COVID-19

[shpalman]

That article also says that in China

81% of cases caused only minor illness, 14% of patients had symptoms described as “severe”, and just 5% were considered “critical”

Italy's numbers right now:

Tra i 5061 positivi:

1843 si trovano in isolamento domiciliare
2651 ricoverati con sintomi
567 in terapia intensiva

There wouldn't necessarily be mapping between the categories but that's 36% at home in isolation, 52% admitted to hospital, 11% in intensive care. I'm not taking into account recoveries (589) and deaths (233) but either there are a lot of mild undetected illnesses out there or the Italians are being admitted to hospital under a lot less than what the Chinese defined as "severe".

[shpalman]

Seems like all of Lombardy is now a red an orange zone.

[mikeh]

Case definitions and different level of caution will vary greatly from country to country, depending on many factors including where they are in contain/delay/panic-and-buy-bog-roll status.

UK guidance (https://www.gov.uk/government/publicati ... ible-cases) now refers to patients who are 'clinically stable' as being potential candidates to self-isolate at home, rather than remaining in hospital.

I'm not sure how 'clinically stable' is defined, but it seems a term that could be vague enough to allow interpretation to differ a fair bit, depending on who and where is doing the thinking. UK also has guidance around other factors to consider when determining candidates for a fortnight at home.

What's Italy got along those lines?

[shpalman]

Case definitions and different level of caution will vary greatly from country to country, depending on many factors including where they are in contain/delay/panic-and-buy-bog-roll status.

UK guidance (https://www.gov.uk/government/publicati ... ible-cases) now refers to patients who are 'clinically stable' as being potential candidates to self-isolate at home, rather than remaining in hospital.

I'm not sure how 'clinically stable' is defined, but it seems a term that could be vague enough to allow interpretation to differ a fair bit, depending on who and where is doing the thinking. UK also has guidance around other factors to consider when determining candidates for a fortnight at home.

"patient is considered by clinician to be well enough not to require admission to hospital"

What's Italy got along those lines?

I wouldn't know where to look to be honest.

[mikeh]

"patient is considered by clinician to be well enough not to require admission to hospital"

Yeah, but that's what is subject to variation. I imagine, for example, right now that most clinicians are under pressure to not admit to hospital where in quieter times they might have done so. And when in hospital, likely more pressure to shift people out asap. Plus local considerations around quality of healthcare, distance to hospital, ability to get to hospital etc.

[El Pollo Diablo]

So, would this be a bad time to try to get my wife's great grandfather's birth certificate from the registrar in Lodi?

[Woodchopper]

So, would this be a bad time to try to get my wife's great grandfather's birth certificate from the registrar in Lodi?

Yes, a really bad time: https://www.theguardian.com/world/2020/ ... aly-set-to

[shpalman]

The draft decree didn't actually get signed. Probably tomorrow though.

[shpalman]

So, would this be a bad time to try to get my wife's great grandfather's birth certificate from the registrar in Lodi?

Yes, a really bad time: https://www.theguardian.com/world/2020/ ... aly-set-to

Their correspondent in Palermo is probably further from the red zone than you are.

[bmforre]

virus will not keep Chinese in poverty

The Chinese government has decided to lift all rural residents living below the current poverty line out of poverty by 2020. For seven consecutive years, China had lifted more than 10 million people out of poverty annually. By the end of 2019, 5.51 million people were still living in poverty, but none of them will be left behind on the nation's way to become a moderately prosperous society in all respects.

Friday's symposium showed that the top leadership is fully aware of the difficulties in the final push, including the impact of the COVID-19 outbreak ...

While the US may send many people into poverty because of medical bills. Even people who are insured.

And Televangelists act to profit from virus fear

[shpalman]

"patient is considered by clinician to be well enough not to require admission to hospital"

Yeah, but that's what is subject to variation. I imagine, for example, right now that most clinicians are under pressure to not admit to hospital where in quieter times they might have done so. And when in hospital, likely more pressure to shift people out asap. Plus local considerations around quality of healthcare, distance to hospital, ability to get to hospital etc.

I'll post this now and check/translate it later
https://www.med4.care/nuovi-criteri-amm ... intensivi/

[Woodchopper]

The draft decree didn't actually get signed. Probably tomorrow though.

Yes, it has been signed.
https://twitter.com/tancredipalmeri/sta ... 55808?s=21

area involving 10 million of Italians now in lockdown for #coronavirus outbreak.
All Milan’s region, Lombardy, plus cities like Parma, Modena etc.
All kind of public activities are suspended, including wedding and funerals.

[shpalman]

The draft decree didn't actually get signed. Probably tomorrow though.

Yes, it has been signed.
https://twitter.com/tancredipalmeri/sta ... 55808?s=21

Of course the leak of the draft last night caused everyone to rush to the stations to try to get out of Milan.

[shpalman]

"patient is considered by clinician to be well enough not to require admission to hospital"

Yeah, but that's what is subject to variation. I imagine, for example, right now that most clinicians are under pressure to not admit to hospital where in quieter times they might have done so. And when in hospital, likely more pressure to shift people out asap. Plus local considerations around quality of healthcare, distance to hospital, ability to get to hospital etc.

I'll post this now and check/translate it later
https://www.med4.care/nuovi-criteri-amm ... intensivi/

This is mainly about deciding who gets admitted to intensive care, since beds there are running out. Non-covid ICU cases have already been moved out of Lombardy to make space. It basically says that on a case-by-case basis and in discussion with the families etc. older cases with pre-existing conditions may be moved to palliative care to make space in the ICU for younger cases who are more likely to survive.

I'm still not sure about the criteria for leaving someone at home in self-isolation versus admitting them to non-intensive care in hospital. My understanding was that until the point that someone needs to be intubated face-down due to acute respiratory insufficiency,* there isn't a huge amount that a hospital can do to help a person fight the virus.

* - I saw a post which gave a protocol in Italian medical-sounding language, but I think it basically said that non-invasive respiration was a waste of time but that once intubated the respirator doesn't need to actually apply a particularly high pressure to get the oxygen in.

[shpalman]

Italian data http://opendatadpc.maps.arcgis.com/apps ... e38d4138b1

[shpalman]

The draft decree didn't actually get signed. Probably tomorrow though.

Yes, it has been signed.
https://twitter.com/tancredipalmeri/sta ... 55808?s=21

Of course the leak of the draft last night caused everyone to rush to the stations to try to get out of Milan.

Morons trying to get to the south of Italy last night to avoid the measures designed to stop the virus spreading to the south of Italy

[mediocrity511]

Hmm I wonder if that's known as the perturbation effect, just like in the badger culls?

Selfish idiots!

[shpalman]

Italians are great at the "but I've got a special reason why I'm allowed to ignore that rule" thing. Lots of Italians vote for borderline fascists while ignoring restrictions on travel or public gathering...

This graph compares deaths in Italy to death in Hubei province 36 days earlier (population of about 60 million in both cases).

photo_2020-03-08_12-27-15.jpg (44.61 KiB) Viewed 53429 times

The dotted line extrapolates the exponential growth. China manages to slow it down by applying restrictive measures.

I've kind of changed my perspective regarding the death rate. Yes, it's probably lower than we think due to the large number of asymptomatic or mild cases which go unnoticed. But the deaths are still that number, and asymptomatic cases have obviously been spreading the disease. (There was this whole #milanononsiferma ["Milan won't stop"] thing last week "let's not panic everyone keep shopping and going out having a nice time")

Yesterday's numbers were that 567 patients were in intensive care. I don't know how close to full occupancy that is. At some point, possibly quite soon, full occupancy will be reached and the death rate will go up but we can tell ourselves that they were old and going to die soon anyway.

[shpalman]

Hmm I wonder if that's known as the perturbation effect, just like in the badger culls?

Selfish idiots!

I should add that while the decree was signed at about 2am last night, the forces of law and order are still working out what to do with it, so nobody is stopping people catching trains out from Milan stations.

[discovolante]

This has echoes of Seeing by Jose Saramago. Which I haven't yet finished because I had to return it to the library, so no spoilers please.

[lpm]

If you were working temporarily in Milan but lived elsewhere, would it really be selfish to get the hell out and back to your children? Back to your elderly mother? Back to your new boyfriend?

I think there's serious ethical issues with locking people in and it leads to misery, suicides, additional deaths. It's more reasonable to say "Pick your place and stay there, and if you're going home from Lombardy you must self-isolate."

[headshot]

Did anyone listen to this? https://www.bbc.co.uk/programmes/m000gfcx

I was really interested in the interplay between the scientists and the politician.

Their approach to the solutions to the crisis seemed very pragmatic and calm.

[mediocrity511]

If you were working temporarily in Milan but lived elsewhere, would it really be selfish to get the hell out and back to your children? Back to your elderly mother? Back to your new boyfriend?

I think there's serious ethical issues with locking people in and it leads to misery, suicides, additional deaths. It's more reasonable to say "Pick your place and stay there, and if you're going home from Lombardy you must self-isolate."

Well yes it would be selfish in those cases still. Understandable definitely, but still selfish. Those people will now go home and put their children/elderly mother/boyfriend at increased risk. They may choose to self isolate upon return, but looking at what the UK guidelines are in that situation, they are very difficult to get right in households with more than a couple of occupants.

[shpalman]

If you were working temporarily in Milan but lived elsewhere, would it really be selfish to get the hell out and back to your children? Back to your elderly mother? Back to your new boyfriend?

I think there's serious ethical issues with locking people in and it leads to misery, suicides, additional deaths. It's more reasonable to say "Pick your place and stay there, and if you're going home from Lombardy you must self-isolate."

The rules do say that people are allowed to go home, as well as move around for urgent work or medical needs. Reducing the numbers to a reasonable minimum makes screening people for symptoms much more manageable.

Milano Centrale apparently looked pretty empty this morning anyway, apart from journalists there to report on it.

As did Como town center according to this video which was obviously shot by a journalist doing important work and not randomly wandering around for no reason which you're not supposed to do anymore

If people are generally a bit wary of actually going outside unless they need to, then this is kind of the desired effect. Yes, cultural and entertainment businesses will suffer but this is considered worth trading off against a collapse of the health service.

[shpalman]

If you were working temporarily in Milan but lived elsewhere, would it really be selfish to get the hell out and back to your children? Back to your elderly mother? Back to your new boyfriend?

I think there's serious ethical issues with locking people in and it leads to misery, suicides, additional deaths. It's more reasonable to say "Pick your place and stay there, and if you're going home from Lombardy you must self-isolate."

Well yes it would be selfish in those cases still. Understandable definitely, but still selfish. Those people will now go home and put their children/elderly mother/boyfriend at increased risk. They may choose to self isolate upon return, but looking at what the UK guidelines are in that situation, they are very difficult to get right in households with more than a couple of occupants.

I mean, if I decided to try to escape to Lincolnshire right now (which I am not going to do) I would certainly risk infecting both my parents (74-80 years old) and possibly, via my sister, my brother in law who has recently been on a course of chemo- and radiotherapy for cancer in his throat. So no, I am going to stay here.

ETA: and I'm also going to stay home instead of going for a walk through the pleasantly empty town in the sunshine.