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The Catastrophe in Italy

People line up to donate blood at an Italian Red Cross center in Rome, Italy, March 17 2020. (Remo Casilli/Reuters)

The numbers in Italy keep getting worse, with nearly 800 fatalities on Saturday. Why is it so bad? Hopefully, what we are seeing is still a reflection of the situation prior to the national lockdown and at some point soon we’ll begin to see the effect of the quarantines. But the velocity of the disease has been astonishing. As the New York Times notes, “the rate of increase keeps growing, with more than half the cases and fatalities coming in the past week.” As recently as March 9, when the earliest version of the national lockdown went into effect, the figure for deaths was 463.

The body count has been literally overwhelming.

The Times piece posits that the root of the problem has been the lockdowns have been behind the curve at every step.

It also wasn’t an ideal time for cultural exchanges with China:

On Jan. 21, as top Chinese officials warned that those hiding virus cases “will be nailed on the pillar of shame for eternity,” Italy’s culture and tourism minister hosted a Chinese delegation for a concert at the National Academy of Santa Cecilia to inaugurate the year of Italy-China Culture and Tourism.

Michele Geraci, Italy’s former under secretary in the economic development ministry and a booster of closer relations with China, had a drink with other politicians but looked around uneasily.

“Are we sure we want to do this?” he said he asked them. “Should we be here today?”

With the benefit of hindsight, Italian officials say certainly not.

The Telegraph points, unsurprisingly, to the old population in Italy, but also quotes an expert saying how Italy categorizes its deaths has played a role in the surge in numbers:

According to Prof Walter Ricciardi, scientific adviser to Italy’s minister of health, the country’s mortality rate is far higher due to demographics – the nation has the second oldest population worldwide – and the manner in which hospitals record deaths.

“The age of our patients in hospitals is substantially older – the median is 67, while in China it was 46,” Prof Ricciardi says. “So essentially the age distribution of our patients is squeezed to an older age and this is substantial in increasing the lethality.”

A study in JAMA this week found that almost 40 per cent of infections and 87 per cent of deaths in the country have been in patients over 70 years old.

But Prof Ricciardi added that Italy’s death rate may also appear high because of how doctors record fatalities.

“The way in which we code deaths in our country is very generous in the sense that all the people who die in hospitals with the coronavirus are deemed to be dying of the coronavirus.

“On re-evaluation by the National Institute of Health, only 12 per cent of death certificates have shown a direct causality from coronavirus, while 88 per cent of patients who have died have at least one pre-morbidity – many had two or three,” he says.

STAT News reports on a new paper by Italian doctors in Bergamo arguing that caring for so many coronavirus patients in the hospitals is part of the problem:

One such step reflects the finding that hospitals might be “the main” source of Covid-19 transmission, the Bergamo doctors warned. The related coronavirus illness MERS also has high transmission rates within hospitals, as did SARS during its 2003 epidemic.

Major hospitals such as Bergamo’s “are themselves becoming sources of [coronavirus] infection,” Cereda said, with Covid-19 patients indirectly transmitting infections to non-Covid-19 patients. Ambulances and infected personnel, especially those without symptoms, carry the contagion both to other patients and back into the community.

“All my friends in Italy tell me the same thing,” Cereda said. “[Covid-19] patients started arriving and the rate of infection in other patients soared. That is one thing that probably led to the current disaster.”

Pray for Italy.

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