Report. The medical diagnostic activities at the moment are reminiscent of firefighters trying to deal with a burning forest: they are trying to isolate the edges of the outbreak in order to contain it and then focus on extinguishing it.

Lombardy is at the epicenter of the pandemic, with Italy topping 2,500 deaths

Monday’s daily numbers on the coronavirus outbreak paint a clear picture: the peak is still far off, although the numbers are growing at a slower pace than before. Over the 24 hours ending Monday night, 349 deaths and 3,233 additional positive cases of infection were recorded. (UPDATE: The government released the latest figures for Tuesday, showing a further 345 deaths.)

At the time of Monday’s update, data from Puglia and the province of Trento was not yet available, but that would have made a very small difference in any case. Lombardy alone recorded 202 deaths due to COVID-19 over the 24-hour period. This is only one region, but it is seeing more daily deaths than any country in the world. The total number of Italian victims, now at over 2,100, will take only a few days to exceed the number of deaths recorded in China since December, even as China’s population is thirty times larger than Italy’s.

The medical diagnostic activities at the moment remind one of firefighters trying to deal with a burning forest: they are trying to isolate the edges of the outbreak in order to contain it and then focus on extinguishing it. However, testing patients and isolating their contacts is still not enough: despite the increase in the number of swabs (there were over 13,000 performed yesterday), the number of cases seems to be growing even faster.

In Lombardy, 43% of the tests are giving positive results, while in Emilia-Romagna the proportion is 41% and 39% in Marche. Only among the 2,500 tests administered in Veneto does the percentage of positive results drop to 12%, the sign of an outbreak that is almost under control. One of the contributing factors to the success in Veneto lies in the large number of tests carried out, a strategy that some are proposing to extend to the whole country.

The immunologist Dr. Sergio Romagnani from the University of Florence is proposing a massive expansion of the method used in the village of Vo, where the entire population was swabbed. “A study has shown that the majority of people infected with SARS-CoV-2 are asymptomatic, but represent a formidable source of contagion,” Romagnani wrote on the website. Therefore, the scientist argues, “it seems crucial to try to find people who are asymptomatic but still infected.”

However, those responsible for containing the epidemic don’t agree. Franco Locatelli, the president of the Superior Health Council and a prominent member of the governmental task force, says that expanding the number of tests is “unrealistic and of little use for containment strategies.”

It would also require resources that we do not have at the moment.

On Monday, Locatelli called for “greater responsibility in communication.” For once, this admonition was not addressed to the media, but to doctors. “This is the time for maximum rigor to document the validity of therapeutic approaches which are certainly promising, but whose effectiveness must be proven without undue emotion.”

While the addressees were not named, the message was clearly directed at the doctors at the Cotugno Hospital in Naples, who have been experimenting in recent days with using a drug, tocilizumab, commonly employed in the treatment of arthritis, against COVID-19.

The positive results disclosed to media outlets about the very few patients on whom the medicine was tried led other doctors to request it (and the manufacturer, Roche, to deliver it), but outside of the context of a controlled trial protocol that would guarantee its safety. The role of the Italian Drug Agency will be “crucial” from now on, Locatelli said.

The emergency situation continues with regard to the supply of protective equipment for doctors and patients, such as face masks. Civil Protection Commissioner Angelo Borrelli admitted the difficulties in meeting the demand, with twenty million masks that have already been ordered but have not arrived due to the blocks on exports from producer countries. The game of passing the responsibility for the lack of supplies in Lombardy between the region and the civil protection authorities continues: “We’re working day and night to secure them,” Borrelli said, who also took pains to stress that ”the management of healthcare is the responsibility of the regions. The civil protection authority does not produce or sell face masks.”

As the institutional dance of declining responsibility continues, healthcare workers remain stuck in the middle. According to the latest report from the Istituto Superiore di Sanità, doctors and nurses account for 9% of the positive cases. In China, this number was less than 4%, even in the emergency conditions in which the Chinese healthcare personnel had to work.

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