Italy’s leading epidemiologist on why the virus spread in a “surprisingly persistent” way and how Germany managed low mortality

Carlo RavecchiaA professor of medical statistic and epidemiologist at the University of Milan explains what is behind the second wave, why Germany has done better than most other countries, and what to expect for Christmas.

Did Italy “waste” this summer’s progress, when the number of cases reached nearly zero?

I partially agree with this interpretation. On the other hand, if the incident did not occur until the end of September, we would have a completely different story today. Nevertheless, I do not intend to attribute all negligence to the actions of people during the summer. We opened the country on June 3rd and only one died on August 23rd, so there was little evidence that the virus had been circulating for months. According to September data, the curve was flattened and the “summer problem” seemed to be a past problem.

Unfortunately, when the school opened in October and resumed activities, the number of cases increased and the line began to rise, especially in large cities. On October 15, the numbers “exploded.” I will attribute some of the problems to social and work activities, an increase in human interaction during completely normal activities. You also need to consider the weather conditions. As far as we know, droplets last in moist and cold air, but fall rapidly in the hot and dry environment of summer in Italy.

Data for the past few days seem to indicate that the country is flattening the curve again, perhaps thanks to the second gentle blockade, but viral circulation is increasing. Recently, a positive rate of 10% has been seen. We must admit that the virus is still spreading in a surprisingly persistent way.

In your opinion, what is unique about how the virus appears to be prevalent in Italy compared to other European countries?

The second wave of this pandemic is very similar in the four countries of Italy, Spain, France and the United Kingdom. In the spring, Italy faced a pandemic problem about 15 days before other countries, with a case fatality rate of over 10%. Other. At that time, a two-week “warning” gave other European countries time to prepare for the National Health Service.

The second wave seems to follow a different pattern. Currently, 10 to 15,000 people are expected to die in each country, but the number of first waves is not expected to be reached due to the significant improvement in medical conditions in almost everywhere. Comparing Italy and the UK, you can see the subtle differences in percentages. Italy, with a population of 60 million, has 50,000 deaths, and the United Kingdom, with a population of 66 million, has 54,000 deaths. A very unique case in the EU is Germany, which has a population of 80 million and 14,000 deaths. This is believed to be due to the very different and more efficient National Health Service, which offers small but well-equipped practice throughout the country and even in smaller towns.

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Why were there so few deaths in Germany? Why does Italy now need an intensive care unit, doctors and nurses?

The reason is very simple. Germany is richer than the rest of the EU. They have the ability to double public spending on health care in Italy and budget more for health care each year. In contrast, Italian financial statements show a dedication to retirement benefits. In addition, Italy’s huge debt consumes most resources and the government rarely funds essential services. After the 2007 economic crisis, Italy, as well as Britain, France and Spain, has suffered continuous cuts.

What was missing from the Italian healthcare system?

The answer is very simple. Italy had no pandemic program prior to COVID-19. Each year, our intensive care unit fills up rapidly during the normal flu season. The reaction was always to wait for the waves to pass and did nothing to improve the hospital’s capabilities. For the past 20 years, despite the warning, there have been no pandemic plans. This is a political responsibility and a big economic problem. It must be admitted that Germany was very ready, while Italy was not at all ready to face this pandemic. At least for now, I’ve doubled the beds in the intensive care unit.

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What will your Christmas holidays look like in this COVID era?

Everyone needs to be careful and reduce contact between parents and children. This will be a Christmas of caution and awe for viruses. Take this into account: we estimated that about 1% of the population would be infected during the summer, but now that number has reached at least 5%. All contacts made are more dangerous than ever. Over the next few weeks, we will see flattening of various indicators and overall improvement in the situation, but people still need to comply with regulations. The virus is still spreading rapidly. In addition, vaccines cannot be prepared before Christmas and herd immunity cannot be achieved without vaccines. At this time, we need to mitigate the risk and expect prompt confirmation and distribution of the vaccine.

How long can scientists study this epidemic and what can they do to avoid making the same mistakes?

A century later, while teaching at university, I still use the “Spanish flu” as a classic example of the epidemic. Humans forget that illness can come at any time without knocking on our front door. And we haven’t had this experience in the last 50 years. The illness is periodic. We hope we can learn this lesson now and adapt our health care system, public spending and education system. To prepare for such an event, it is necessary to build a highly specialized hospital and train new specialists.

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