Heading into the Next Phase of the Covid 19 Crisis.

Welcome to Act II of this pandemic.

And there is no intermission. No catching one’s breath. Are we even remotely past the initial shock of waking up mired in the Covid 19 crisis nightmare?

The featured image in this post represents, for me, our journey into the next phase, which is largely undefined and hidden from our eyes. Who wants to zoom into so much uncertainty? Who wants to find themselves in such a wilderness without answers or a reliable plan? What comes next and how our lives might change?

Here in Italy, we’ve been watching the daily stats and anxiously waiting and hoping for a downward trend. If you look at the WorldoMeter website you’ll see that our new coronavirus cases peaked on March 21, and deaths peaked six days later on March 27. The lag makes sense. Both trends headed downhill, and we didn’t seem to get stuck on a plateau. Still, we need another week or more to have greater confidence in this trend, which we’d hoped to manifest as a steeper falloff. That ain’t happening. Oh well.

And lurking in the back of our minds are two BIG unknowns here in Italy (and probably in many other countries):

The true rate of infection and number of cases. Without widespread testing, we have to make loads of assumptions. Consider this news snippet from the WorldoMeters tracking:

“Italy: the real number of COVID-19 cases in the country could be 5,000,000 (compared to the 119,827 confirmed ones) according to a study which polled people with symptoms who have not been tested, and up to 10,000,000 or even 20,000,000 after taking into account asymptomatic cases, according to Carlo La Vecchia, a Professor of Medical Statistics and Epidemiology at the Statale di Milano University.”

The true number of  Covid 19 deaths. In the mayhem of the Italian healthcare system being severely taxed, many people have died with the cause of death being listed as pneumonia, heart attack, and other things. Most of these people haven’t been tested after the fact. Take Bergamo in Lombardy, perhaps the most afflicted town in Italy during this Covid 19 crisis.  An eye-opening article in TheLocal.it is well worth a read. It points out a huge disparity in deaths from last year to this year, even when subtracting the Covid 19 deaths.

“It is plausible that deaths are underestimated,” Higher Health Institute president Silvio Brusaferro stated. “We report deaths that are signalled with a positive swab. Many other deaths are not tested with a swab.”

Italy's government is sniffing out the next moves in the Covid 19 crisis.

Italy sniffs out an interim Covid 19 crisis plan.

Thankfully, the government leaders don’t seem to have an itchy trigger finger to release the masses back to life as we’ve known it. I believe leaders got so burned being slow to implement firm lockdown action in the beginning that they now are doubly determined not to let this coming roaring back.

So, when, what, and how? Prime Minister Conte addressed the nation last night, announcing the lockdown would continue at least until May 3. The only “tweak” is that bookstores and children’s clothing stores may be allowed to open. Beyond that, life will pretty much be the same for  3+ weeks. Personally, I’m glad we have the time to make sure the stats are continuing to drop to a level at which the risk might be manageable. We also need the time to intelligently craft a phased opening solution which, I’m certain, will still fall dramatically short of “life as we know it.”

I have no idea of what might come next and when. A tour around the globe shows us a pretty wide variety of approaches. One country’s strategy freaks me out a bit, and another country, in my opinion, might lead us to the light.

Sweden stays open during the Covid 19 crisis.Sweden takes a gamble with the Covid 19 crisis.

The Swedes are taking a very different path. They’re not implementing any lockdown or social distancing rules. Their strategy is based on one thing: Appealing to their residents to exercise good common sense. Interesting, isn’t it? Dangerous? Quite possibly.

The article “Sweden goes it alone: The Eu’s coronavirus exception” on the European Council on Foreign Relations website offers an interesting analysis and perspective on Sweden’s strategy.

“Sweden’s European partners have heaped criticism on its approach: riskyexperimentalcynicalnaiveslow, and crazy are some adjectives they’ve hurled at their normally compliant neighbour. A Danish journalist, looking at the Swedish approach, said ‘it’s like watching a horror movie.'”

The article points out that Swedes and Germans in particular like rules and are good rule followers. Germany has enforced rules, and while its cases per 1M are higher (1,411) vs. Sweden’s (935), Germany’s deaths per 1M (31) are less than half of Sweden’s (79). Resist the temptation to draw too many conclusions, including, “Well, look at Sweden, they didn’t implement any restrictions and they’re faring pretty well comparatively.” When you consider that Sweden’s population density in 2020 is 25 people per square kilometer and Germany’s is 240 people per square kilometer (Source World Meters) things get really interesting. I share this mainly to underscore the point of leaving this to the brilliant, qualified statisticians and analysts.

Let’s keep watching Sweden and see how their strategies factor into a broad, worldwide analysis further down the road.

Statistics as of April 10, 2020

And then there’s South Korea and how swiftly they swung into action.

I hope and pray that the world is making South Korea’s Covid 19 crisis response a poster child to prepare ourselves for the next pandemic threat. South Korea saw what was happening and swiftly crafted a strategy that included, at its heart, widespread testing (I’ll keep banging that drum, so get used to it). They also recognized, quite early, the enormous risk factor of asymptomatic carriers of coronavirus. Being the wizards of technology that they are, they also employed tracking of positive cases using cellphones.

I found this story in The Diplomat, entitled “A Democratic Respons to Coronavirus: Lessons From South Korea” to summarize the response quite effectively.

“While much of the credit has been attributed to the government, an equally important feature of South Korea’s response went largely unnoticed: the rapid mobilization of the public.”

I invite you to compare South Korea’s infection curve with other countries. I’d give anything to be so far and so low on the downhill slope. Instead, I’m afraid Italy is in for a slow downhill curve.

Lastly, lest people forget, the real hotbed of infection in South Korea was traced back to a religious group who gathered elbow-to-elbow in spite of the news and growing threat of Covid 19. I hope that similar stories don’t play out elsewhere.

This pandemic caught most of the rest of the world with its pants down.

The covid 19 crisis caught most of the world with its pants down.

Sorry, folks. That’s how I see it and I have and continue to hold Italy up as a cautionary note in this regard. I’ve experienced, firsthand, Italy’s deadly reticence to take decisive, proactive steps. Then, I’ve watched (with disbelief and horror) as the U.S. made many of the same mistakes and bumbled its way behind us. Hindsight is twenty-twenty but I will never get why the American government lost so much valuable time swinging into action.

I endeavor to keep political opinions out of my blog posts 95% of the time. But, with lives at stake, I feel emboldened to say “The Emporer has no clothes.” Why can’t, for just one tiny moment, President Trump say, “I misjudged, I miscalculated,” instead of doubling down on boasting of his prowess in tackling this expeditiously? Just where is the copious evidence to back up such articulated might? How can any sane person respect and trust a person who holds not one iota (at least publically) of culpability?

Yes, people have to deal with the hand we’ve been dealt (I get it, water under the bridge) but at what point do we recognize the danger of things to come under such leadership? I remain incredulous at the number of people who keep looking past these behaviors and Trump’s megaphone of misinformation and bravado. The latest example, and one that comes at a crucial juncture:

“You’re gonna see nobody’s gonna be getting sick anymore. It will be gone and it won’t be that much longer.” – Donald Trump. Friday, April 10, 2020, at White House briefing.

This was when The President was asked by NBC’s Peter Alexander how he could know that the coronavirus “will be soon in full retreat.” In my opinion, Trump’s response completely ignores the HUGE threat of asymptomatic spread and, therefore, the critical need for widespread testing.

Getting a grip on what we know and what we don’t know about the Covid 19 crisis.

Each country is attempting to construct a go-forward strategy rather than the world joining together to establish an international task force and accord to tackle this with agreement and consistency. That’s too bad, but it is what it is.  We’re in the throes of trying to get Pandora’s Box closed again. There’s so much we still don’t know about this coronavirus, and until we have much more solid information, this is going to be like trying to grab hold of vapor and put it safely away.

What we know:

  • Covid 19 is highly contagious/transmittable.
  • A large percentage (25% +) of infected people can be asymptomatic, yet can still spread the Covid 19.
  • Manifestation of symptoms can be a few days to a couple of weeks (research seems to indicate that this is the most infectious/transmittable stage).
  • Covid 19’s fatality rate is highest in the elderly population, especially with those who have preexisting conditions. BUT, younger, healthier people are being taken out as well.
  • The majority of people infected by Covid 19 have mild or moderate disease.
  • While some people have a few days of mild symptoms and discomfort, moderate to severe cases can linger for several weeks. Recovery can be a long haul.
  • Vigilant social distancing, use of PPE and stepped-up hygiene slow the spread of Covid 19.
  • Warm weather doesn’t appear to be blunting this virus. Rising cases in subtropical and tropical climes bear this out.
  • Estimates for an effective vaccine is 12-18 months.
  • No proven therapies of treatment currently exist. While there are anecdotal studies of Chloroquine, a time-honored anti-malarial drug, the jury is out until bigger test groups have been vigorously applied. The line between dosage and toxicity makes researchers and doctors particularly wary. Read this BBC article about Chloroquine. Remdesivir, an anti-viral developed in hopes of treating Ebola, is showing early promise in clinical trials. “Over 18 days, 68% of the patients improved, with 17 of the 30 patients on mechanical ventilation being able to get off the breathing device.” (by Michelle Fay Cortez, Robert Langreth, and Jason Gale, Bloomberg 4/10/20). Read the article here.

What we don’t know:

  • Level and length of immunity of people who recover from Covid 19. Researchers are testing and tracking Covid 19 antibodies to see how long immunity sticks. A year, two years, forever? And what happens if, like the flu, the virus mutates? Will people who have antibodies have at least partial immunity? We need years before we have these answers.
  • The true rate of infection. Until we have widespread testing, we don’t and can’t know how far the tendrils of this highly-contagious virus reach.
  • Real death rates. With coronavirus testing primarily limited to people who have exhibited obvious symptoms, may experts (see the story about Bergamo above) believe many people who have other causes of death listed may have been due to Covid 19.
  • Why are there pesky cases of people who recover, test negative, and then test positive again? Read this recent article. Are they shedding the virus again and infecting more people?

At best, we are armed with educated guesswork.

I believe that the above lists illustrate just how in the dark we are at this point in time. I also believe they tell us how dangerous wishful thinking can be in the understandable urge to return to some semblance of normal living. I get the motivation to get people back to work and the economy humming. But what happens if we jump the gun without understanding the extent of the Covid 19 crisis and the things that are hidden from our eyes? Do we find ourselves assaulted by second waves of this?

Are our lives about to change more materially than we’ve ever imagined?

This is an important question to ponder. Potential answers might help us began preparing us for behavior changes and mind shifts that will be with us for a long time.

And, that my, friends, will be the subject of my next post.

 

 

 

 

 

 

By |2020-04-14T18:11:20+02:00April 11th, 2020|Healthcare in Italy, Living in Italy, My Life in Italy|10 Comments

About the Author:

I’m an American expat living in Italy!

10 Comments

  1. Robin April 13, 2020 at 4:56 pm - Reply

    Thanks Jed,
    You are the kindest, most decent man I have ever met, and the same stands for Markus. We hope to see you soon in Umbria. Kiss and hugs, R & M

    • Jed April 20, 2020 at 1:04 pm - Reply

      You’re too sweet, Robin! I’m fortunate that I have such wonderful, compassionate friends (and parents who taught me a thing or two!).

  2. Marty April 13, 2020 at 12:26 am - Reply

    Always appreciate you perspective from afar. thanks …

    • Jed April 13, 2020 at 11:26 am - Reply

      Prego!

  3. Bill April 11, 2020 at 10:45 pm - Reply

    Good post Jed. I know Italy will survive this because of its people. They are strong and determined. I do agree we have a leader in the states that has not taken any responsibility even to the point his administration decided to shut down the pandemic task force created under George W and carried on with the Obama Administration. There is an interesting video of a speech that then President Obama made in 2014. If you haven’t seen it, it’s a good watch but also makes me so mad. What do you have if you gain the greatest economy that has been built on sand? He refused to take any responsibility yet he made the very decisions that could have at least slowed the outbreak.

    Here is the video link: . https://www.youtube.com/watch?v=pBVAnaHxHbM

    Godspeed to you!

    Bill

    • Jed April 12, 2020 at 7:58 pm - Reply

      Thanks, Bill, for the link. I am going to watch the video tonight. Or, maybe I should wait until the morning in case I have a similar reaction of exasperation of where “things” have landed now. That way I can work off my ire during the day! Let’s hope that at least one byproduct of this crisis is that people will reexamine their values and build their lives on rock, not sand. Thanks for writing, and Godspeed to you as well! Jed

  4. Mark Hinshaw April 11, 2020 at 6:49 pm - Reply

    A very good, concise article covering all the significant elements.
    Yes, Italy does seem to be conforming to the Bell Curve indicated by models. The downward side will be as long as the upward climb. But as you say, at least we are not stuck in a plateau.
    And I’m afraid the U.S. is in for a seriously long cycle. Even now, I am appalled at some of my otherwise intelligent friends in the U.S. who are taking long recreational bike rides. Why is it seemingly so difficult for people to get that Stay at Home means just that?
    Mark

    • Jed April 12, 2020 at 7:54 pm - Reply

      Grazie, Mark. I was a little worried yesterday (Saturday) to see the stats pop up again, but today’s death toll is the lowest in three weeks and new cases continue to stabilize. What we’re doing seems to be working. I, too, get really, really exasperated with people still heading outside in the States. I get the benefits of exercise on physical and mental health, but it only takes a small % of people who don’t practice outdoor exercise with good judgment to keep this thing spreading. This isn’t something with which to mess around! Let’s hope people everywhere get on board and act wisely! Jed

  5. Robin April 11, 2020 at 6:40 pm - Reply

    Thanks so much for this series Jed. We wholeheartedly agree with you, and appreciate the time involved, with such extensive research. Sending well wishes to you and Simone.

    • Jed April 12, 2020 at 7:49 pm - Reply

      Thanks for cheering me on, Robin. I think writing this series keeps me sane and forces me to dig deep into the information coming at us from all directions and trying to sift it down to the most helpful. I’ll keep at it. Big hugs to you and Markus!

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