A virus, a series of disconnected actions, the media “replacing” the experts, and experts who have different and often conflicting opinions. This is the unfortunate recipe that has led Italy to overtake China with the highest number of victims, due to the coronavirus.
Let’s analyze the Italian situation and see which other nations can learn to combat the unwavering advance of COVID-19.
Only a month ago, the COVID-19 cases in Italy numbered about 300 and the deaths “only” seven. On March 24th, there were over 69,000 cases and a mind-blowing 6,820 deaths. During the same period (February 24th to March 24th), China had 3,500 new cases and approximately 600 deaths.
Impressive numbers when compared with the overall populations of the two nations.
What did Italy lack, in order to be effective in the battle against SARS-CoV-2?
It’s easy to say today, by being “historians”. It would have been better to know it a month ago to avoid the suffering and mourning of so many people; mostly elderly people — who are no longer here with us. Unfortunately you know, the “art” of forecasting is very difficult, and the few who know how to practice it are sometimes not even believed.
It also happened to the now very famous Dr. Burioni who, since the beginning of the spread of the coronavirus in Italy, has been listened to but not fully believed; thanks also to the oftentimes conflicting opinions of his colleagues who defined COVID-19 “little more than an influence” diluted the strength of the message of those who tried to sound alarm signals — much like a shipwrecked person in the middle of the ocean.
What went wrong with the measures taken by both governments and leaders?
The policy of containment was not restrictive enough, and the messages of politicians were conflicting, such as the Mayor of Milan (Giuseppe “Beppe” Sala). Mr. Sala publicized the now infamous “Milano non si ferma” slogan (loosely translated as “Milan doesn’t stop”), and at the same time, the President of the Lombardy Region (Attilio Fontana) pleaded with the Government for more stringent measures.
The calming messages, also given by many other politicians — certainly in good faith and with the very best of intentions — have often generated a false sense of security, and thereby legitimized the view that Italians should have maintained their normal behavior and follow their natural inclination to merely “interpret” the rules.
In addition to mixed messages, what also hasn’t helped is what experts define as “active surveillance” (i.e. this was basically not even taken into consideration in Italy); it was very well applied, both in China and South Korea and has produced self-evident results. In order to apply this, it’s necessary to “diagnose positivity” with the now famous swab.
I’m taking this opportunity to make it clear that the swab itself does not diagnose anything at all; it’s just a means of sample collection that is then analyzed by molecular-biological methods.
Returning to the diagnosis of positivity, you can obviously start from a person who is sick and then discover that the person who demonstrates flu symptoms is infected with COVID-19; you must therefore treat him and put him in isolation, but it doesn’t simply end there — because that same person may have already transmitted SARS-CoV-2 to someone else.
This is exactly the point at which we stopped in Italy, and it was definitely carried-on in both China and South Korea. These two countries have, in fact, identified all the people who had been in contact with the positive patient and have diagnosed them for COVID-19, thus identifying asymptomatic patients who could still transmit the virus, placing them in “active surveillance”.
The “trump” card used against the spread of the coronavirus was ISOLATION. This measure would have led to a more effective containment and, above all, would have had two other very important effects: to reduce the pressure on Health Services, and to allow for the opening of factories. In the latter case, it would have also required appropriate safety measures (of course).
The municipality of Vò and “active surveillance”
Not all of Northern Italy has acted the same way. The municipality of Vò was the first to apply active surveillance, assessing the people with whom the patient had come into contact, in an effort to identify the asymptomatic people who had unwittingly spread the virus.
Today’s news is that the Veneto Region has ordered more extensive swab controls, and also in the same way as with South Korea (i.e. checks in cars). People enter a special area with their cars, and without getting out of the car, they’re swabbed. The advantages are the strong limitation of contact with other people, the general hospital environment, and also greater safety for healthcare workers.
The “new heroes” — doctors and nurses and the problem in Southern Italy
Returning to healthcare workers and according to them, they haven’t been provided with the necessary safety systems, in an effort not to become infected.
Doctors and nurses come into daily contact with dozens of patients and therefore can spread the virus exponentially within a short time — if they’re not protected first. In addition, a sick healthcare worker is of little help to anyone!
Now, Italy can still make up for all of this if it continues to exercise the restrictive measures adopted — and especially if it exercises active surveillance in the South of Italy, where the wave of contagion is expected over the next two weeks and where the situation in the hospitals is less favorable than in the regions of Northern Italy. Diagnosis, isolation and surveillance should be the watchwords there.
What can all other nations learn from this?
At this point, for the rest of Europe — but also for the United States — there are no more excuses. They have two examples where containment measures have led to the desired effect; China and South Korea, and one case where it could have been executed a lot better.
Certainly, being a democratic country like Italy doesn’t help when implementing both drastic and unpopular measures. But it can’t be an excuse when we talk about the health and economic well-being of an entire nation.
Finally, a note on diagnostic tests. There are now dozens of manufacturers of diagnostic tests. These tests have been put on the market and are reliable in detecting the presence of the virus and therefore the infectivity of the person. There are also tests that identify the presence of antibodies (i.e. that the person has contracted the virus and that at the time of the test, is immunized, at least against the strain of COVID-19 with which he or she came into contact).
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