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As COVID19 continues to spread around the world, numerous countries have taken dramatic steps to diagnose, treat, and most importantly, curb the spread of the disease. As of March 14, 2020, Italy has reported more cases and deaths from COVID19 than any other country in the world with the exception of China.
As of 7:52 p.m. on 3/15/20, Italy reported 24,747 cases of COVID19, 1,809 deaths and 2,335 recovered. Today alone Italy reported 368 new deaths. By the time you read this, those numbers will have increased.
Johns Hopkins University has a real-time, interactive dashboard that tracks the cases, deaths, and recoveries by country and region.
The Initial Quarantine
The initial steps taken by the Italian government involved a quarantine of certain regions in northern Italy, particularly in the Lombardy region. That region had reported the most cases in a short period of time, and the confirmed cases were growing rapidly and were soon referred to as the “Lombardy Cluster.”
People were told to stay in their homes and to stay in the region. Many fled before the quarantine took effect out of fear of being trapped in a hot zone. Unfortunately, many of those people were already infected and spread the disease to other parts of the country.
Italy Goes into Lockdown
On Monday, March 9th, Italian Prime Minister Giuseppe Conte announced that all travel in the country would be restricted, schools would be closed, and numerous events that gathered people in an enclosed, public place would be canceled.
As the world’s 8th largest economy with a population exceeding 60 million people, the move is unprecedented. Italy is in a nationwide quarantine and the country has essentially become a “red zone” which highly limits how and when the population moves about on a daily basis.
“Stay at Home”
The Prime Minister and government officials have exhorted people to stay at home. And that’s exactly what is happening.
Destinations and venues that fall in the category of “recreational” or “entertainment” have not only been closed but would have shut down anyway because no one was going out to restaurants, theaters, museums, sporting events, and even the opera.
Basic Goods, Services, and Industries Still Functioning
People are free to move about but only for necessities, work, or health reasons. When they do go out, they are advised to keep a one-meter distance from others. The result is that even though people can go out, they’re staying home. Schools are closed and teachers are being trained in how to engage in virtual, home-schooling via the Internet.
The degree to which people choose to quarantine themselves varies depending on areas and regions. The hardest-hit regions like Lombardy and Venice are showing some of the most obvious signs of concern.
Grocery stores and pharmacies are all open and are some of the few retailers still open for business. What Italy is seeing is what has begun to appear in grocery stores in the United States. Certain items in grocery stores are sold-out and, not surprisingly, toilet paper is hoarded as soon as it appears.
The chilling fact is that panic buying and hoarding happened in Italy weeks ago and was a signal of what was to come.
People are still going to work but the “work-from-home” concept is being widely applied. Banks and other institutions necessary for day-to-day life are open, but a far greater concern is the cumulative effect on Italy’s already struggling economy.
The Economic Cascade Effect
As more and more businesses shutter, the country is at risk of a domino effect of unpaid bills, loan defaults, unemployment, and other factors causing a ripple effect across the entire Italian economy. It’s a ripple effect that is also starting to show up in France, Spain, other countries and, as seen in recent weeks, the United States.
Like many countries, Italy is implementing measures to soften the economic shock including moratoriums on loan payments, extending tax deadlines, and paid sick leave. The big question is how long it will take Italy to recover economically. The larger question is what impact COVID19 will have on the global economy.
The Stark Medical Tragedy
One of the most disturbing effects of COVID19 in Italy is how it has overwhelmed their medical professionals and hospitals. The sheer number of patients in critical condition exceeds the medical staff, hospital beds, and equipment needed to care for someone suffering from severe symptoms. The result is a medical triage process seen only in war.
According to Lorenzo Casani, the health director of a clinic for the elderly in Lombardy:
“We do not have enough beds in the intensive care units. Doctors must make this horrible choice and decide who is going to survive and who is not going to survive. Who is going to get a monitor, a respirator and the attention they need?”
As the cases mount and the patients begin to appear with more severe symptoms, the triage process becomes increasingly difficult for the medical staff and the patient’s family.
Adding to the burden is the fact that Italy has one of the most elderly populations in the world second to China. In the cold calculation of triage, the elderly are often the ones who are not chosen for the limited medical care available.
According to Christian Salaroli, an anesthesiologist:
“We decide based on age, and on health conditions. Just like all war situations.”
Flattening the Curve
The entire rationale for quarantine in the event of a pandemic is to limit the number of cases so that they do not exceed the capacity of a health system.
Statistically, this is referred to as “flattening the curve.” It’s accomplished by reducing person-to-person contact and taking necessary steps to prevent the spread of the disease like handwashing and sanitizing surfaces, but because COVID19 is transmitted as airborne droplets as a result of a cough or sneeze, reduced physical contact is the best solution.
When contact is reduced and the spread of the disease is inhibited, the number of people infected decreases and that drop is flattened statistically on a graph showing the curve peaking just below the healthcare system capacity.
It’s All Because of a Long Incubation Period
COVID19 has a long incubation period. That means someone can be infected and not show any symptoms. As a result, an infected person will not feel the need to stay home or take care of themselves for the simple reason that they don’t feel sick.
What has made COVID19 such a threat is that the incubation period is believed to be up to 14 days. That means someone who is infected can interact with others and frequent public places for up to 2 weeks without knowing they are spreading the disease.
Not to scare you, but this means you could have COVID19 right now and be spreading it unaware. And if you give it to someone older or someone with an underlying condition, they could die. That’s why people need to take this seriously.
Quarantine is Not Forever
The quarantines in place in Italy and other countries are going to be measured in weeks, not years. What’s critical to understand is that people who ignore the quarantine and take no steps to prevent the spread of the disease will in fact be the ones to spread it and cause the curve to peak above the health system threshold.
It’s like the people who fled from Lombardy when they first heard of the quarantine in Italy. It was irresponsible and is believed to have had an impact on the ultimate spread. It’s at that point that deaths from the disease spike, and it’s what has allowed COVID19 to ultimately emerge as a global pandemic.
What’s Next for the U.S.?
It’s here and it’s spreading. One of the things that helped Italy forestall an even worse outbreak was their ability to test thousands of people a day and their willingness to take drastic and immediate action. The U.S. is struggling to catch up, especially with testing, which means that many people can be infected but undetected or mistake the COVID19 symptoms for the flu or a bad cold.
And while it’s true that some people will not suffer severely from COVID19, others can and will if the spread of the disease is not limited, and fatal triage decisions can be the result. The key is not to be the person who avoids getting the disease, it’s to avoid being the person who spreads it.
As more testing is done, the true scope of the pandemic in the U.S. will become apparent. In the meantime, some of the measures that are in place in Italy are very sound decisions and should be respected and understood.
If we don’t flatten the curve, things will get much, much worse.