Lombard Chronicles - Day 28th

"The Art of War has to do with life and moral forces. Consequently, it cannot reach the absolute, or certainty; but it always leaves a margin of uncertainty, in the biggest things as well as in the smallest. With uncertainty on one scale, courage and self-confidence must be placed on the other to correct the balance."  Carl von Clausewitz, On War

Italian version here

At the end of the fourth week of isolation, we resume the usual commentaries on the Lombard and international numbers, which we had suspended to give the right priority to the start of the project #tamponailvirus whose goal is to stimulate the increasingly necessary reflection (and action) on the "exit strategy" from the emergency that, fortunately, sees new confirmations every day (read today's interesting article by the Economist The coronavirus pandemic - An antibody test for the novel coronavirus will soon be available ).

To reiterate the absolute need for an "exit strategy" I want, as always, to start from data analysis, which is the only source of relative certainty in a world of fake news and cognitive distortions "at gogò".

Let us start from the statements of Prof. Franco Locatelli, President of the Istituto Superiore di Sanità, at the usual press conference at 6 p.m., now transmitted to unified networks. To the question of how many lives have been saved thanks to the confinement initiative, the answer "that an authoritative study documents that more than 30,000 lives have been saved".

The study to which the professor refers is the one we had already reported from Imperial College (which you can find here). The professor's statement therefore only validates the reliability of the study, which not only provides a hypothesis on the positive effects of isolation but also provides an epidemiological model that allows its calculation.

The model therefore certifies, as of March 30, an extension of the contagion estimated at 9.8% of the population equal to 5.9 million infected and in this hypothesis, the effect of the containment measures would have allowed to avoid at least another 38,000 deaths.

I have to remember that the official infected are (as of yesterday) 124,632. It is therefore evident that any reference to the "official" infected as an indication of the spread of the disease is simply illusory.

It is also necessary to remember that a percentage varying between 45% and 75% of those infected are asymptomatic (i.e. no symptoms, such as fever, cough, difficulty breathing).

It is important to keep these numbers in mind, because it is very likely that the effectiveness of containment policies will be greatly reduced by the extent of the contagion.

A further element that confirms our conviction that the extent of the contagion is some scales higher than recorded comes from the observation that some uncertainty must also be placed on the number of official deaths.

ISTAT has made available the "MORTALITY DATA" until 21 March 2020 and the comparison with the previous 5 years.

Some municipalities in Lombardy have not yet transmitted the relative data until March 20, so the comparison is relative only for the municipalities with the historical series 2015-2020 complete.

The deaths officially attributed to COVIS-19 are 2,526 (Civil Protection data) while the total difference is 5,067 compared to 2019, practically double. 

The data by province, unfortunately, show impressive deviations, which become terrible in the case of the two "hotbed" areas of Bergamo (+454%) and Cremona (+285%).

In terms of age groups, the data is equally shocking and shows that the over-65 age groups are particularly hardest hit, even if the 0-65 age group has also paid (relatively speaking) a tribute to the disease.

With no news of other epidemics, it is highly likely that these deaths are also attributed to the SARV-COV2 epidemic.

It will be useful to remember how the overall lethality for Italy (and worse for Lombardy, at 18%) already puts us at the top of the world, simply using the "officially" recorded data:

In the light of this new information, if we were to consider the official contagion data as reliable, we would have to double the lethality rate to 36%, (practically at the level of the Ebola virus).

At this point, of the two, one. Either we are facing a new Black Plague, or the data are not reliable (because they are partial). I'd go with the latter.

If, in fact, we use the epidemiological model of Imperial College, which estimates the volume of infected individuals at March 30 between 2 (3.2%) and 6 million individuals (9.8%, using only the data of the lower range), even doubling the number of official deaths (11,591 at March 30) we would obtain an estimate of the average lethality for Italy between 1.2% and 0.3% (a figure very similar to the German figure).

The "statistical" signals that therefore lay in favour of a situation of contagion much more extensive than what has been detected are becoming more and more evident every day.

Even assuming the lowest estimate (3.2% of the Italian population) we are in the presence of at least 2 million (as of March 30) infected and of which we have "traces" only 124,000 !

Let's remember that, probably, one million of these are asymptomatic, without knowing it, and therefore potentially a danger for the others (that's why it is good that everyone wears masks in public, because we are all potentially contagious, unless tested).

At this point we can analyze the data of the last few days and with the previous considerations in mind we can read the data with different eyes.

It is necessary to premise that the cases that "stumble" into the detection system are probably for the most part only those whose symptoms require hospitalization or in any case home observation.

The relationship between positive cases and hospitalization is practically a constant. 71% of positive cases were hospitalized. You will remember how in the first Chinese analyses, it was certified that about 15/20% of cases required hospitalization (in that case the 35,226 Lombards who passed through hospitals would correspond to a total of 234,840 infected instead of 49,118, almost 5 times more).

We can see well that until March 20 the curve has grown almost linearly (at that time we were, more or less all, at home for a little more than a week).

While from March 21 the figure dropped until March 30, when it started to grow again (back to the level of March 15/16).

After the good news of the reduction of the balance 3 days ago, in the last two we have lost the advantage with about 213 new admissions in total, which brings the total number of hospitalized patients to 13,326.

While not wanting to be pessimistic, the dynamics of the last week show a certs recrudescence of the epidemic which, if on the one hand justifies the requests for further closures and prolongation, on the other hand imposes with renewed urgency, the need for a change of approach.

The interesting data is in what appears to be a new testing policy that seems to have established a "standard" of about 7,000 (8,100 today) tests per day and at the same time a relative reduction in incidence (which is below 20%).

Analyzing the situation of hospital admissions and home admissions, probably also a consequence of the increased number of tests, it can be observed that the use of home admissions has exceeded hospital admissions.

The total number of admissions to hospital remains at a very high level (13,326 which is exactly the average level of the last week).

The good news comes from the intensive care that drops by 64 cases in two days, while the total number of patients in ICU remains high (1,326), thus reducing the need for relocation to other regions or even countries (Thank you Germany!).

While the death curve seems to be slowing down slowly, the number of hospital discharges (which we always read in moving average to eliminate the fluctuations attributable more to data transmission) is increasing, albeit in an extremely irregular way.

In summary, as you can see, light and dark. Cases decrease but find new thresholds of "resistance", hospitals are always loaded without a real reduction in the number of patients, deaths slow down even if, being a "derivative" of the hospital load, as long as we do not observe a sharp decrease in the same, it is not reasonable to expect a real reduction in deaths as well.

Finally, let us hazard a hypothesis on the "resistance threshold" of new cases. The large volume of asymptomatics that, escaping every possible control, slows down the descent of Ro (of the contagion factor) to the level (below 1) that we all expect.

Finally, the international picture.The dynamics seem to be consolidated by now.

The European countries of the panel (Spain, UK, France and Germany), in terms of cases (always to be considered with extreme caution and a little scepticism) show dynamics of strong alignment with Italy.

The USA, on the other hand, seem decidedly "out of control" both in terms of number of cases,

that in the dynamics of deaths, where all countries have overtaken China, with the exception of Germany, (which, however, we estimate to be equally in trend to overcome it).

A similar dynamic is also reserved to us by the analysis of lethality data, on the significance of which I believe will fill annals of scientific "papers".

COVID-19 is a new virus and we are really at the dawn of our knowledge. We have repeated it several times and we still do so on this occasion, it is necessary to undertake an innovative, articulated and multidisciplinary path to identify the actions that will allow us to live with this beast in the coming months.

In the meantime, for some more #stiamoacasa #wearyourmask #teniamoduro !

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