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In Italy Over the past two weeks, the number of people testing positive for the coronavirus has risen day by day to touch the threshold of 1,500 cases this week (click here for all data and maps). This resumption of viral transmission that affects the entire national territory seems to be driven by prevalent socialization behaviors mainly among young people (but not only) and by cases of imports. The virus spreads by exploiting people’s social behavior – the more people you meet, the more likely you are to be infected. It happened to those who regularly went to crowded places and discos without taking precautions. Now we come to the same number of cases that we read with apprehension in the Civil Protection bulletin when, under the shock wave of hundreds of deaths a day, a nationwide lockdown was decreed. However, this resumption of the broadcast presents some differences compared to what we observed during the terrible months of February, March and April (it is there for all to see): most infected people are young, mostly asymptomatic or with very mild symptoms. And comfortingly, the number of people hospitalized in Covid and resuscitation rooms increases by a few units a day without putting pressure on the health system. The scientific community, the media and all Italians wonder what is happening. Leading scientists argue that the virus has mutated, weakened, and thus the emergency is over. Others recommend caution and encourage not to lower your guard and justify a state of emergency. The number of patients hospitalized in intensive care and the people who, sadly, still die from Covid-19 have become flagships of opposing scientific and political factions.
The analysis
Analyzing the data and knowledge that we have acquired so far, I believe that it is possible to give a balanced and coherent explanation of the situation that promotes a constructive debate on the measures that must be taken all together to live with the virus while waiting for a possible vaccine. Let’s start again with the number of cases verified (1,492) the day Italy entered emergency shutdown And we do an effort of memory: reagents for swabs were scarce, tests were carried out only in hospitalized people who were in serious condition and many patients stayed at home without treatment or diagnosis. There was no trace of the asymptomatic patients whose presence and contribution to transmission was strongly denied by all the health authorities. Everyone now agrees that those numbers were a dramatic understatement of reality.. Before drawing conclusions, based on comparing the number of cases in recent days with those registered during the darkest days of the pandemic, and affirming that the virus has mutated or has become “better” (in fact, the data comes from the rest of the world suggest that Covid-19 maintains all its danger) we must, therefore, try to reconstruct how many cases there really were in Italy during the first weeks of the pandemic. The serological survey recently carried out by Istat throughout the country helps us in this exercise, which in my opinion has not had the media and scientific coverage it deserved. We learn from this analysis that Covid-19 cases in Italy totaled one million 482 thousand, a figure well above the number of confirmed cases (265 thousand). Given that around 70% of the cases verified with swabs were registered in the period from February 22 to April 3, using data from Istat, it is possible to calculate that during those 40 days in Italy there were around one million 40 thousand cases of contagion (70% of one million 482 thousand) which corresponds to 26 thousand cases per day. In the current phase, aware that infected people may be asymptomatic or have mild symptoms, tests are carried out on people who previously would have been neglected and therefore the data is much more representative of the actual transmission of the virus. At this point, the accounts add up. The cases of these days are about 15 to 20 times lower than those of the first weeks of the pandemic, calculated taking into account the contribution of asymptomatic and mild cases. If we multiply by 15 the number of patients hospitalized in intensive care and the daily deaths of these days we are approaching the values of February-March. Another element to consider is that older people have adopted very prudent behavior to avoid transmission and at the same time nursing homes are subject to much stricter measures. Even the observation that the average age has decreased is an apparent phenomenon not attributable to the genetic and biological characteristics of the virus. In fact, the results of the Istat serosurvey have shown that during the acute phase of the epidemic about 70% of cases affected people under 59 years of age.
The breakout threshold
The delay in transmission observed in our country compared to neighboring countries is more likely to be attributed to the gradual elimination of the distancing measures adopted by Italy. This places us in a privileged situation since it allows us to see in advance what could happen to us in the coming weeks. If the cases increased at the observed rate, we could reach the numbers of Spain and France in a few weeks. The resumption of work activities, the start of schools, the important date of the elections, as well as the beginning of the fall season will inevitably create interactions between people that the virus will use to spread. Therefore, it is essential to keep your current balance of numbers as low as possible., because if the failure threshold is reached, with the number of cases exceeding the response capacity of the health system, the only option remains emergency shutdown which, given the economic situation, is still an extreme option. The breaking point of balance can be avoided by honestly explaining to people what we are experiencing and encouraging virtuous behavior. However, this is not enough.
The proposal
The great problem in counteracting the spread of the virus is the high frequency of asymptomatic subjects who can transmit the infection without knowing it. Identifying the asymptomatic is precisely the challenge we face to prevent cases from reaching the limit. Here I would like to remind you that on February 27 the virus had already infected 5% of the population in Vo ‘before creating symptomatic clinical cases. The systematic identification of asymptomatic patients through the massive but targeted use of tampons was the key to Veneto’s success. At this time the regions as a whole can at most reach the capacity to perform about 90,000 swabs, a peak that is reached occasionally and is not enough to cover the demand for tests that will exist. It is, therefore, this urgency that led me to present, at the invitation of some members of the government, a plan that leads to an increase, up to quadruple tampon manufacturing capacity nationwide overcoming regional barriers and divisions that have generated an insane panoply of technology initiatives and adoptions that are certainly confusing and in some cases counterproductive.
* Director of the Department of Molecular Medicine, University of Padua
August 31, 2020 (change August 31, 2020 | 07:50)
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