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Ranieri Guerra, Deputy Director of WHO, lThe curves seem to increase with less speed, but the cases increase. How to read the epidemic data?
“There is no contradiction. We are seeing a slowdown in the transmission speed that is not the same as decreasing cases. The growth is simply less abrupt. These are probably the effects of the first Dpcm on October 24 that introduced very light measures. Then there were another two, the last linked to the introduction of the color zones determined by the monitoring system that the Government and the regions have committed to activating. And it is from this that we expect more important results. Time of about ten days ».
Italy is the only country that has adopted the system of differentiated risk zones. Haven’t other governments found it efficient?
“In reverse. Italy has implemented a very complex monitoring system, based on complex indicators, fed by the flow of information that the Regions transmit to a control room formed by the Ministry, the Istituto Superiore di Sanità and the Regions themselves. An analytical mechanism that not all health organizations can implement.
Exactly, isn’t the mechanism too complex and cumbersome?
«No, the Regions are asked for ordinary data, but quality data and they are sent on time. The problem is that the communication of the data at this initial moment is weekly. To be even more effective, the frequency of sending and analyzing data should be higher, at least twice a week, to ensure the timeliness and appropriateness of restrictive and release actions. Regions that don’t provide data at the right time are automatically assigned to a critical area. In my opinion, rather than putting them in immediate closure, it would be more appropriate to help them and ensure that the system is sustained and of quality. The red areas do not have all the same characteristics, they have different points of suffering.
What is the purpose of the indicators?
“They should not only aim to define closure or reopening criteria, but also to channel additional resources to correct the weaknesses that are identified.”
How is data quality used for weekly monitoring?
“Initially there were some doubts about its credibility and the system was working, with processes that could be improved. Now, with a considerable effort on the part of the Regions especially, but also on the part of the control room technicians, we can say that it very faithfully reflects the situation that is going to be explored and will surely be refined more and more. The Regions have understood very well that the information must be timely and reliable and that the data cannot be an element of negotiation, otherwise we will not be able to get out of the emergency situation in which we find ourselves ”.
Aren’t there too many 21 indicators that risk assessment depends on?
“No, the grid of indicators is very well designed and reflects the reality on the ground. Furthermore, no one prohibits taking measures to simplify these parameters. However, it is better to proceed this way at this time, than with generalized closings. I think the trend of the curve will show that the government was right, that it strongly wanted it. We will be able to progressively optimize the system and perhaps discuss a review of it together, for example with colleagues from the Italian Epidemiology Association and the Italian Society for Hygiene, Preventive Medicine and Public Health and the many academics and practitioners who are trying to Give instructions. Very appropriate and relevant termination, but the architecture of the system is still very valid and works, unique in Europe.
How will we spend Christmas?
Well, it will be a sober Christmas, even if the epidemic numbers improve. It would be a big mistake to let it go, as it happened in the summer. The image is very clear. The virus is transmitted through human contacts. Either we limit them spontaneously, at the individual level, with the sense of responsibility to which we continue to appeal, or we will have to impose closures with the economic and social consequences that we already know well. Unfortunately, there are no shortcuts. Forecasts? “The curve is slowing down and will soon start to decline again but will lengthen over time, compared to the first wave as we have more cases, spread across the country, diagnosed even much better, thanks to a testing activity in continuous growth. And let’s not forget that we are at the beginning of the winter season. “
There are already those who are thinking about the third wave.
“Epidemics behave like this. The curve, I repeat, will become less steep but that does not mean that the virus will disappear. Like last summer, it will remain under the radar and it will be a long time before it is removed for good, despite the availability of vaccines. When they arrive, it will also be necessary to rush to protect the population to contain the speed of transmission and interrupt the chain of infections.
To understand the trend of the epidemic we have to read the RT?
“We know that if the value of RT falls and remains below unity, the epidemic stops. But it is not the only value to consider. The ability to secure the health system is essential.
And it is
“The biggest problem right now is with admissions to medical wards. Beds are often occupied by people with social rather than clinical needs. Lonely people who have no support and cannot stay or go home. The creation of alternative structures is necessary and urgent to free hospitals and guarantee people in suffering, perhaps elderly and lonely, the support and security they need. It is an aspect that worries more than the occupation of intensive care beds where the income is certainly adequate from the clinical point of view, for patients who really need the work of the intensivists ”.
November 15, 2020 (change November 15, 2020 | 07:02)
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