Thursday, March 26, 2020

Coronavirus: Quick fixes or slow Italian slogs


Early in the 1980s Italian cars had seatbelts but if you wanted you could just let them dangle. The cops once pulled me over for wearing one, apparently because for someone at the wheel of a sporty Rabbit convertible this was suspicious behavior. When seatbelts finally became obligatory, Neapolitans responded by printing up t-shirts with a broad black stripe from left shoulder to right waist, to make it look from a distant police car as though you were had one on. 
Now the same national ingenuity has been put to work for a nobler purpose. Ten days ago a hospital in the northern Italian city of Brescia, hard hit by covid-19, was running out of the valves that hook up patients to ventilators, and the supplier couldn’t keep up with the demand. Two young Italian guys who owned a 3D-printing company brought a valve home, took some measurements, and 24 hours later had printed 100 fully-functional replicas. Their latest trick is turning snorkeling masks into respirators…
Italy is otherwise short lately on quick fixes – and on la dolce vita. Under the gentle Californian social distancing rules, we can’t eat in a restaurant but we can order out anything from Burmese to Ethiopian. We can’t go to a gym but we can stroll around the neighborhood any time we want or drive up to Tilden Park for a hike. We can’t have a friend over to dinner but we can meet her in a green space and have a chat, though at two meters one may avoid intimate subjects. We drove way across town to score a bottle of olive oil good enough for adoptive Romans.
The Italian stay-at-home, on the other hand, is more like house arrest – you can’t walk out the front door without written justification, which is frequently checked. Most of our friends in the now truly naked city of Rome can’t even take a pleasure walk. That privilege is limited to dog-owners, and then only within 500 meters of home. Parks are closed, you can’t drive except for health or essential work purposes, and in-person meetups are a no-no at whatever distance. All my informants agree that Romans, defying their reputation as scofflaws, are being amazingly compliant with the restrictions, and from conviction, not just fear of the patrolling cops and drones. There are no spring-break parties on Italian beachs.
Desperate measures are being taken – Italian medical students, who usually get little hands-on training, are being brought to work on the wards, courageous physicians from southern Italy have gone to the covid-striken North to fight the virus, and doctors have come out of retirement to lend a hand. Twenty-four of the 33 physicians who have died of covid-19 were over 65, including an 87-year-old woman psychiatrist from Brescia. Thousands of physicians and nurses have fallen ill with the disease.
Rome now has five dedicated covid-19 hospitals or buildings, two of them comandeered private hospitals, with a total of over 1000 beds.
Italy had to practically abandon the test-and-track-contacts strategy after a month cohabitating with the coronavirus, for lack of test kits and of personal protective equipment for the testers. Only people sick enough to require hospitalization are now getting a definitive diagnosis. Widespread testing is strongly advocated by the World Health Organization, and has proved invaluable both in Korea and in Italy itself.
Some aid is coming in from China. Chinese provinces have already donated 30 ventilators, 400,000 masks, 60,000 test kits, and 5500 protective suits to Italy, the Bank of China donated 100,000 masks and 50 ventilators, and a combination of donations and purchases brought another 100 ventilators and 2,000,000 masks. Two batches of Chinese doctors and nurses arrived bearing both their own experience and bags of convalescent serum for treating patients. It was rumored two weeks ago that China was making another 1000 ventilators, 50,000 test kits, and many million masks available for Italy to purchase, but that seems to have come to naught.
Part of that Chinese know-how is an artificial intelligence program supposedly capable of diagnosing covid-19 with 98.5% accuracy in 10 seconds by analyzing CAT scan images of the lungs…
It turns out, by the way, that I was wrong in my last post about the 500,000 test kits supposedly shipped on military planes to the US: they weren’t Chinese but Italian (from the Copan company in Brescia), they weren’t test kits but just swabs (those long Q-tips they stick up your nose), and they are, remarkably, not in short supply.
Incidentally, I keep trying to track the million masks and 500,000 test kits Jack Ma promised to the US. A first shipment supposedly arrived over a week ago, but I’ve found no word of it since. 
But there is now truly good news coming out of Italy: the rigorous countrywide social distancing measures are bearing fruit. In parts of the North the situation in hospitals is still horrific, 662 Italians died yesterday from covid-19, and in Rome the epidemic still hasn’t hit its peak. After just two weeks of nation-wide lockdown, though, the number of patients in Italy’s intensive care units is already plateauing, and the number of deaths are falling day by day – today the total death toll went up by only 8.8%, compared with over 30% a day before the lockdown. My updated graphs are below, and a New York Times article has made the same mathematical point. Deaths should start trending downward about ten days from now, trailing the ICU curve by a week or so. Exactly as optimistic virologists predicted.


(It’s important to understand that covid-19 is a slow disease, so the effects of preventive measures take a long time to kick in. As a comparison, if influenza develops into pneumonia it takes only a few days. With covid-19 pneumonia develops gradually, over two or three weeks, and recovery is also much slower, so patients who need a respirator need it longer.)
I had hoped to be able to devote this piece to debunking putative covid-19 treatments, but after Donald Trump’s latest about-face I thought it was better to hammer home the Italian example instead. Just ten days ago, before I last posted, Trump embraced social distancing and those of us who believe in science started to breathe easy. Now he has back-tracked, floating on Sunday the prospect of getting back to business as usual, doubling down on Monday, declaring Tuesday that social distancing is a “cure worse than the disease,” and proposing that the country should be “opened up and raring to go” by Easter. 
The number of deaths in New York City has gone from 10 a week ago to 281 just now. Trump fiddles while his hometown burns – and proud of it. Just as he’s proud of having chosen Easter as a deadline not based on any scientific data but because “I just thought it was a beautiful time.
You don’t have to go as far as Italy to demonstrate the advantages of social distancing, by the way. The Imperial College study by Ferguson and his colleagues, the one that pushed Boris Johnson and – briefly – Donald Trump into advocating social distancing, thought “Stopping mass gatherings is predicted to have relatively little impact.” Unfortunately that may have been one of their few inaccurate guesses, judging from the counter-example of New Orleans. Its Mardi Gras was followed two weeks later by the very first case of covid-19 in Louisiana, and now, a month after Mardi Gras, there have been 1795 cases and 65 deaths. 
Experts agree that in the first growth phase of this pandemic, which the United States has barely entered, social distancing will take time to work – only now, after two months of draconian measures, is China cautiously daring to begin a return toward normality. Something like that time scale, however painful, will have to be applied here as well if we want to avoid going down the paths of China and Italy. A brillian new study shows that countrywide distancing measures are very effective in reducing covid-19 deaths even if they are not as draconian as China’s or even Italy’s. Fortunately city and state governments, the only ones to impose social distancing regulations thus far, can do so whatever the President says. But there is justifiable concern that the 60% of Americans who told Gallup pollsters last week they think Trump is handling the coronavirus crisis just fine will now feel freer to flaunt any guidelines put into place locally. 
The chance of a concerted national effort to contain the virus already lost three precious weeks between Feb 26, when Trump said “We’re going very substantially
down, not up
,” and March 17 when he “Felt it was a pandemic long before it was called a pandemic.” Now there may be no chance at all.
Bill Gates has already lost billions due to the shutdown of the economy. Here, contrary to his own financial interest, is his vicious paraphrase of the President’s new position: “Hey, keep going to restaurants, go buy new houses, ignore that pile of bodies over in the corner.” 
Or you may prefer The Onion’s version: “Trump Urges Loosening CDC Restrictions To Let Coronavirus Get To Work.”

2 comments:

  1. Charles AmirkhanianMarch 27, 2020 at 6:36 PM

    Susan, What are your thoughts now about being stuck in Berkeley when your next two stops were to be NYC for a while and then back home to Rome? And are you suggesting that we NOT walk around the neighborhood but just stay indoors as much as possible?

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    1. We decided just yesterday to stay on in Berkeley at least until the end of April. Life in Rome is just a) too sad/limited, and b) too risky, New York ditto, and we're both doing pretty well here - I spend my days on the computer, we take walks, Alvin has a borrowed keyboard, and we may soon be moving somewhere that even has a piano. About staying indoors no, sorry to have been unclear, I think the level of stay-at-home that is being done in California is sufficient, and should be enacted on a national scale. See what I called, including typo, "a brillian study".

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