Lombard Chronicles - Day 36th

"Ignoranti quem portum petat nullus suus ventus est." (No wind is favourable for the sailor who doesn't know which port he wants to dock" - Lucius Anneus Seneca) 

Italian version here

In my life, my professional (and human) career path has developed starting from our country, and gradually moving far beyond the Alps. 

From this professional "Grand Tour", which lasted over thirty years, I have learned a lot. 

One of the first lessons I learned was "the art of planning" and coming from a country that plans very little, it was also one of the most difficult lessons to learn. 

When I was working with the French, the time horizon of strategic plans was 6 years, while with the Germans I had to learn to go beyond 10 years. 

At the beginning it wasn't easy at all, but in the end, I learned that a strategic plan is not a divinatory exercise on the future but simply the rational and weighted expression through the evaluation of the most probable scenarios (negative or positive), of an objective that we aim to achieve in the long term. 

It is basically, a bit like saying, what we want to become when we grow up, and then, with great discipline and focus, really try to do it. 

What I think therefore distinguishes certain peoples from others is the "social discipline" with which they pursue their goals. 

That the world could be hit by a pandemic, (and that we have been very close to pandemic risks several times in history) is a fact. 

Equally explicit is the fact that different countries are showing different degrees of preparedness to deal with these crises.

In these days a lot of people are talking about the RSA disaster (residences for the elderly) and some "Chronicles" ago I also talked about it in the analysis of the differences in the cases between Italy and Germany, noting how Germany appears to be the only European country that is managing the epidemic crisis in the best way, limiting the confinement policies and, at the same time, also the deaths. 

In particular, I observed how (also on the basis of personal experience) the management of the residence for the elderly (Seniorenhaus) in that country seemed to me particularly effective. 

The hypothesis has been supported by a series of studies that confirm that unpreparedness or worse, improvisation has played a decisive role, unfortunately measurable in lost human lives. In particular, this new study: ""Mortality associated with COVID-19 outbreaks in care homes: early international evidence" published last April 12 also by the London School of Economics and carried out through the contribution of statistical research on 5 European countries (Italy, Belgium, UK, France and Spain) comes to the following conclusions: 

Key findings:

• Data from 3 epidemiological studies in the United States show that as many as half of the people with COVID-19 infections in nursing homes were asymptomatic (or pre-symptomatic) at the time of testing.
• Data from 5 European countries suggest that residents in nursing homes have so far accounted for between 42% and 57% of all COVID-19 related deaths.

In particular for Italy: 

"Extrapolating this mortality rate to the total number of residents in nursing homes in Italy (about 297,158), would suggest that about 9,509 deaths of residents in nursing homes are related to COVID-19. This would represent 53% of the total of 18,000 deaths in Italy on 9 April."

Although the problem appears to have affected countries other than our own, the finding that the emergency has been dealt with in a largely unprofessional manner is overwhelming. 

In particular, a survey carried out on 2,500 facilities, by the Istituto Superiore di Sanità and published last April 12: "Survey on COVID-19 contagion in RSAs" documents that between February 1, 2020 and March 24, 2020 (the interviews were conducted between March 24 and April 7) 48.5% of the guests in the residences were affected by flu symptoms. 

Swabs were performed only in a small part of the cases (133 out of 3859 deaths) but 37.4% of deaths were attributable to COVID-19 Symptomatology. 

Moreover, the percentage rises to 53% where it is considered that more than 60% of deaths occurred between March 1 and 24. 

It is also useful to analyse the second document, part of the same survey "Report on COVID-19 and Long-Term Care in Italy: lessons learned from an absent crisis management" which reminds us that: 

"The outbreak of the COVID-19 epidemic in Italy has tragically opened Pandora's box on the state of the Long Term Care (LTC) sector. Italy was one of the most affected countries in the world, as evidenced by the numbers of confirmed deaths and positive cases. In this emergency situation, the Italian demographic model already appeared particularly critical: 23% of the entire population is over 65 years old (Istat, 2019) - the highest percentage in Europe - which means that almost a quarter of the country's entire population is currently the most fragile and exposed to the lethality of the virus". 

The report identified three problematic "Issues" as the cause system of the "RSA disaster": 

• Issue 1: Deficiency in crisis management guidelines for the LTC sector
• Issue 2: Delay in the provision of personal protective equipment (PPE) to doctors and healthcare workers in nursing homes
• Issue n.3: Non-controls (testing) on the diffusion of COVID-19 in nursing homes

Again, the Istituto Superiore di Sanità informs us, in the latest edition of the analysis of "Characteristics of SARS-CoV-2 positive deceased patients in Italy" that the average age of deceased and SARS-CoV-2 positive patients is 79 years. There are 6339 women (34.0%). The median age of deceased patients positive for SARS-CoV-2 infection is more than 15 years higher than that of infected patients (median age: deceased patients 80 years - infected patients 62 years): 

It seems therefore confirmed, with extreme rawness, that a large part of the "industrialized" world has dramatically underestimated what was an evident characteristic of the epidemic, namely its particular lethality for the male age group over 70 years with at least one pathology and that too little and too late has been done to shelter these segments of the population. 

Any reflection on the "Exit Strategy - Phase 2", must absolutely start from providing an adequate response to the issue of the protection of the elderly over 70 years of age and which will mean providing an answer to 84% of the COVID-19 problem (and if we then include the 60-year-olds, we will solve 95% of the problem). 

And that's all for today as well.

In the meantime, let's #stiamoacasa and #teniamoduro !

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Today's sources:

• https://ltccovid.org/2020/04/10/report-on-covid-19-and-long-term-care-in-italy-lessons-learned-from-an-absent-crisis-management/
• https://www.protezionecivile.gov.it/attivita-rischi/rischio-sanitario/emergenze/coronavirus
• https://www.worldometers.info/coronavirus/#countries
• https://ltccovid.org/2020/04/12/mortality-associated-with-covid-19-outbreaks-in-care-homes-early-international-evidence/
• https://www.epicentro.iss.it/coronavirus/sars-cov-2-sorveglianza-dati
• https://www.epicentro.iss.it/coronavirus/bollettino/Infografica_13aprile%20ITA.pdf
• https://www.epicentro.iss.it/coronavirus/bollettino/Report-COVID-2019_13_aprile.pdf
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