No one Wants to Follow the Sad Fate of the Italians

Americans love Italians but no American wants to follow the fate of the Italians in their encounter with COVID-19. More Italians, 5,476, have died of COVID-19 in just the last month than any other country in the world by far.  China is second at 3270 total to date.  Scaling this 29 days rate to a year, it would mean 68,900 deaths for a country with a population of 61M.  This is a worse rate than the 153,200 Italian civilians that died over 6 years in WWII. 

And there is very little sign that the curve has peaked (see figure below).  The number of active cases has risen to 46,638.  This has overwhelmed the health care system in many parts of Italy resulting in the highest mortality rates in the world, 9.3% (coincident).  Our best guess lagged5 rate is a horrendous 17%.  Aside from an overstressed health system where a scary high 31% of all hospital beds in Italy on average have been used to treat COVID-19 victims, Italy also has one of the oldest populations with a median age of 45.5 years contributing to the high mortality rate.  Given this high mortality rate and number of active cases, we project that another 8,000 Italians will die in the next few weeks no matter what they do – very, very sad. 

So where does one look for a ray of sunshine in this dark winter that has just passed?   In both China and South Korea where the virus has been “controlled” – stringent travel restrictions were imposed and then the curve turned 3-4 weeks later.  In Italy, the upgraded travel restrictions including closing the borders were put into place on March 8th and we expect improvement by the end of this month or early in April.  Expect means little with a pandemic that has shocked the world with surprises and new records set almost every day.  However, if you look at the graph of active COVID-19 cases in Italy, you can see that yesterday's data suggest a bend in the curve could arrive in a week or two.  While the number of active cases increased by 2,957, the rate of increase dropped below 10% for the first time in 10 days.  This shows that the number of active cases could soon stop rising at an accelerating rate – a necessary pre-condition for peaking.  We cannot be really optimistic until we see a true turn - when the number of resolved cases (recoveries plus deaths)  per day exceeds the number of new cases as they have in China and South Korea.  This milestone would mean that the count of available hospital beds would finally increase after a month of decreasing capacity.  The first signs of spring may arrive soon in Italy.  

A second reason for optimism is that a report emerged this week that a town of 3,000 in Italy was able to eradicate the coronavirus in an experiment that called for widespread testing that resulted in zero new cases this past week. We have always called for early and thorough testing, tracking, and treatment (TTT) as a necessary condition to combat a pandemic.  We did not know that when combined with strict travel restrictions (TTTT-4T approach) they would be sufficient to eradicate the virus from a city, region, or country.  But this is essentially what the South Koreans have been able to do.  They have controlled the virus infection and are working toward virus-free status.  As long as they remain vigilant against foreign re-infection they can achieve zero cases from both domestic and foreign sources.  It would be important to replicate this approach with a proof of concept test for a Western city of size, for example, San Francisco.  Trump, with his war powers, can order all American companies with test-kit manufacturing capacity to make millions of test kits or purchase them from foreign suppliers in the coming days for this test.  If Trump fails to do this we will have to appeal to private institutions such as the Gates Foundation.  The virus has spread widely in the Bay Area, but if they test everyone and apply this Italian 4T approach and demonstrate that it works, If more test-kits can be made or bought in the next week, we can immediately apply this 4T approach to metro-Seattle and metro-NYC which has become the new epicenter of coronavirus infections in the world.  Americans should be ready to follow this Italian model in the war against the coronavirus.  Then, all the Italian suffering would not have been in vain.