Read the whole thing, but this passage in particular is just chilling.
"5/ Patients above 65 or younger with comorbidities are not even assessed by ITU, I am not saying not tubed, I’m saying not assessed and no ITU staff attends when they arrest. Staff are working as much as they can but they are starting to get sick and are emotionally overwhelmed."
Please note that Lombardy has a very very good health service. The OECD put a score on this [1]: 9.9/10. This is in the top 5% across all regions.
Other european regions seem to have lower average scores and their governments are not taking serious actions. [2]
How the US is reacting from my perspective (italian confined near Rome) seems borderline madness.
Something about this situation confuses me a lot.
Politicians have no understanding of exponential growth. They look at low numbers and think "we have a lot of time" then are surprised later when they in fact don't.
I spent a few months in the region with a sick toddler and can attest to the speed, quality and friendliness of the public health system there.
That the virus is spreading so quickly, and that the health system is getting overwhelmed is cause for real concern. If northern Italy can't handle the outbreak, I'm not sure anywhere will do much better.
There is an answer, and it is political (thank you for allowing me the indulgence to bring this room-elephant up). There is a slow burn civil war between mission-focused bureaucrats and administration loyalists. Consider: https://twitter.com/Imm_Judges_NAIJ/status/12371515163955363...
The CDC is updating their recommendations for healthcare providers several times a day. There's plenty of epidemiologists working on this topic in the us: shutting down airports and roads also kill people and it has varying effects depending on the point of the epidemic you are in.
I can't believe I'm saying this as a libertarian but you have to put some faith into the government's action here. The public in a panic already took away all the masks healthcare providers needed to safely attend patients, diminishing the capacity to serve.
Note that OECD's 9.9/10 is based on mortality rate and life expectancy, and therefore not a direct indicator of health service quality. Maybe the air in Italy is just very clean and the food healthy.
Actually this event may also become a test of the validity of those measures / indicators. One may argue those measures / indicators are not setup for this purpose.
I am struggling to reconcile this story with the numbers of deaths so far vs the number of deaths in any given year. A french infectious disease specialist mentioned that 2017 had been a bad year for infectious respiratory diseases in France, with over 60,000 additional deaths in winter, to the point that it affected life expectancy tables [1]. I don’t remember any mention of hospitals being overwhelmed and doing war-time triage then.
It is possible than one hospital may be overwhelmed, but surely it cannot be representative of hospitals across Italy or even a region.
Which shows how damn important context is. Without 100% testing (which I don't think to be necessary) for COVID-19 and comaprative baselines case numbers aren't tellig us anything. Without the proper domain expertise to actually interpret the numbers that is. So whithout that particular domain expertise, epidemilogy and virology, I don't interpret the numbers or build models, rather I believe the experts to make sense out of them.
Remember with Flu, the doctors and nurses can't get it, and can't spread it. The danger with this is that all the doctors get sick/quarantined and then no-one gets treated.
I am from Italy and every single friend of mine working in healthcare as a doctor has confirmed me that the situation is like the one described here. A friend of mine who is an orthopedist outside lomdardia has also confirmed that they have already asked him to work extra hours and they are already at full capacity, so he's preparing to assist covid patients.
Personally I know a girl whose soon-to-be husband from zero symptoms went to being intubated in 3 days. Luckily for him there were still machines available and he's relatively young and in good shape so they have allocated it to him.
One can surely ignore these reports as they are not provided first hand by doctors. In that case it is sufficient to wait. Soon this situation will be a reality in many more regions/countries so it will be easy to experience this first hand.
I know what you mean, that phrase 'from a friend' rings a few alarm bells.
However official statements widely reported in the media are essentally saying similar things:
Antonio Pesenti, head of the Lombardy regional crisis response unit, told the Corriere della Sera newspaper the health system in Lombardy was “a step away from collapse” as intensive care facilities came under growing strain from the new cases.
“We’re now being forced to set up intensive care treatment in corridors, in operating theaters, in recovery rooms. We’ve emptied entire hospital sections to make space for seriously sick people,” he said.
The rate of death counts confirms it. Im in south korea most of the death is because theres no available hospital bed and they have to stay home and call the ambulance when symptoms get really bad and they die on the way to the hospital.
That's the problem with coronavirus that everyone's missing.
If we had the hospital capacity to deal with it, it wouldn't be so bad. But the suffering (and mortality rate) spikes pretty significantly when you run out.
If we were halfway rational we'd be rapidly scaling up medical capacity now and practicing strong social distancing now... but people are too worried it would unduly wreck the economy.
I am a Chinese living in Bay Area. What's described by the Italian doctor was exactly like the situation in Wuhan right after the lockdown for the first 2-3 weeks. Unfortunately, I think it will hit Italy harder this time, China locked down Wuhan but every other provinces send in supplies and doctors to help, just building new hospitals is not enough, and I don't see France/Germany doing the same to Italy. The US response so far feels very much like what I saw early Jan in China, the government kept assuring the public everything is in control and risk is very low. One could argue it's either cover up or they simply didn't know, I think it's a combination of both. But I really cannot understand why US is handling it this way after seeing what happened in Wuhan and now Italy, it almost feels like Trump has some secret weapons ready to save the day. You would think that, since most of the leaders are in a high risk demographic and spend large chunk of their time shaking hands with strangers, they would be more vigilant
I am extremely disappointed in the American government on this. We have had a significant warning and we've seen the virus in multiple countries and the response has been so lackluster.
Why should we wait 20 days for things to get terrible before going to quarantines and lock down? Surely China and Italy have shown us our future.
I partly think the problem is political. If you quarantine and the virus is controlled, then it looks like you panicked over nothing, because you took this huge reaction and nothing much happened. However, if you wait till it's sufficiently bad and then you quarantine everyone will understand what you did, and later, you may get praised for your decisive leadership in a time of struggle.
What I mostly wish is that citizens could throw some sort of flag now to say "This crisis is being poorly handled. If this goes badly, let's have a review, figure out why, and correct the problem once this is settled."
It's not just the US though, you have other countries in Europe handling this abysmally like The Netherlands. Indonesia is still in the "pray to make it go away" stage despite multiple cases in Singapore being traced back to Indonesian travel (including one rich Indonesian who couldn't find anyone to treat them in Indonesia so deliberately flew to Singapore on a private plane to get healthcare).
The USA is a disaster waiting to happen. I've lived through a disease outbreak that required lockdown/curfews in another country and I don't think the US is logistically or culturally prepared.
I don't want to go into longer detail as it will be subjective and seem political, but I'm expecting things to Get Weird.
They didn't believe what happened in Wuhan would happen to them, mostly because of racist superiority I think. Surely our hospitals must be better than China's, we are healthier, et cetera.
And people distrust anything coming out of China's government so they simultaneously think China covered up a lot and there were way more dead, and they exaggerated how bad the virus is...
> it almost feels like Trump has some secret weapons ready to save the day. You would think that, since most of the leaders are in a high risk demographic and spend large chunk of their time shaking hands with strangers, they would be more vigilant
He's behaving entirely consistently with how he always has: deny everything, project perfection.
There's no signal here of a secret weapon, it's a complete shit show.
Italy is following China's lead. It has been harder to change social behavior here. But it will change due to the severity of the situation. The lag in response will definitely make things more severe. But the climate may help, assuming warmer temperatures reduce transmission.
Trump's performance so far is a massive disappointment to say the least, and more of a parody even by Trump's standard.
I am not sure what he is doing is even remotely serving himself that well either. Addressing the Coronavirus upfront is the only way to cheer up the market right now. Did he really think he can just fight this virus with speech or tweets?
This is bothering me no end, and severely impact my confidence in US itself overall. Damn it, this is a full on crisis, the shit is about to hit the fan so hard.
I don't have this impression. Many nations are trying to find a cure or a vaccine.
Nobody knows the long term development of this virus. You could lock up everything, the economy collapses and it would hurt people even more than the virus might have. It is a gamble at this point.
Political games come into play if people demand answers that nobody can give. If some presume to be able to do that, they are lying to your face.
If this is over in June and 100,000 people died, what would we call this? It would just be another disease probably.
For people who lost loved ones it was a catastrophe, for other part of the normal life risk. Any publicly uttered judgement has to keep that in mind, so it will always be relative. Some are more forthcoming, but probably not public officials.
Of course the virus is not under control, how could it be? I would prefer measures to reduce its spread, but that is basically intuition and listening to some doctors with the knowledge that it just buys time.
Anyone using this crisis for political points doesn't really win any cookies with me personally, on the contrary.
The incentive to cover something up is just a reflex to save face. I don't like covering something up. There is a risk of disproportionate overreaction, but I think a bad information policy reinforces this. If they covered something up, it must be really bad, right?
Trump is indifferent to the suffering to come, and doesn’t feel it will touch him. He welcomes chaos, because it provides opportunity for personal enrichment.
“You know what solves it? When the economy crashes, when the country goes to total hell and everything is a disaster, then you’ll have a, you know, you’ll have riots to go back to where we used to be when we were great,”
I fixed the formatting, typos, and expanded the jargon:
From a well respected friend and intensivist/A&E consultant who is currently in northern Italy:
I feel the pressure to give you a quick personal update about what is happening in Italy, and also give some quick direct advice about what you should do.
First, Lumbardy is the most developed region in Italy and it has a extraordinary good healthcare, I have worked in Italy, UK and Australia and don't make the mistake to think that what is happening here is happening in a 3rd world country.
The current situation is difficult to imagine, and numbers do not explain things at all. Our hospitals are overwhelmed by COVID-19, they are running 200% capacity.
We've stopped all routine, all Operating Rooms have been converted to Intensive Care Rooms and they are now diverting or not treating all other emergencies like trauma or stroke. There are hundreds of patients with severe respiratory failure and many of them do not have access to anything above an oyxgen mask.
Patients above 65, or younger patients with comorbidities, are not even assessed by Intensive Care. I am not saying not tubed, I'm saying not assessed and no staff attends to them when they arrest. Staff are working as much as they can, but they are starting to get sick themselves and are emotionally overwhelmed.
My friends call me in tears, because they see people dying in front of them and they can only offer some oxygen. Ortho and pathologists are being given a leaflet and sent to see patients on ventillation. PLEASE STOP, READ THIS AGAIN AND THINK.
We have seen the same pattern in different areas a week apart, and there is no reason that in a few weeks it won't be the same everywhere, this is the pattern:
1) A few positive cases, first mild measures, people are told to avoid the Emergency Department. People still hang out in groups, everyone says not to panic.
2) Some moderate respiratory failures and a few severe ones that need intubation, but regular access to Emergency Departments is significantly reduced so everything looks great.
3) Tons of patients with moderate respiratory failure, that over time deteriorate to saturate intensive care first, then intubation equipment, then CPAP hoods, then even O2 masks.
4) Staff gets sick, so it gets difficult to cover for shifts, mortality spikes from all the other causes that can't be treated properly.
Everything about how to treat them is online but the only things that will make a difference are: do not be afraid of massively strict measures to keep people safe. If the governments won't do this at least keep your family safe: your loved ones with a history of cancer or diabetes or any transplant will not be tubed if they need it even if they are young. By safe I mean YOU do not attend them and YOU decide who does and YOU teach them how to. Another typical attitude is read and listen to people saying things like this and think "that's bad dude" and then go out for dinner because you think you'll be safe.
We have seen it, you won't be safe if you don't take it seriously. I really hope it won't be as bad as here but prepare.
Did you also fix the uncoroborated nature of the news? You know, the "well respected friend" part of it by reaching out to said person? If not, this whole thing just shows again how dangerous Twitter can be in that regard.
What do the healthcare workers actually do while caring for these people? Is this something that actually requires significant medical knowledge?
What does arrest mean? Is that cardiac arrest? Is that how people are dying? If they’re dying and people aren’t attending, should they even be there at all?
Most severe cases require trained medical staff. Since ~20% of infections requires hospitalization, no healthcare system is prepared for an exponential rise in SARS-CoV-2 infections.
Most fatalities are from pneumonia. Lots of details are available all over. You may want to read up.
I was not very surprised that Italy turned out to be the (first?) major hit in Europe. Considering the strong business connections, it had to be either us or Germany.
We are, as much of the world, importers from China, but many enterprises here are also, somewhat, strong exporters to China (I can see it from my dayjob as industrial automation SI), and if you factor in the small average size of Italian companies requiring many individual contacts (contrast with Germany where companies on average are bigger), you can imagine that there is a strong flow of people to and fro. Maybe the small size of companies requiring more people to establish commercial links + population being more uniformly settled across the country (no huge wildland or sparsely inhabited area left in Po Valley, except maybe some parts of Piedmont?) + a certain cultural inclination for useless quarreling hindering political action + inefficiencies in the administration + an unsolved conflict of power between central gov't and periphery possibly causing some waste of time in other quarreling + having to keep the vast group of small business owners somewhat quiet has resulted in a vast spreading of the virus.
The interesting thing is that, if you replace China with Germany in the paragraph above (wrt. the possible German origin of the outbreak in Italy), the consideration about business links would still apply.
Another interesting thing I have just noticed is that some journalists are now openly praising the Chinese handling of the crisis. Maybe this may sound strange to an American :D but there has been for some time a growing cross-partisan movement calling for stronger links to China. In fact this movement is somewhat present in European business community, so it is not so special to Italy, but nonetheless it is interesting to see these comments of open praise.
> Another interesting thing I have just noticed is that some journalists are now openly praising the Chinese handling of the crisis.
I think this is a very interesting effect. China has a fantastic ability to mobilize as one when needed. The vast majority of the time, the insane amount of control this requires, is something we're simply not comfortable with giving to governments. But sometimes, just sometimes, the results are worth it.
The closest equivalence I could think of that'd be familiar to American ears, would be the WW2 war effort. It's not how most of us would want a country run day-to-day, but the ability to do so when needed is incredibly powerful.
Pumping a hospital out in a week or a battleship out in a month aren't dissimilar in national focus. And they're both achievements. What makes China feel alien to us is that this is their default stance.
(And that said, there's plenty to be critical of in the earlier days of China's response. But in the interest of sharing data and research, we're catching more flies with honey.)
China's ability to mobilize as one as quickly as it did is no doubt a consequence of strong central control. The same centralization, though, is also to blame for its inadequate early response. Officials in Wuhan didn't have the authority to act on their own without Beijing's permission.
After this pandemic has died down, we should compare and contrast different countries' responses and try to appraise objectively just how much of a difference they made. China is trying really hard to make the case that their authoritarian approach is a model for the world, and it's too easy to be persuaded by that rhetoric when everyone is afraid and panicking. Meanwhile, some countries are trying just as hard to persuade their citizens that everything is okay when in fact it isn't. When all is said and done, we'll see how well that works, too.
Depending on how things go, I think South Korea could become either a model for the free world or a lesson in the shortfalls of democracy. They were doing pretty well until mid-February without imposing any travel bans or other measures that might be considered authoritarian, but then the number of cases exploded and everyone had to scramble. Instead of strong central control, most things were delegated to local governments. Different cities and provinces took different initiatives, quickly learning from each other when one of them came up with a new idea such as drive-thru testing. The shortage of hospital beds was met by large companies (hello, Samsung) and megachurches donating their own resorts and conference facilities for use as quarantine centers. Hundreds of doctors rushed to Daegu to help with the medical crisis there, and faced very little bureaucratic red tape in doing so.
The decentralized approach has its own inefficiencies, of course, especially in places with incompetent leaders or when dealing with a cult that refuses to cooperate. But when South Korea says that there were only 35 new cases last night, compared to hundreds a week ago, you can actually trust that it's a good-faith report because it's been cross-checked by so many independent players. The central government misreported the case count for my city a couple of times lately, and the city immediately issued corrections.
"What makes China feel alien to us is that this is their default stance" - Very well said!
I relate to this a lot based on my visit there. Things seem very unified. Hell, even dozens of old people get together every night and dance on the street. When have you ever seen communities like that in the US? We're too busy being self absorbed. We have no shared mission.
Live in n. italy.
Went shopping today to large supermarket. On way, few people in cars, many people out walking though, especially with kids. Supermarket nose-wipe section hit fairly hard, but that was it. Stockers were tending to other areas (either no nose wipes left, or not bothered?). Nobody was panicking buying. There was a pa with 'keep a meter away from everybody' announce, which made my kid laugh as we'd been watching you tube video on how far a sneeze can travel. Italians are touchy-feely poeople and this scare might make them take things a bit more seriously healthwise. Friday, i have a hospital appointment for a recent leg injury - will let you know :-) as three weeks ago i was in hospital for 6 days and i got the impression they were 'preparing' for a big outbreak - very few actual doctors around, nurses stepping up, orderlies assisting nurses with basics.
>We are, as much of the world, importers from China, but many enterprises here are also, somewhat, strong exporters to China
Italy also has a surprisingly large number of Chinese migrant workers, mainly in the fashion and leather goods sector. Skilled Chinese workers in Milan and Prato provide the kudos of the "Made in Italy" label at considerably lower cost.
You hit the nail on the head. In addition to the fashion industry, Italy is a favourite destination for Chinese tourists for sightseeing as well as buying luxury and said fashion goods.
There is good evidence the initial cases in Italy were tourism related.
As for praising the Chinese response - I think the reasons will be very clear soon to most people - without a very decisive and heavy handed response the health care systems in most developed countries will face very severe consequences or collapse.
We are at the denial stage still with people finding excuses why Italy is different, etc, etc
The US is 8 days behind Italy is 8 days behind Korea.
Italy is a country of 60M+ people and the 8th largest economy in the world, with a very high national debt and that significantly relies on tourism for its economy. Above and beyond the Coronavirus, this can terribly affect the long-term solvency of the country.
As the EU is mostly only its parts and everyone now in alert, I highly doubt it. Everyone is keeping their medical items to themselves now, because there is not even sufficient for their own country. EU will mostly be talk.
A full-scale failiure of the Italian economy and/or failing of any major Italian bank is "game over" for the Euro. The Greece bailout already had the Eurozone down on its knees, but this is a different dimension.
National debt is merely a number's game. ECB can simply eat it. They are suffering from deflation after all and they could use some inflationary move. Debt accounting for the national governments is there to enforce financial discipline in normal times. Right now it is much more akin to war time. Evenly distributing the pain through bond and currency holders will be seen as just compared to the lives that can be saved through decisive actions.
National debt may be a numbers game, but it's not merely that.
There's nothing simple about any ECB decision on monetary policy, and the composition of the EU when combined with the nature of the Euro is such that pain almost by definition can't be evenly distributed.
Fully agreed, this is a big concern of mine as well. We've got a 2 week trip planned to Italy in May, but that is likely to get cancelled this week based on the growing concerns throughout the country. I am fully expecting to reschedule our same trip later in the year, but until the virus starts to slow down significantly, I'm not comfortable rebooking.
Had one end of March. Booked well before COVID-19 was a thing, paid for before it was in Europe. Already cancelled, now we're fighting with the travel agency to waive the cancellation fee.
It seems a little silly to talk about how some particular instance of desperate measures will effect some particular polity, without considering the context of that these measures and the devastation that's tied to them will be present absolutely everywhere within 1-2 months.
The ripple effect is already in place. Flybe airline just defaulted, I've read a post on Linkedin that a small catering firm is suffering in Hungary due to cancelled events and other companies in the food chain will probably suffer a lot more especially if they operate with a razor thin margin.
After the human factor, the virus will hit the economy hard. It's probably only a matter of time till it triggers a serious recession. I'd really like to be wrong here.
If the ECB forbears they can in turn forbear with their own customers. That is the only sane thing to do. This is not the banks' doing and they don't need to be disciplined at this particular moment.
You would be right; Italy's private savings are in the ballpark of $10T+, which means a "patrimoniale" (tax on wealth) would be the last resort to avoid bankrupcy.
The US really really /really/ needs to get out in front of this. We have the lowest per-capita testing rate in the world, there are likely already significant outbreaks in Seattle, Santa Clara co, NYC, and DC. Probably elsewhere. We are literally like 12 days behind and can see into our future.
If this virus does indeed require such intense hospital resources (as in Wuhan and now Northern Italy) letting it spike is just madness. Must put into place heavy restrictions now.
We don't need travel lockdowns, but public events, movie theatres, etc should be closed, and businesses should be highly urged to allow workers to WFH if nec and/or try furloughs with public money (ha! good luck...)
In any case, just waiting until we see a spike in cases and then trying to get behind it seems like so much madness.
The only thing that be called reasonable statistic is the number of deaths and that hasn't spiked - I hate to say - yet. It's possible hospitals are even missing those, it's a big country. And it's a dispersed country so things might not spread as quickly.
But other, what you say. Stopping large public events and doing mass testing seems crucial. South Korea seems to have gotten a handle on their infection process at the moment things are out-of-hand in Italy. South Korea has done mass testing for a while.
Tocilizumab drug in Naples hospital seems promising: «The health of the patient suffering from covid 19, who arrived in critical condition, intubated and treated with the new drug therapy is recovering. Maybe we extubate him because his conditions have improved a lot ». They also say they got confirmation from Chinese colleagues who tested that earlier on 21 cases. The drug is now undergoing trial at Roche.
I'm incredibly ignorant, can someone explain why a drug used to treat arthritis might work against a Coronavirus? I just don't understand the connection/interaction, or why this was even tried originally?
Rheumatoid arthritis is an autoimmune disorder. The severe cases who contracted the Coronavirus seem to experience an autoimmune reaction towards otherwise healthy lung tissue.
The two doctors in the video say that it interferes with a similar auto-immune reaction that happens at pulmonary level because of the Coronavirus, so that it works.
The Italian Department of Civil Protection is now publishing detailed confirmed case statistics on GitHub. I just finished throwing together a little animated map of of how it's been spreading across provinces:
I reply with my humble contribution, based mainly on John Hopkins' data. I tried to understand if the effect of restrictions is already visible (I hope it will... since I live in Milan), thus I fitted an exponential on the data from the week before March 1 (when the initial mild restrictions started) and compared with the actual growth.
Just spoken to an Italian friend, apparently they got a few hours notice before this was enforced (much more kept under-wraps than the previous quarantine of Northern Italy).
Expect other Western European Countries to follow this pattern as the number of cases increase [1]. I would specifically be looking at France, Spain and Germany as potential next candidates.
If people here haven't already, I would recommend not leaving your shopping to the last minute and to stock up on a few extra supplies to help not exhaust the local food-chain when people do start panic buying.
> Without that irresponsible leak, and the irresponsible
> reaction of people trying to "escape", this total lockdown
> would probably not be necessary.
The leak was far from ideal, but I still think Italy would be in the same situation. I suspect there were already an un-contained spread in the South before the lockdown in the North.
> People sometimes are right shits.
This is still true, but I am not so sure they can be completely blamed. When people are scared they act irrationally and this should be incorporated into any plan.
The toilet roll thing seems to be everywhere (Germany is full of "why toilet paper!" outrage as well), but do people really panic buy so much? Toilet paper is an item you buy once every few weeks or months, depending on household size, it's very high volume per unit of money so shops stock just enough to satisfy an even random distribution of individual buying times. Now if all of a sudden, triggered by news, a considerable number of the people who would otherwise be in the market for a fresh pack sometime in the next few weeks decide to stock up a bit earlier there will inevitably be a brief but highly visible local shortage everywhere. Stocking up a bit earlier is far from panic buying, but due to the low price per volume of this specific product the result (empty shelves) will easily give that impression. This might admittedly trigger some second order panic buying effects, but that's not the effect of a coming virus, is the effect of people setting empty shelves.
It’s probably a good thing honestly. Better that people panic buy now, when the disease is still rare, than later when it isn’t. There’s only so many toilet rolls that a person needs.
Sensible choice all things considered. I think instant noodles are also a pretty good bet, I personally make a noodle soup with vegetables to bring up the nutrition a bit. I would also add frozen vegetables to the list as it keeps for ages and balances out most meals, whilst still being quite good for you.
Australia has had every supermarket totally cleared of toilet paper for 2 weeks now. Long life foods have had unstable availability as well. At least everyone will be stocked up while the supply chain is still fine and before any real issue comes up.
I am living in Italy (not in the zones where the virus starts spreading) and I want to say that our healthcare system is still working even if it's struggling.
The big problem is that the number of places for critical care is going to saturate; they are starting moving sick persons from Lombardia to other regions in order to reduce pressure on the critical care hospitals departments.
The number of death is so high because they count person who had other illness (cancer, heart disease, etc) and because we have lot of elder persons (the probability of dying is higher for over 75).
I just hope that other government in Europe will take it seriously, because it seems spreading fast over France, Germany, Spain and Netherlands.
> The number of death is so high because they count person who had other illness (cancer, heart disease, etc) and because we have lot of elder persons (the probability of dying is higher for over 75).
I don't know how the count is made, but since the pressure will affect the care for the other patients as well, it makes sense to at least take them in consideration in the stats.
Yes, it make sense.
The strange value is the one from Germany with more than 1000 cases and only 2 died. I suspect that the criteria for counting the death is not the same across different EU countries.
Readit News
Read the whole thing, but this passage in particular is just chilling.
"5/ Patients above 65 or younger with comorbidities are not even assessed by ITU, I am not saying not tubed, I’m saying not assessed and no ITU staff attends when they arrest. Staff are working as much as they can but they are starting to get sick and are emotionally overwhelmed."
[1] https://oecdregionalwellbeing.org/ITC4.html
[2] https://www.youtube.com/watch?v=s85xG9Ol3Po
I can't believe I'm saying this as a libertarian but you have to put some faith into the government's action here. The public in a panic already took away all the masks healthcare providers needed to safely attend patients, diminishing the capacity to serve.
It is possible than one hospital may be overwhelmed, but surely it cannot be representative of hospitals across Italy or even a region.
[1] for french speakers: https://www.youtube.com/watch?v=pb8Q1yr2cjo
Sadly, it is representative of hospitals across all northern Italy: https://www.ilpost.it/2020/03/08/pesenti-emergenza-ospedali-... https://www.ilpost.it/2020/03/09/coronavirus-terapia-intensi... ("Affollamento e scelte difficili")
I remember my nurse friends freaking out in 2017 because they were having trouble dealing with the extra flu cases.
"From a well respected friend and intensivist/A&E consultant who is currently in northern Italy:"
Basically, that make this twitter thread uncorborated news unless someone reached out to the Italian doctor referenced in it.
Personally I know a girl whose soon-to-be husband from zero symptoms went to being intubated in 3 days. Luckily for him there were still machines available and he's relatively young and in good shape so they have allocated it to him.
One can surely ignore these reports as they are not provided first hand by doctors. In that case it is sufficient to wait. Soon this situation will be a reality in many more regions/countries so it will be easy to experience this first hand.
However official statements widely reported in the media are essentally saying similar things:
Antonio Pesenti, head of the Lombardy regional crisis response unit, told the Corriere della Sera newspaper the health system in Lombardy was “a step away from collapse” as intensive care facilities came under growing strain from the new cases.
“We’re now being forced to set up intensive care treatment in corridors, in operating theaters, in recovery rooms. We’ve emptied entire hospital sections to make space for seriously sick people,” he said.
https://www.reuters.com/article/us-health-coronavirus-italy/...
https://translate.google.com/translate?sl=it&tl=en&u=https%3...
Dead Comment
If we had the hospital capacity to deal with it, it wouldn't be so bad. But the suffering (and mortality rate) spikes pretty significantly when you run out.
If we were halfway rational we'd be rapidly scaling up medical capacity now and practicing strong social distancing now... but people are too worried it would unduly wreck the economy.
Why should we wait 20 days for things to get terrible before going to quarantines and lock down? Surely China and Italy have shown us our future.
I partly think the problem is political. If you quarantine and the virus is controlled, then it looks like you panicked over nothing, because you took this huge reaction and nothing much happened. However, if you wait till it's sufficiently bad and then you quarantine everyone will understand what you did, and later, you may get praised for your decisive leadership in a time of struggle.
What I mostly wish is that citizens could throw some sort of flag now to say "This crisis is being poorly handled. If this goes badly, let's have a review, figure out why, and correct the problem once this is settled."
I don't want to go into longer detail as it will be subjective and seem political, but I'm expecting things to Get Weird.
And people distrust anything coming out of China's government so they simultaneously think China covered up a lot and there were way more dead, and they exaggerated how bad the virus is...
He's behaving entirely consistently with how he always has: deny everything, project perfection.
There's no signal here of a secret weapon, it's a complete shit show.
I am not sure what he is doing is even remotely serving himself that well either. Addressing the Coronavirus upfront is the only way to cheer up the market right now. Did he really think he can just fight this virus with speech or tweets?
This is bothering me no end, and severely impact my confidence in US itself overall. Damn it, this is a full on crisis, the shit is about to hit the fan so hard.
https://twitter.com/realDonaldTrump/status/12370273563148697...
https://twitter.com/realDonaldTrump/status/12370245512943820...
I'm amazed not only at these affirmations, but at the likes they get. Incredible.
Nobody knows the long term development of this virus. You could lock up everything, the economy collapses and it would hurt people even more than the virus might have. It is a gamble at this point.
Political games come into play if people demand answers that nobody can give. If some presume to be able to do that, they are lying to your face.
If this is over in June and 100,000 people died, what would we call this? It would just be another disease probably.
For people who lost loved ones it was a catastrophe, for other part of the normal life risk. Any publicly uttered judgement has to keep that in mind, so it will always be relative. Some are more forthcoming, but probably not public officials.
Of course the virus is not under control, how could it be? I would prefer measures to reduce its spread, but that is basically intuition and listening to some doctors with the knowledge that it just buys time.
Anyone using this crisis for political points doesn't really win any cookies with me personally, on the contrary.
The incentive to cover something up is just a reflex to save face. I don't like covering something up. There is a risk of disproportionate overreaction, but I think a bad information policy reinforces this. If they covered something up, it must be really bad, right?
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“You know what solves it? When the economy crashes, when the country goes to total hell and everything is a disaster, then you’ll have a, you know, you’ll have riots to go back to where we used to be when we were great,”
https://www.rawstory.com/2019/01/country-goes-hell-2014-vide...
From a well respected friend and intensivist/A&E consultant who is currently in northern Italy:
I feel the pressure to give you a quick personal update about what is happening in Italy, and also give some quick direct advice about what you should do.
First, Lumbardy is the most developed region in Italy and it has a extraordinary good healthcare, I have worked in Italy, UK and Australia and don't make the mistake to think that what is happening here is happening in a 3rd world country. The current situation is difficult to imagine, and numbers do not explain things at all. Our hospitals are overwhelmed by COVID-19, they are running 200% capacity.
We've stopped all routine, all Operating Rooms have been converted to Intensive Care Rooms and they are now diverting or not treating all other emergencies like trauma or stroke. There are hundreds of patients with severe respiratory failure and many of them do not have access to anything above an oyxgen mask.
Patients above 65, or younger patients with comorbidities, are not even assessed by Intensive Care. I am not saying not tubed, I'm saying not assessed and no staff attends to them when they arrest. Staff are working as much as they can, but they are starting to get sick themselves and are emotionally overwhelmed.
My friends call me in tears, because they see people dying in front of them and they can only offer some oxygen. Ortho and pathologists are being given a leaflet and sent to see patients on ventillation. PLEASE STOP, READ THIS AGAIN AND THINK.
We have seen the same pattern in different areas a week apart, and there is no reason that in a few weeks it won't be the same everywhere, this is the pattern:
1) A few positive cases, first mild measures, people are told to avoid the Emergency Department. People still hang out in groups, everyone says not to panic.
2) Some moderate respiratory failures and a few severe ones that need intubation, but regular access to Emergency Departments is significantly reduced so everything looks great.
3) Tons of patients with moderate respiratory failure, that over time deteriorate to saturate intensive care first, then intubation equipment, then CPAP hoods, then even O2 masks.
4) Staff gets sick, so it gets difficult to cover for shifts, mortality spikes from all the other causes that can't be treated properly.
Everything about how to treat them is online but the only things that will make a difference are: do not be afraid of massively strict measures to keep people safe. If the governments won't do this at least keep your family safe: your loved ones with a history of cancer or diabetes or any transplant will not be tubed if they need it even if they are young. By safe I mean YOU do not attend them and YOU decide who does and YOU teach them how to. Another typical attitude is read and listen to people saying things like this and think "that's bad dude" and then go out for dinner because you think you'll be safe.
We have seen it, you won't be safe if you don't take it seriously. I really hope it won't be as bad as here but prepare.
What does tubed mean here?
That's basically a nice way of saying "We will have to let people die"
If you don't have beds and incubutors, you can't treat people. Then people start dying.
Similar situations will play out in the US unless strict protocols are enforced now.
https://www.brusselstimes.com/all-news/belgium-all-news/heal...
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Sad but people are their own now. Hopeless.
What does arrest mean? Is that cardiac arrest? Is that how people are dying? If they’re dying and people aren’t attending, should they even be there at all?
Most fatalities are from pneumonia. Lots of details are available all over. You may want to read up.
https://www.ecodibergamo.it/stories/bergamo-citta/con-le-nos...
this is an online profile for the doctor:
https://www.dottori.it/daniele-macchini-516895
The post was originally shared on Facebook.
I think I have 5 tweets in the last 10 years.
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https://www.cbc.ca/radio/asithappens/as-it-happens-monday-ed...
We are, as much of the world, importers from China, but many enterprises here are also, somewhat, strong exporters to China (I can see it from my dayjob as industrial automation SI), and if you factor in the small average size of Italian companies requiring many individual contacts (contrast with Germany where companies on average are bigger), you can imagine that there is a strong flow of people to and fro. Maybe the small size of companies requiring more people to establish commercial links + population being more uniformly settled across the country (no huge wildland or sparsely inhabited area left in Po Valley, except maybe some parts of Piedmont?) + a certain cultural inclination for useless quarreling hindering political action + inefficiencies in the administration + an unsolved conflict of power between central gov't and periphery possibly causing some waste of time in other quarreling + having to keep the vast group of small business owners somewhat quiet has resulted in a vast spreading of the virus.
The interesting thing is that, if you replace China with Germany in the paragraph above (wrt. the possible German origin of the outbreak in Italy), the consideration about business links would still apply.
Another interesting thing I have just noticed is that some journalists are now openly praising the Chinese handling of the crisis. Maybe this may sound strange to an American :D but there has been for some time a growing cross-partisan movement calling for stronger links to China. In fact this movement is somewhat present in European business community, so it is not so special to Italy, but nonetheless it is interesting to see these comments of open praise.
I think this is a very interesting effect. China has a fantastic ability to mobilize as one when needed. The vast majority of the time, the insane amount of control this requires, is something we're simply not comfortable with giving to governments. But sometimes, just sometimes, the results are worth it.
The closest equivalence I could think of that'd be familiar to American ears, would be the WW2 war effort. It's not how most of us would want a country run day-to-day, but the ability to do so when needed is incredibly powerful.
Pumping a hospital out in a week or a battleship out in a month aren't dissimilar in national focus. And they're both achievements. What makes China feel alien to us is that this is their default stance.
(And that said, there's plenty to be critical of in the earlier days of China's response. But in the interest of sharing data and research, we're catching more flies with honey.)
After this pandemic has died down, we should compare and contrast different countries' responses and try to appraise objectively just how much of a difference they made. China is trying really hard to make the case that their authoritarian approach is a model for the world, and it's too easy to be persuaded by that rhetoric when everyone is afraid and panicking. Meanwhile, some countries are trying just as hard to persuade their citizens that everything is okay when in fact it isn't. When all is said and done, we'll see how well that works, too.
Depending on how things go, I think South Korea could become either a model for the free world or a lesson in the shortfalls of democracy. They were doing pretty well until mid-February without imposing any travel bans or other measures that might be considered authoritarian, but then the number of cases exploded and everyone had to scramble. Instead of strong central control, most things were delegated to local governments. Different cities and provinces took different initiatives, quickly learning from each other when one of them came up with a new idea such as drive-thru testing. The shortage of hospital beds was met by large companies (hello, Samsung) and megachurches donating their own resorts and conference facilities for use as quarantine centers. Hundreds of doctors rushed to Daegu to help with the medical crisis there, and faced very little bureaucratic red tape in doing so.
The decentralized approach has its own inefficiencies, of course, especially in places with incompetent leaders or when dealing with a cult that refuses to cooperate. But when South Korea says that there were only 35 new cases last night, compared to hundreds a week ago, you can actually trust that it's a good-faith report because it's been cross-checked by so many independent players. The central government misreported the case count for my city a couple of times lately, and the city immediately issued corrections.
I relate to this a lot based on my visit there. Things seem very unified. Hell, even dozens of old people get together every night and dance on the street. When have you ever seen communities like that in the US? We're too busy being self absorbed. We have no shared mission.
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Isn't having a massive military Americas default stance as well?
Italy also has a surprisingly large number of Chinese migrant workers, mainly in the fashion and leather goods sector. Skilled Chinese workers in Milan and Prato provide the kudos of the "Made in Italy" label at considerably lower cost.
https://www.economist.com/special-report/2018/05/17/long-ter...
http://www.xinhuanet.com/english/2020-03/03/c_138838575.htm
As for praising the Chinese response - I think the reasons will be very clear soon to most people - without a very decisive and heavy handed response the health care systems in most developed countries will face very severe consequences or collapse.
We are at the denial stage still with people finding excuses why Italy is different, etc, etc
The US is 8 days behind Italy is 8 days behind Korea.
Italy has 3.18 beds per 1,000 people. The United States has 2.77 beds per 1,000 people.
https://en.wikipedia.org/wiki/List_of_OECD_countries_by_hosp...
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Otherwise, EU's future is jeopardy.
There's nothing simple about any ECB decision on monetary policy, and the composition of the EU when combined with the nature of the Euro is such that pain almost by definition can't be evenly distributed.
After the human factor, the virus will hit the economy hard. It's probably only a matter of time till it triggers a serious recession. I'd really like to be wrong here.
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If this virus does indeed require such intense hospital resources (as in Wuhan and now Northern Italy) letting it spike is just madness. Must put into place heavy restrictions now.
We don't need travel lockdowns, but public events, movie theatres, etc should be closed, and businesses should be highly urged to allow workers to WFH if nec and/or try furloughs with public money (ha! good luck...)
In any case, just waiting until we see a spike in cases and then trying to get behind it seems like so much madness.
Large sports events? Museums? sigh
1) the CDC told all the other labs to stand down and wait for the CDC test kit
2) the CDC refused permission to test except under very narrow conditions
3) the CDC test kit was defective due to being over engineered, and delayed availability during a very critical period
Now that we're behind the exponential growth curve, any measures that politicians can take are going to be much less effective.
https://www.nbcnews.com/health/health-news/after-missteps-cd...
The only thing that be called reasonable statistic is the number of deaths and that hasn't spiked - I hate to say - yet. It's possible hospitals are even missing those, it's a big country. And it's a dispersed country so things might not spread as quickly.
But other, what you say. Stopping large public events and doing mass testing seems crucial. South Korea seems to have gotten a handle on their infection process at the moment things are out-of-hand in Italy. South Korea has done mass testing for a while.
https://www.corriere.it/video-articoli/2020/03/09/dopo-cina-...
Genuinely looking to learn.
0: https://www.nationalgeographic.com/science/2020/02/here-is-w... 1: https://en.wikipedia.org/wiki/Cytokine_release_syndrome 2: https://en.wikipedia.org/wiki/Tocilizumab
Rheumatoid arthritis is an autoimmune disease and not a "oh I'm old and I've worn down all of my cartilage" disease.
Chloroquine remains quite promising for the early stages http://news.southcn.com/nfplus/gdjktt/content/2020-03/09/con...
https://observablehq.com/@jashkenas/italy-coronavirus-daily-...
I reply with my humble contribution, based mainly on John Hopkins' data. I tried to understand if the effect of restrictions is already visible (I hope it will... since I live in Milan), thus I fitted an exponential on the data from the week before March 1 (when the initial mild restrictions started) and compared with the actual growth.
https://www.kaggle.com/mattiamonga/covid19
The model is quite simplistic, but the decrease seems real. Let's hope a bigger one will happen in the next days.
Expect other Western European Countries to follow this pattern as the number of cases increase [1]. I would specifically be looking at France, Spain and Germany as potential next candidates.
If people here haven't already, I would recommend not leaving your shopping to the last minute and to stock up on a few extra supplies to help not exhaust the local food-chain when people do start panic buying.
[1] https://www.worldometers.info/coronavirus/#countries
Without that irresponsible leak, and the irresponsible reaction of people trying to "escape", this total lockdown would probably not be necessary.
People sometimes are right shits.
> reaction of people trying to "escape", this total lockdown
> would probably not be necessary.
The leak was far from ideal, but I still think Italy would be in the same situation. I suspect there were already an un-contained spread in the South before the lockdown in the North.
> People sometimes are right shits.
This is still true, but I am not so sure they can be completely blamed. When people are scared they act irrationally and this should be incorporated into any plan.
I believe that the world is mocking a phantom.
Sensible choice all things considered. I think instant noodles are also a pretty good bet, I personally make a noodle soup with vegetables to bring up the nutrition a bit. I would also add frozen vegetables to the list as it keeps for ages and balances out most meals, whilst still being quite good for you.
I just hope that other government in Europe will take it seriously, because it seems spreading fast over France, Germany, Spain and Netherlands.
I don't know how the count is made, but since the pressure will affect the care for the other patients as well, it makes sense to at least take them in consideration in the stats.