Lombard Chronicles - Day 19th

"Remember, there are five elements of military strategy: first, measurement of space; second, evaluation of quantity; third, calculation; fourth, comparison; and fifth, probability of victory" (Sun Tzu, The art of war)

Italian version here.

Before commenting on yesterday's data, which the media have already widely commented negatively, I believe it is useful to repeat that the punctual data has little significance, while the trend is much more representative.

The "trend", is nothing more than a straight line (or a curve) which, by interpolating data of several days, eliminates the inevitable fluctuations that the punctual data undergoes.

This is the reason why, we prefer to look at multi-term moving averages and interpolation curves rather than raw data.

Specifically, it is useful to remember also some "bits" of information that may have escaped many reporters.

The first is the order n.514 of 21/3 of the Lombardy Region which has extended the number of tests also to subjects with body temperature above 37.3 °, the second is the request, now generalized, by the administrators of the 85 municipalities of the Metropolitan City to increase the number of tests. The third is the saturation of the relatively few laboratories responsible for analyzing the tests (and the consequent accumulation and delay with which the tests are made available: "A delay of 3.6 days (95% CI, 1 to 10) was found between the date in which the result of the test was received and the date of the recording in the dataset").

The fact that the real number of infected people is much larger than that detected begins to be evident to many, as well as already measured in some scientific papers that we have already mentioned in recent days.

An exemplary case is that of the municipality of Vò Euganeo, absorbed in the honor of the chronicles, such as the "hotbed" of the Veneto.

In a recent interview, prof. Andrea Crisanti (director of the microbiology and virology laboratory of the University-hospital of Padua) who studied the outbreak of the Veneto municipality of Vò Euganeo (which was tested at 100% ) tells us that the important lessons that that case they taught us are three:

1. the percentage of the infected, already very high at the time of the first case, was 3%
2. 45% of those infected were asymptomatic,
3. a second sampling showed that 3 out of 8 (37.5%) of the new cases were cohabitants of asymptomatic infected people.

We know that the virus has been around in Lombardy since early January, and that the first confinement measures were taken in early March.

It therefore seems reasonable to assume that, compared to the 34,889 "officially registered" cases, the real cases could be in the hundreds of thousands (3% of the Lombard population is approximately 300,000, which obviously represents an indication of the maximum theoretical).

Moreover, starting from the only (semi) certain data we have, which is represented by 4,861 deaths as of yesterday (remember that only deaths related to people who had previously been tested are counted in the statistics) and we compare it with the index worldwide lethality (divided by sick), net of the Italian figure, equal to 3.51%, we obtain 138,490 possible infections, of which over 60,000 are probably asymptomatic, a figure much more consistent with the figure of Vò Euganeo and as suggested by the literature science we have.

Therefore, all considering, we still rely more on the "hard" data as represented by the dynamics of hospitalized and deaths, whilst the number of infected people will inevitably be influenced by the number of tests that it will be decided to be carried out (and also by the ability to process them in a reasonable time).

We come then to the analysis of yesterday's data.

The "net balance" between new cases and resignations / deaths is again growing strongly, given that it worries above all because it represents a constant and inexorable increase in pressure on the health system.

The 2,543 new cases of yesterday, we have already commented on them and therefore we focus rather on their destination.

916 cases were destined for home isolation while the remaining 1,627 were directed to hospitals.

Even ICU admissions have still grown by 27 new units, which clearly "squeak" with the growth of hospitalizations and therefore make the finding of the system's ever-decreasing efficiency inevitable.

The theme of the "resilience" of the health system is definitely the central theme that I imagine will take the sleep away from those who have responsibility for decisions.

The previous graph (which I do not like to show because objectively "difficult") shows the trend of cumulated deaths on the total number of hospitalized (before discharge and deaths, therefore all those who have been hospitalized since the beginning) and compares it with the percentage that instead represents the ICU patients on the net hospitalized (ie those who are currently hospitalized).

It appears terribly evident, from the intersection of the two curves, how the growth of deaths as a percentage of hospitalizations can only refer to the system's less than proportional ability to offer intensive care responses.

Coming to less painful notes, the number of discharged was 558, which is still far from the three digits we need to begin freeing hospital capacity.

The number of deaths curve (387 yesterday), despite remaining high, always appears to be still attributable to a downward phase.

We estimate that the overall picture, linked to hospital overload, will keep the level of casualties still for several days at a level compatible with the current picture.

The international picture is decidedly very dynamic.

The US has "snatched" the record of contagion from both Italy and China and, in the awareness of the different and more timid approach to the Anglo-Saxon lockdown, it is to be feared that the "escalation" will be dimensionally significant.

Increasingly evident, therefore, how the "Wuhan Method" is, in its brutality (death penalty for those who did not respect confinement) more effective, at least from an epidemiological point of view (on the economic one, it will be seen, the writer greatly prefers that South Korean).

The different approach also reflects on the lethality indexes which show a trend that is more and more similar to the case than to the Chinese one. The picture is therefore extremely mobile and there is always little certainty.

We believe it is necessary to develop more selective and targeted strategies and I believe (indeed, I am sure, for once) that on this point the time is ready for a strategy change.

In the meantime, #stiamoacasa and #teniamoduro

Sources:

• https://docs.google.com/spreadsheets/d/e/2PACX-1vTkU8J3Y85CtSQ8VPtufO2xNP10_IXAtffBDNahe3B5hqQuTIb4EAe5a68zlbdCFg/pubhtml
• https://opendatadpc.maps.arcgis.com/apps/opsdashboard/index.html#/b0c68bce2cce478eaac82fe38d4138b1
• https://www.worldometers.info/coronavirus/#countries
• https://experience.arcgis.com/experience/685d0ace521648f8a5beeeee1b9125cdhttps://science.sciencemag.org/content/early/2020/03/13/science.abb3221
• https://www.ijidonline.com/article/S1201-9712(19)30328-5/fulltext
• https://www.epicentro.iss.it/coronavirus/sars-cov-2-sorveglianza-dati
• https://arxiv.org/abs/2003.09320
• https://www.maccura.com/en/product/uwMA7UmFXAE-.html
• https://www.nytimes.com/2020/03/23/world/asia/coronavirus-south-korea-flatten-curve.html
• https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.10.2000180?fbclid=IwAR2ac_EdG19dnnnUjFoBUmIQZNMFMzqaD3yZ9gPDFuZRXGqparM3MBfUWnw#t1