left out without being checked.
Sassari, the closest major city next to the port, has only 23 ICU beds.
sardegnalive.net/news/in-sardeg…
Sassari, the closest major city next to the port, has only 23 ICU beds.
sardegnalive.net/news/in-sardeg…
45/ Lombardy is considering closing production activities and transportation.
"We cannot sustain another 15-20 days of such a frantic run of people to the ER and to the ICU," said Lombardy's welfare minister, "the measures adopted are perhaps still not enough."
"We cannot sustain another 15-20 days of such a frantic run of people to the ER and to the ICU," said Lombardy's welfare minister, "the measures adopted are perhaps still not enough."
46/ Italian region of Valle d'Aosta asks all tourists to leave and go home, because the region has a single hospital with limited capacity.
(are there still tourists?)
(are there still tourists?)
47/ How’s the Italian lockdown enforced?
By making random police checks across highways and streets, checking only 297 people in a day in a region with 4.5 million people.
(asking them why they’re moving around)
Slightly inadequate, if you ask me.
By making random police checks across highways and streets, checking only 297 people in a day in a region with 4.5 million people.
(asking them why they’re moving around)
Slightly inadequate, if you ask me.
48/ Piedmont’s President is considering temporarily stopping productive activities.
49/ The crisis unit of Piedmont states that 😳 “absent symptoms, testing is not supported by scientific rationality as it does not produce information relevant for clinical purposes.”
50/ If the stats of today look like we added less cases in ICU, it is because we ran out of beds (we're adding a few with big effort). The patients who cannot be treated are left to die,
said Bergamo 🇮🇹 mayor Giorgio Gori, a city in the red zone.
said Bergamo 🇮🇹 mayor Giorgio Gori, a city in the red zone.
51/ Curfew in Messina 🇮🇹 . All businesses will be closed, forbidden to go out, the decree is in preparation.
52/
53/ It will become possible to requisition hotels for quarantine purposes, in Italy.
54/ The president of Lombardy: about 1500 new cases today.
Not clear from the context, but it's my understanding he means in Lombardy alone (which would be terrible: it has already about 4500 cases to date and a healthcare system already saturated).
Not clear from the context, but it's my understanding he means in Lombardy alone (which would be terrible: it has already about 4500 cases to date and a healthcare system already saturated).
55/ Lombardy doctors: the data underestimates the real diffusion.
This on the day where Lombardy alone prepares to announce 1500 new cases (yesterday it was about 1200 in the whole country).
This on the day where Lombardy alone prepares to announce 1500 new cases (yesterday it was about 1200 in the whole country).
56/ Italian PM Conte to extend red zone to all of Italy.
