The pandemic seems to be slowing down in Italy. It started to slow down some two weeks ago moving away from exponential increase. The numbers reported for coronavirus daily deaths have stayed below 800 for the past few days.
Coronavirus Tests in Italy
Like WHO and, my former colleague, Werner Benger, who should write something for this blog, correctly point out, testing is crucial to understanding the pandemic and to having functional quarantine. In Lombardy, they started in February by doing 200 - 300 tests for every death. As the epidemic progressed and the system got overwhelmed, they could only test 20 people alive for every coffin. By this loose testing policy, Lombardy let many people free to spread the illness. And spread it did. By March 23, Lombardy lost 3776 people to COVID-19. Given Lombardy's population of 10 000 000, it means 0.038% of the citizens of the province lost their lives to COVID-19. The apparent mortality rate, if we only consider the people tested, was a staggering 13%. The reported number of deaths is still below my death rate estimate of 0.2%. However, it is known that the number of deaths is under-reported.
When quarantine worked
At the opposite end, is the city of Vo, where everyone was tested. There were positives before the very first clinical illness. No one died.
Veneto had a more German approach. They tested vastly more. Compared to Lombardy, Veneto started doing 3 times more tests per capita when Veneto had one dead and Lombardy had 6. About a week later, Veneto had 2 deaths and Lombardy 55. On March 23, Lombardy reached 3776 deaths while Veneto only had 192. Overall, Veneto used 70% more tests per capita and lost 40 times fewer people to COVID-19.
In Lombardy today, nearly 60% of the tests are positive. In Veneto, only 11%, with an apparent mortality rate of 3.5%. A negative test can mean that
-- the patient has never been exposed to COVID-19
-- the patient has had the illness and is now healthy. People test negative when they leave the hospital.
-- there was an error with the swab.
We can distinguish between a person who has never been exposed to COVID-19 and one who has antibodies that protect them against this virus only when antibody tests become available. We will then be able to tell how many of us have had COVID-19, compute a true death-rate and determine whether quarantine is still needed.
-- the patient has never been exposed to COVID-19
-- the patient has had the illness and is now healthy. People test negative when they leave the hospital.
-- there was an error with the swab.
We can distinguish between a person who has never been exposed to COVID-19 and one who has antibodies that protect them against this virus only when antibody tests become available. We will then be able to tell how many of us have had COVID-19, compute a true death-rate and determine whether quarantine is still needed.
Meanwhile, the discrepancy between Veneto and Lombardy showed that widespread and early detection surely makes a difference. If we fight something -- anything -- it sure helps to find the thing. That's what tests do. If there is a silver lining, with nearly 60% of tests returning a positive, Lombardy should be done with COVID-19. Herd immunity should have been achieved and a second wave of COVID-19 is not expected (by me). Veneto and Vo, on the other hand, were able to contain the virus spread. So, as soon as the quarantine ends, the virus should come back. Unless they did some magic...
In both Veneto and Lombardy, the deaths slow down. They still increase by about 10% each day -- but this is slow compared to the 30% a day increase that seems to be the norm in this epidemic. Thus, the peak should be near.
Lombardy should expect a sharp drop in deaths after the peak is reached, whereas in Veneto it should continue burning slowly and coming back in new waves.
A note on Germany
A private clinic today offering tests to the general public for 150 Euro per test and reported that about 4-9% of the tests are positive. They test people who would not qualify for testing under the more strict criteria of state sponsored free tests. However, the down side is that some private tests may be more experimental and thus are less accurate than those approved by the government.
If the numbers are correct, here too, the peak shouldn't be too far away. We should all be exposed and get over it. And then, we'll be finally free. Free to fly like a few weeks ago.
Germany has also been seen a reduction in fatalities, which appeared too soon to be a result of the reduction in COVID-19 infections associated with the quarantine.
Thus, it must be due to the fact that people in quarantine are less likely to die. Like with most illnesses, it is important that each person takes care of themselves. When they are home, they are less likely to be overworked and tired or to go out in the cold. Staying home in the first days of the illness before the symptoms appear seems to be associated with better outcome for COVID-19 and with a lower chance of complications and hospital admission.
Germany has also been seen a reduction in fatalities, which appeared too soon to be a result of the reduction in COVID-19 infections associated with the quarantine.
Thus, it must be due to the fact that people in quarantine are less likely to die. Like with most illnesses, it is important that each person takes care of themselves. When they are home, they are less likely to be overworked and tired or to go out in the cold. Staying home in the first days of the illness before the symptoms appear seems to be associated with better outcome for COVID-19 and with a lower chance of complications and hospital admission.
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