Lombard Chronicles - Day 40th (ex-isolation)

"If we want to bring down the enemy, we must commensurate our effort with his capacity for resistance; this is expressed through a product whose inseparable factors are: the size of the means available and the strength of the will". - Carl von Clausewitz 

Italian version here

These days, the production of the chronicles has slowed down for some, and I hope good, reasons.

The first reason is related to the decision to direct the efforts, in this period of "domestic captivity", towards a more constructive mission than the simple representation of numbers (also taking into account the many uncertainties that accompany them) and in particular, to work on the #tamponailvirus project, of which I'll tell you about the progress in the next days.

The second reason, on the other hand, was linked to the decisive change of scenery that we had begun to read in the figures and the need to let the consolidation of the data, that we have been reading over the last few days, offer some greater clarity of interpretation and yet, there are many questions without adequate answers.

As the days go by, the volume of data and the analyses available allow a better reading of the epidemic phenomenon and allow us to begin to draw two assessments, one good and one bad.

Let us start with the good one.

Since the beginning of this epidemic, the "key performance indicator prince" (kpi) has been the saturation trend, but we should better say oversaturation, of the availability of intensive care units.

It is clear that we left the peak behind us at the beginning of the month and that, with 947 current admissions, we find ourselves at the level of March 18, i.e. about a week from the beginning of the "lockdown" (we remember that the initial maximum availability was 900 beds, which were then increased to about 1,400 not counting the 400 that should have been available in the famous and never fully operational hospital of the former Milan trade fair and made possible thanks to the 21 million donated by 1,200 benefactors.

The general trend is the same for hospital admissions.

While ICUs have declined more gradually, hospitalizations have undertaken a decisive downward trend in the last three days.

In fact, it has gone from a few dozen hospital discharges per day to a few hundred, while the number of "home admissions" is growing without interruption, making the mass of "currently positive" apparently still growing:

But that the number of positives is really growing, we allow ourselves to doubt it, preferring a different explanation, which we already tried a few days ago.

Estimating, retroactively, and on the basis of deaths and serious cases (the only reasonably objective data) the volume of those infected, the picture we would get is the following:

Much more similar (and plausible) than the one recorded through the ondivagus test policy that in the last few days has seen, again, a marked increase.

The number of new positives, therefore, continues to show more than a thousand cases per day, with push-ups that are more expression of the variations in the number of tests than of the epidemic dynamics.

Therefore, if, with the same volume of positives, the number of hospitalizations decreases, it is quite evident that the "quality" of the positive cases that are identified daily has changed.

What does "quality change" mean?

It means that 1,000 new cases a week ago were probably 1,000 critical cases, whereas today's 1,000 new cases are only 50% critical (or maybe even less).

Similarly, deaths also show a similar dynamic as in intensive care:

Leaving it to be assumed that we are therefore a couple of weeks away from the time when we could record a level of deaths in the order of a few dozen or so cases and ever closer to zero.

The international comparison, sees very little news.

In fact, if on the one hand we record the clear convergence of the European panel (FR, DE, UK, ES) around the dynamics of the Italian cases, (the graph compares the cumulative number of cases of each country to the Italian ones from the moment in which the 150 cases were exceeded).

Convergence also visible in the comparison with the USA, obtained by aggregating the data of the 5 European countries (homogenized by date of beginning of infection).

On the other hand, we must continue to see the diversity of the effectiveness of the actions put into practice to contain the number of human losses.

With Germany proving to be, among Western democracies, the true "champion" in the management of the epidemic, managing the epidemic through perfect social discipline, limited recourse to lockdown, and the continuation of productive activity. (Anecdotally, we point out that the Chinese figure has been "corrected" with a further 1,260 cases a posteriori, which brings lethality in China to almost 6%).

The good news is then that we can say that the worst is behind us, while the bad news is that the first balance sheets on the different reaction and above all management capacities shown by the different countries are beginning to be available. And we are not coming out of it well.

The Deep Knowledge Group has developed an interesting analysis, comparing the different countries on the basis of a series of 72 parameters:

And the result of the analysis expressed the following ranking, which basically confirms, in a more articulated and reasoned way, the observations made so far:

"Rewarding" our country as the most "risky" in the world (followed by USA UK, Soagna and France).

Instead, whether we like it or not, the safest countries to date appear to be the usual "known" (Israel, Germany, South Korea...).

We have repeatedly highlighted the need for a more systemic and selective approach to pandemic management.

If we analyze the countries covered by the DKG analysis, we find a number of common factors.

Above all, what we understand is that the best response to the pandemic is systemic, i.e. given by the teamwork of all relevant factors (speed, information flow, infrastructure, efficiency of the state system, monitoring and testing) and cannot, under any circumstances, depend on a single person or a single parameter.

The reflection on the "Exit Strategy - Phase 2", is now underway, but it is absolutely necessary to understand that, even if the next serological test scheduled on a sample of 150,000 Italians will show the true extent of the epidemic, the vast majority of the population will still be potentially exposed to infection.

It is necessary, with immediacy, to take advantage of the "best practices" of the countries that have shown better capabilities and replicate them, at best, in Italy.

In the great football matches, we have always praised the superiority of the Italian "fantasists" in comparison with the "teamwork and athletic preparation" of the German teams.

I fear that an epidemic is not a football match and to quote Sir Winston Churchill "Italians lose football matches as if they were wars and lose wars as if they were football matches" but unfortunately we are not playing football here.

In the meantime, for a little while longer, let's #stiamoacasa e #teniamoduro !

And if you would like to help us : #tamponailvirus !

We thank all those who will support our initiative!

Today's sources:

• https://www.ilsole24ore.com/art/si-parte-i-test-immunita-150mila-italiani-ADsgbTK
• https://www.dkv.global/methodology
• https://www.ospedalefieramilano.it/it/notizie-dall-ospedale/l-ospedale-fiera-e-in-funzione-e-con-i-suoi-primi-53-posti-letto-nel-padiglione-2-e-accoglie-gia-i-pazienti-covid-19.html
• 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