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Covid 19: Italy Experience

Italy has recorded the highest number of Covid 19 deaths (15887) in the world.  It also has the second highest national fatality rate of 263 deaths/million people.  This in comparison to the US which has has 9652 deaths and a national fatality rate 29 deaths/million people.  It is not completely clear why the Italian and US experience is so different.  It is likely that the virus was spread during the 3 week period from the first detected case to the date that a nation wide quarantine was put in place.  Restaurants and bars remained open for another 2 days after the national quarantine was announced.

As of April 6, there has been a decline in the number of deaths for 3 straight days.  It is hoped that this signals that the ‘peak’ of the infection has passed and that quarantine efforts are having an effect.

Here is a timeline of events in Italy.

The first 2 cases of Covid 19 were made on Jan 31, 2020 when 2 Chinese tourists in Rome tested positive.  On the same day, Italy suspended all flights to and from China.

In February, 11 municipalities in northern Italy were identified as infection centers and placed under quarantine.

February 23.  Additional specific towns are placed under quarantine.  Carnival celebrations and some soccer matches were cancelled.

March 4.  Schools and university were closed but there were now over 3000 known cases.

March 8.  Quarantine expanded to all of Lombardy and 14 other northern provinces.

March 9. Quarantine exteded to all of Italy.

March 11.  All bars and restaurants closed.

March 22. Factories are closed and all nonessential production is halted (59,138 cases).

 

 

Covid 19 in California

Because so many of my family and close friends are in California.  I thought I’d provide an update on some of the latest numbers.

April 5, 2020.  There are currently 334,730 confirmed cases and 9572 deaths due to Covid 19.  In the US.  California accounts for 14,812 of these cases and 344 deaths.  California has the 4th highest number of cases after New York, New Jersey and Michigan.

IF the process was random, there are 378 cases of Covid 19 for every million Californians so, the chance of getting is numerically small, but in reality, the odds go up the more you are in contact with people.  If you bump into the wrong person, that’s all it will take.  Also, if you are in a ‘hot spot’, your chances of getting it are much higher.

Within California over half of the cases and half of the deaths are in Los Angeles, San Diego and Santa Clara Counties.  This illustrated in the map below.

ca map

When will the ‘peak’ arrive?  There is little data to go on, but the data from China and South Korea indicate that the curve flattens (new cases and deaths decrease) somewhere between 20 and 30 days after the 50th case has been confirmed.  IF (and it’s a big IF), this hold, then the peak for Ca and most of the US should come before the end of April.

top usWe are looking for the dark blue squares to become lighter blue – that will signal the turn down in the curves.

You already know this, but the disease is primarily passed person to person – stay distant…if you don’t come into contact someone, you probably won’t get it.  Also, up to 50% of infected people will have either no or very mild symptoms, so feeling ok is does NOT mean infection is not present.

 

A brief review of Pandemics

Since 3000BC there have been records of epidemics (spread over limited areas) and pandemics (involving many countries). This is a summary of the 3 most deadly episodes since the early 1900s’. This information is just meant as historic background to the current Covid 19 pandemic. It is interesting to note that in many cases, vaccines were never developed but in each case, the disease spread eventually stopped likely due to a combination of deaths and development of immunities.
A reminder that this is not meant to downplay the seriousness of Covid 19. It is measnt as a historical perspective only. I hope that all of our precautions will prevent Covid 19 from reaching the numbers of these other deadly viruses.
1918 The Spanish Flu. The origin of this disease has not been agreed upon. It did NOT come from Spain. At the time of the outbreak, the world was plunged in World War I. The spread and lethalisty of the disease was a consequence of the cramped conditions, poor neutrition and poor health conditions of the soliders and civilians. Spain was a neutral country at the time and the Spanish press published early accounts of the disease.As a result, readers assumed the disease originated in Spain and the name stuck.
Global Infected: 500 Million (estimate)
Global deaths: 50 Million (estimated)
US Deaths: 675,000
Most effected age group: 20-40
 
Asian Flu 1957-1958
The earliest reports were about outbreaks in Singapre in Febrary and in Hong Kong in April 1957. It is unclear how many total people were infected.
Global deaths: 116 Million (estimate)
US deaths: 116,000
 
H1N1 – Swine Flu 2009-2010
This virus was believed to have originated in Mexico.
Global infected: 1.4 Billion
Global deaths: 284,000
US Deaths: 12,469 (80% younger than 65)
 
A reminder that as of 3/30/3030, Covid 19 statistics are:
Global infected: 771,985
Global deaths: 37,016
US deaths: 2,935
Animated Pandemic Word Cloud on a Blue Background

What is Covid 19?

Covid 19 is the name of the name of the respiratory diseases caused by new corona virus. Coronaviruses (CoV) are a family of RNA viruses that typically cause mild respiratory disease in humans.

However, in 2003 the Severe Acute Respiratory disease coronavirus (SARS-CoV) demonstrated that CoVs are also capable of causing outbreaks of severe infections in humans.

A second severe CoV, Middle East Respiratory syndrome coronavirus (MERS-CoV), emerged in 2012 in Saudi Arabia. Coronavirus name derived from the Latin corona, meaning crown. When viewd by an electron microscope, the virus appears to be ‘crown like’ due to small projections on the surface. The virus that causes Cov-19 is SARS-CoV-2. The origin of the virus is not specifically known at this time but it has been speculated that it came from an animal such as bats or pangolins.

The disease is transmitted by respiratory droplets.The time for symptoms to appears (incubation period) has a range of 2-12 days with an average of 6.4 days. This is why a 14 day quarantine or isolation period is set for those who are suspected of having an infection.

The most common symtoms are: fever (83-98%); dry cough (46-82%); and shortness of breadth (11-44%). Current estimates are that 80-85% of those infected will have minor or no symptoms. Because these symptoms are similar to other diseases, such as the flu, it is not possible to easily distuingish Cov-19 to other diseases without specific testing.

As of 4/3/2020 it appears that as many as 50% of those infected will have no or mild symptoms. 40% of those infected will feel like they have a bad flu and may have trouble breathing but will recover without hospitilization. The fatality rate is still not known, but current estimates believe that it will be about 1% in the US.

South Korea: Covid 19 Containment vs Privacy

Despite having a population of 61 million people and outbreaks in large cities, South Korea was able to contain the spread of the virus with incredible efficiency.  How did they do this?  They were greatly aided by reacting very quickly to the appearance of Covid 19.  They began early traveller inspections, bans, quarantines and testing.

However, they also used  the tools the modern digital age to collect, process and disclose personal data that allowed authorities to conduct contact-tracing (follow the infected person and who they interacted with).

Upon the discovery of a confirmed case of COVID-19, the health authorities used personal data to determine the point of infection and possible close contacts. This process begins with an interview follwed by obtaining credit card transactions, mobile phone tracking, and CCTV,  provided by both private business owners and employers. The result is a detailed hour-by-hour reconstruction of the individual’s whereabouts in the days leading up to the confirmation of infection. In some instances, data processors can even determine whether the person in question was wearing a mask at specific times inside certain venues, suggesting that business owners and employers disclose personally identifiable images to the government.

Close contacts are identified in this manner, questions and if necessary tested and quarantined. The government also uses the location data to deploy teams to disinfect locations where a confirmed case has been, such as offices and even private residences.

Further, data regarding the real time location of infected people was made public so that the uninfected could take precautions to stay away from infected indviduals.

There is no doubt that this was a very effective way to enforce social distancing.

Would the US public trust the government to conduct this kind of information gathering and dissemination to control Covid 19 AND trust that they would do nothing else with the data collected?face recognition technology concept illustration of big data and security in city with crowd

Covid 19: Italy vs South Korea

Italy has second number of confirmed covid 19 infections and the most deaths of any country. As of April 2:

Italy: 119,827 cases: 14681 deaths. Population 61 Million Deaths/Million: 273

US: 264,159 case: 6714 deaths: Population 375 Million Deaths/Million 20

South Korea 10,064 cases: 174 deaths. Population 61 Million Deaths/Million 3

So why the difference?

Italy has the second highest number of people over 65 (27%). Italy is very densely population with 583 people/square mile compared to 94 in the US. Rome has 5800 people/square mile Milan has an amazing 19,000 square/mile! On average, New York has 28,000 people/square mile. Like New York, Milan is a hub for international business. High numbers of travelers from great distances go in and out of Milan. Last, the outbreak was not discovered until it well underway. Once a high number of infections occur, it is dificult to ‘flatten the curve’.

South Korea. Despite the benefit of the availability of early testing and strict social distancing, South Korea had some demographic advantages over Italy. Only 18% of the population is over the age of 69. Only 20% of the cases were in people over 60. In fact, the largest age group infected were those in 20% which accounted for 30% of the cases. Seoul has a huge population density of 45,000 square mile but still managed to keep the infection rates low.

Don’t be a Patient 31

South Korea is given a lot of deserved credit for their handling of the Convid 19 outbreak.  However, there are some facts not generally discussed.  For insance:

80% of the infections can be traced back to people who attended two churches.

There is one person, designated Patient 31 who diretly infected over 1000 people.  These other people then went on to infect others and there you have an epidemic.

Patient 31, a 61-year-old woman, was a member of Shincheonji Church of Jesus in Daegu and tested positive on February 18.  In 2 days, 15 other members of the church were confirmed with Covid 19.  By March 25, members of the church accounted for 5080 confirmed Covid 19 cases.  This was over 50% of the nations infections.

The location of the second largest outbreak was due to people from the Shincheonji church who attended a funeral several miles.

The outbreaks from these two area accounted for 80% of the cases in South Korea.

The message is that the disease is passed along Person to Person.  If you don’t make contact with anyone (or anything an infected person may have touched), you are highly unlikely to get the disease.

It is also estimated that 25-50% of the people who are infected do not know they are infected.  They either have no sumptoms at all, or have mild symptoms that they believe is due to some other illness (cold, flu, etc.).  So, just because you are feeling well, or someone else is feeling well does not mean they infection can not occur.

DON’T BE A PATIENT 51.  Keep your distance.  Six feet is an average safe distance..the further the way, the better.d7bb992c-b4a0-4104-9a75-116b7dd046d7_1920x1080

 

 

 

The Covid 19 Challenge

Today, President Trump, Dr. Fauci and Dr. Birx presented predicitons of deaths due to Covid 19 based on computer models.  The models show predicted that there would be 100,000 to 240,000 deaths due to Covid.

The model was based on current data from all the states and from around the world.  As mentioned in an earlier blog, the range of fatality rates varies greatly by state and by country.  New York, New Jersey and Connecticut clearly have the highest fatality rates.  There are also indications that fatalities may be rising quickly in Louisana (New Orleans) and Michigan (Detroit).  Dr. Birx also pointed out that there were many states such as Washington that seemed to have a fatality rate early but have since leveled off.

Dr. Fauci was clear in his belieft that although the model predicts 100,000 or more deaths, that the actual number will be far lower.  This is based on several factors:

  • The values are largely influenced by a few very high locations.  The data from New York, New Jersey, Italy and Spain greatly influenced the model estimates
  • There are many examples such as South Korea, Washington State and China that have shown that the number of deaths can be significantly lower.
  • The model does not take into account increased testing, experimental treatments and improving patient care in its estimates.

There are daily improvements in the distribution of needed medical supplies, increasing hospital beds, increased testing and the manufacture of masks, respirators and medicines.

The model warns of the severe consequences if the disease should get out of control.  The model also predicted that there could be over 2 million deaths if none of the actions being taken (social distancing, hand washing, travel restricitions etc) was not being done.

The model is a clear reminder that the next 30 days are even more important than the last 15.  The disease has run its course in several other countries and there are some states that are almost uneffected.  This means that the 100,000 deaths don’t need to happen.

model 1model 2

The Covid 19 Prediction

I was shocked at the models Dr. Birx and Fauci presented yesterday regarding the projected deaths from Covid 19.  The models and graphs showed that there could be 100,000 to 240,000 deaths from Covid 19 within the next couple of months.

model 1

However, they cautioned that this model is based on current data is significantly influenced by ‘hot spots’ such as New York, New Jersey, Italy and Spain.  The model also does not take into account the increasing improvements in treatments, detection and continued social distancing.

The following graph is shows the number of cases in each country AFTER the first 100 cases were reported.  This is done as the early rate of increase of detecting the disease varies greatly and is dependent on other factors such as how quickly tests were avaialble.   It is important to note that an increase in cases is a combination of increases in actual cases and also increased amount of testing.  This chart does not indicate the severity of the disease – only if it was diagnosed.

Nonetheless, the lines for China an South Korea appear to ‘flatten’ after 20-30 days after the 100th case was confirmed.  As you can see from the blue US line, we are just now entering this 20-30 day window.  Hopefully, our curve will also flatten, if it does, then we will NOT reach the 100,000 deaths predicted by the model.  Itlay (dark green) is further out in time and beyond the 30 days, but perhaps the curve is flattening – only time will tell.

world deaths edit

The following graph is number of deaths in each country.  If you look closely, there are a number of countries that seem to ‘flatten’ after 20-30 days after cases were confirmed.  Note that the curves actually start on different days, but they are all overlayed so that the rate of improvement can be seen.  China is ‘off the chart’ but has the same shape as the South Korean data.

deaths

 

Will there be US 100,000 deaths to Covid 19?

It was somewhat shocking to hear that the CDC models projected a possible 100,000 to 240,000 deaths from Covid-19 over the next couple of months.

Like any model, the accuracy of the prediction is based on what information was used to create the model.  According to Dr. Deborah Birx of the CDC, the model results were largely influenced by data from New York, New Jersey, Italy and Spain.  These are areas that don’t appear have the ‘peak’ of their disease curve.  In others words, those places could continue on the rapid increase path they are or not.

The dark curve below is the number of deaths if we did nothing…no social distancing, no hand washing etc.  The smaller curve is the predicted deaths based on current information.

THE MODEL IS ONLY A PREDICTION BASED ON CERTAIN ASSUMPTIONS.

For instance, it does not take into account that more testing means more people are getting treatament earlier, there are several treatments being tested (eg hydroxyquinilone), more ventilators are being made available and there are more strict controls being put into place re: travel restrictions.

All of these factors, plus the factor that no country has come anywhere near this number of deaths even though it seems the ‘peak of the number of deaths’ seems to occur in less than 30 after the 100th case is detected.

The 100,000 number can not be dismissed, but it doesn’t mean it will happen.

The disease is passed on person to person – isolate, isolate-you can’t tell who has it, you may not be able to tell if you have it.  The colored graph below is for cases of Covid 19 – not fatalities.  It shows that there appears to be leveling off between 20-30 days after the 100 case is reported.  This gives us another 3 weeks or so level off.

model 1