COVID-19 Lock Down in Italy

Sixteen days after the beginning of the outbreak, Italy’s government is taking the extraordinary step of locking down (quarantine red zone) entire sections of the country’s north (16 million people in 14 provinces till April 3), restricting movement for a quarter of the population in a sweeping effort to fight the coronavirus. They have declared a national emergency.

Funerals and cultural events are banned. The legal order mandates that people maintain a distance of at least one meter from one another at sporting events, bars, churches and supermarkets.

The country’s cases increased more than two-fold last week from about 2,500 infections on Wednesday to more than 5,800 on Saturday. Deaths rose to 233.

Northern Italy is under lockdown

- Lombardy region (entire region)

- Piedmont (provinces of Alessandria, Asti, Novara, Verbano Cusio Ossola, and Vercelli)

- Veneto (provinces of Padua, Treviso, and Venice)

- Emilia Romagna (provinces of Modena, Parma, Piacenza, Reggio Emilia, and Rimini)

- Marche (province of Pesaro Urbino)

In the said areas the following apply:

• Travel in and out of the area, and within the area, will only be possible in response to "duly verified professional requirements, emergency situations, or for health reasons"
• People with symptoms of respiratory disease and fever of 37.5° C or above should stay at home and limit social contact as much as possible, and contact their doctor
• Avoid gathering
• All schools and universities to be closed
• All museums and places of culture to be closed
• All cultural, religious or festive events suspended
• Cinemas, pubs, theatres, dance schools, game rooms, casinos, nightclubs and other similar places to remain closed
• All sporting events and competitions suspended
• Ski resorts closed until further notice
• Swimming pools, sports halls, thermal baths, cultural centers and wellness centers to suspend their activities
• Bars and restaurants can remain open from 8 a.m. to 6 p.m. provided they abide by the safety distance of at least 1 meter between customers - this provision also concerns other commercial activities
• Shopping centers and department stores to remain closed on public holidays and the days preceding them
• Places of worship remain open, provided that the safety distance of at least 1 meter is respected, but religious ceremonies (marriage, baptism) prohibited until further notice
• National restrictions: In the north of the country, cinemas, theatres, museums, pubs, game rooms, dance schools, discos and other similar places will be closed; Sports competitions are suspended with some exceptions.

(Source: https://www.worldometers.info/coronavirus/)

Fatality rate

1. WHO estimate in the previous week of 3.4% appeared to shock experts, some of whom exclaimed that 1% was a more realistic estimate.
2. Not enough people have been tested. Incomplete testing would mean that the reported death rates probably misrepresent the numbers. If many more cases were detected, the rates would diminish. Until last week, people in the United States were tested only if they had traveled to China or had contact with other ill people. Therefore, several infected people in the country were not being counted.
3. The number of coronavirus deaths could be incomplete. Cases where infected people died without being tested might be missed. Additionally, people could be infected for some time before becoming sick enough to be at risk of death, which can escape a short-term calculation.
4. The rate won’t be the same everywhere. Experts state that differences in populations and health systems can increase or decrease the death rate by country. There is robust evidence that older people are at a higher risk of dying, so countries with more older people may end up with a higher rate.
5. Fatality rate for South Korea is 0.68% (widespread testing of cases)
6. Death rate in Italy is 4.9% (high elderly population and mild cases being missed)
7. Fatality rate in Iran is 2.95% (more severe cases tested than all cases)
8. USA fatality rate is 4%.

(Excerpts from NY Times)

Grand Princess Ship

The Grand Princess cruise ship, held off the coast of California after 21 people onboard tested positive for the coronavirus, was to dock on Monday at the Port of Oakland.

Passengers on the ship requiring acute medical treatment and hospitalization will bealighted first and be taken to facilities in California. California has become an early center for the virus in the United States, with nearly 100 cases in all.

Other passengers who are California residents will be put under quarantine at a federal center in the state. Non-California residents will be taken to federal facilities in other states.

The ship is holding over 3,500 passengers and crew members; 19 crew members have tested positive.

Princess Cruises also runs the Diamond Princess, the coronavirus-affected cruise ship that was quarantined off the coast of Japan in February. The virus circulated among the 3,700 plus crew members and passengers who were under a two-week isolation period in Yokohama, with more than 700 cases identified from that ship.

(Excerpts from Receive News)

Comments: They should not follow the Diamond Princess model and do cohort of all cases. They should do the triage, isolate and treat.

Around the globe

March 9:

• 40 new cases, 22 new deaths (21 in Hubei) and 1,525 new discharges in China on March 8 [National Health Commission (NHC) of China]. 

United States:- Washington state: 20 new cases, 2 in Pierce County; 3 new deaths (1 in Grant County)

-        1 new case in Minnesota (Carver County)

-        First 3 cases in Iowa

-        2 new cases in Tennessee (Davidson County and first in Shelby County)

-        2 new cases in Maryland

-        15 new cases in Massachusetts, all connected to the Biogen employee conference in late February

-        7 new cases in California: 5 in Contra Costa County; 1 in Riverside County (locally acquired); 1 in Fresno County (travel related).]- 2 new cases in New Jersey - 1 new case in Connecticut (Wilton) - 7 new cases in Oregon: state of emergency declared, which will last for 60 days - 1 new case in Virginia (Fairfax City) - 1 new case in Indiana (Hendricks County) - 16 new cases in New York state - 2 new cases in New Hampshire: an adult male from Grafton County who had contact with a confirmed case at Hope Bible Fellowship in West Lebanon, NH on March 1st at the morning service, and an adult male from Rockingham County with travel history to Italy - 1^st in Vermont - 1^st in Missouri (Louis County) - 4 cases in Florida: 1 in  Broward County; 1 in Manatee County; 1 in Okaloosa County and 1 in Volusia County, both with a recent history of travel 

• 1 new death in the UK: a man in his 60s with existing conditions and who had recently traveled to Italy 
• 14 new cases in Israel. Prime Minister considering mandatory quarantine for all entrants.
• 1 new case in Canada (Ontario) 
• 2 new cases in Ireland 
•  1,492 new cases and 133 new deaths in Italy
• 16 new cases in Norway 
• 3 new cases in Russia 
•  1 new death (a new case) in Egypt. First death in Africa. A 60-year-old German who arrived in Egypt on March 1, was hospitalized with a fever on Friday, suffered respiratory failure caused by acute pneumonia on Saturday, and died on Sunday 
•  177 new cases and 3 new deaths in France; total tops 1,000 
•  240 new cases in Germany, including 67 new cases in Bavaria, bringing the total to over 1,000 cases nationwide 
• 2 new cases in Romania: a 70-year-old woman who returned from Italy (Bologna and Ancona) and a 42-year-old woman from Bucharest who came in contact with the 49-year-old man who returned from Rome, Italy 
• 4 new cases in the Philippines: a 38-year-old Taiwanese male, contact of a Taiwanese who visited the Philippines and tested positive in Taiwan; a 32-year-old Filipino male with history of travel to Japan; an 86-year-old American male with pre-existing hypertension and history of travel to USA and South Korea; a 57-year-old Filipino male with no history of travel overseas
• 1 new case in Brazil, total rose to 20: São Paulo (13), Rio de Janeiro (3), Bahia (2), Espírito Santo (1) and Distrito Federal (1). One patient is in critical condition. 
• 6 new cases in Iraq 
• 3 new cases in Qatar 
• 3 new cases in Canada: 2 in Alberta and 1 in Quebec 
• 3 new cases in Dominican Republic: three Dominicans who visited Italy 
• 2 new deaths in Iraq 
• 4 new cases in Lebanon 
• 5 new cases in Iceland 
• 7 new cases in Greece 
• 6 new cases in India, bringing the total to 40, of which 14 are Italian tourists who are quarantined in Delhi 
• 4 new cases in Slovenia 
• 5 new cases in the Czech Republic, the latest being a married couple who has been skiing in Val Gardena, Italy. 77% of cases (24 out of 31) in the Czech Republic are related to Italy. The remaining 4 have links to Boston, USA. Starting Saturday, all people returning from Italy (both Czech citizens and foreigners) must report to the doctor and remain in the two-week quarantine 
• 4 new cases in 1 new death in Hong Kong: a 76-year-old woman who had developed fever, shortness of breath, cough and abdominal pain on Feb. 28 and was admitted to hospital
• 1 new case in Algeria: an Algerian national who has stayed in Spain 
• 7 new cases in Portugal: 3 recent: 18-year-old woman, a pharmacy student, and two men, 37 and 52 years old, with connections to the shoe factory in Lousada which was closed three days ago because of the outbreak; 4 earlier today: 3 women and 1 man, aged between 40 and 70 years, all admitted to the Hospital de São João, in Porto;  A man who contracted the virus in Italy was responsible, directly or indirectly, for the contagion of 10 people in Portugal 
• 10 new cases in Vietnam: All foreigners, and all from the same flight (Viet Nam Airlines VN0054, which departed from the UK on March 2): 7 from England, 1 from Mexico, and 1 from Iceland, aged between 58 and 74 
• 64 new cases in the United Kingdom 
• 2 new cases in Kuwait 
• 12 new cases in Singapore 
• 42 new cases in Sweden, 1 is believed to have been infected in the United States 
• 1 new death in Switzerland: a 76-year-old man with several chronic diseases 
• 77 new cases and 2 new deaths in the Netherlands 
• 2 new cases in Hungary: a 22-year-old Iranian male student who attended a birthday party on Feb. 28 along with the Iranian pharmacist student first diagnosed in Hungary, and the 59-year-old Hungarian wife of a British man who got infected in Milan, Italy 
• 8 new cases in Denmark 
• 2 new cases in Poland: a woman (not a Polish national) who came from Germany and a man who returned from Italy 
• 41 new cases and 1 new death in Japan
• 6 new cases and 1 new recovery in Malaysia 
• 10 new cases in San Marino 
• 88 new cases and 7 new deaths in Spain. The first 3 new deaths (aged 73, 77, and 78 years old) have been reported by the Community of Madrid; 3 women died in Euskadi (aged 87, 88, and 92 years old, all with pre-existing conditions) and the Aragonese Government has reported the death of an 85-year-old man with previous pathologies 
• F1 Bahrain Grand Prix (March 20-22) will be held in "the sole presence of the participants" and without audience
•  743 new cases and 49 new deaths in Iran 
•  First 3 cases in Bangladesh: 2 members of a family who returned from Italy and a third person contracted the virus after coming in contact with the two affected people
• 1 new case in Latvia: a woman who was infected at an Italian resort in Cervinia, in northern Italy near the Swiss border, where she had gone with a group from Feb. 29 to March 7 
• 2 new cases in Australia (New South Wales): a man in his 70s with no recent overseas travel (source of infection is under investigation) and a man in his 40s who had traveled overseas recently 
• 1 new case in South Africa (second case in the country): direct contact of the first case, part of a group of 10 people who had traveled to Italy 
• 4 new cases in Saudi Arabia: 3 women (contacts of a previous case) and 1 man who returned from Iran via the United Arab Emirates, but his presence in Iran had not been disclosed at the Saudi port 
• 4 new cases in Finland: 2 in Helsinki and Uusimaa Hospital District, 1 in the Pirkanmaa Hospital District related to a previous case in the Northern Savonia Hospital District, 1 related to tourism in Northern Italy 
• 2 new cases in Indonesia: a 55-year-old man and a 36-year-old man who is thought to have contracted the virus while working as a crew for the Diamond Princess cruise ship in Japan 
• 5 new cases in India
• 2 new cases in Bulgaria: a 27-year-old man and a 61-year-old man with a severe form of pneumonia. The "zero" patient is being actively searched 
• 23 new cases in Austria 
• 4 new cases in Costa Rica, bringing the total in the country to 5 
• 1 new case in Mexico 
• 272 new cases and 2 new deaths in South Korea 
• 1 new case in Kuwait 
• 44 new cases, 27 new deaths (all in Hubei) and 1,661 new discharges occurred in China on March 7 [National Health Commission (NHC) of China]. 
• 1 new case in Australia (Queensland): a man who recently returned from Iran 

More than half of the countries of the world have COVID-19, deaths may cross 5000, Italy deaths may cross 500-750.

(Source: https://www.worldometers.info/coronavirus/)

Dr KK Aggarwal,

President CMAAO, HCFI and Past National President IMA