Give them the malaria drugs at least.
If you're relegating everyone over 60 to death, you've failed your
nation when it comes to health care.
Socialist medicine. Kill the patient.
Well, here’s a boat load of grim evidence from Italy. They’re not abandoning everyone 60 and over now just for the heck of it. We’re seeing what this thing can do if not taken seriously (which it wasn’t at first in Italy) and allowed to run unconstrained for a while before clamping down.
This is the inevitable result from a country that chose government to run their society.
In a free, capitalist society with no government enforced “barriers to entry”, individuals would be working feverishly to fill the void in health services to include building companies to build new health equipment and make-shift hospitals.
In Italy, which is a “mostly” socialist country, they let people die.
Kind of a sharp contrast between socialism and capitalism, eh? So, vote Donald J. Trump, folks. Bernie or Joey will kill us all...but slowly.
JoMa
60? Fornicate!!!
That class of malarial drug increases your risk of disseminated intravascular coagulation from far less than zero to.. we better stop manufacturing. DIC is not how you want your wives, daughters sons and daughters to go. Be wary of miracle drugs.
Perhaps leaving the over 60 in the community is reason for higher death rates by not separating infected from family and friends.
"As his department receives coronavirus patients who are terminally ill the focus is to allow patients to meet loved ones and communicate with them during their last moments despite the quarantine regulations."Bring Out Your DeadOH MY GOD!
Any questions as to why little Italy has over 50,000 cases????
Post to me or FReep mail to be on/off the Bring Out Your Dead ping list.
The purpose of the “Bring Out Your Dead” ping list (formerly the “Ebola” ping list) is very early warning of emerging pandemics, as such it has a high false positive rate.
The false positive rate was 100%.
At some point we may well have a high mortality pandemic, and likely as not the “Bring Out Your Dead” threads will miss the beginning entirely.
*sigh* Such is life, and death...
If a quarantine saves just one child's or one old fart’s life, it's worth it.
Good reason to obtain and keep truthful history books on every topic, and use them to teach the young ones. They’re killing the old ones who have wisdom and knowledge. That is how you got an Idiocracy. No I would not be surprised if this was biowarfare, and meant to kill the wise ones. Weren’t the Great Halls of Science working on exactly that kind of weapon a few years ago? What will kill particular groups of people?
I’m reaching Bath-House-Barry-Era levels of disgust and cynicism today.
Again I note, the vast EU resources seem nowhere near helping in this situation. European morality strikes again.
If you refuse to treat me, I will just take a walk and see if I can find something to do around others.
Old folks have better odds staying home.
To those blaming governments..its not their fault. They are a reflection of the people. And the people want free stuff that rich people pay for, not wise strategic planning. The Italian bed shortage is a direct result of “free” health care.
Here in the US we need a war time response to roll out. Places like Taiwan and Singapore were barely touched because they had a readiness program in place. They had testing, and they threw civil liberties out the window. If you were in contact with a positive person, you were arrested and put in armed quarantine.
It doesn’t take a genius to see how unpopular such a systen would be here. We the people must push for it, it needs to be on both party platforms.
Covid 19 is not the big one. But the big one os coming. We can be ready, or lie back and die.
The consequences of misdirected compassion: cruelty.
Long Live Nationalized Healthcare!
Guess I better get sick now. Before I turn 60 next month. Acckk!
In Mexico people are drinking tonic water for the quinine in it...that and vitamin C. Don’t know if it helps or not, but not going to hurt..
Below is a more complete evaluation of the Italian medical crisis; at least two things jump out for me:
1. Italy has “universal health care”, which basically means no real health care for anyone, as is always the case with socialized medicine.
2. The situation in Italy is EXACTLY what the Trump Administration is trying to avoid by taking the draconian measures that they’ve taken, and even though our health care system is WAY better than the socialized system in Italy, it has been unknown (and still is) if COVID-19 could get out of hand here to the point that people would have to be left dying in the streets.
But as President Trump said a couple of days ago, we’ll know better what’s going to happen in 14-15 days,that is, in two weeks, aided by data from massively increased testing and the possibility of effective treatments, we should know whether the draconian actions we’ve taken have been implemented soon enough and effective enough to avoid the Italian Crisis ...
www.medscape.com
COVID-19: What Can the World Learn From Italy?
Daniela Ovadia
March 13, 2020
The first case of COVID-19 appeared in Italy on January 30th. A couple of Chinese tourists coming from Wuhan via Beijing were admitted to Spallanzani Hospital in Rome, highly specialised in infectious diseases.
The same day, the Minister of Health Roberto Speranza announced an air traffic embargo for flights coming to Italy from any Chinese city, including the autonomous regions of Hong Kong and Macau, in an attempt to block the spread of the infection.
In the days following the hospitalization of the Chinese couple in Rome, a few new cases were detected in a group of Italians who were repatriated from the Wuhan region. Experts started to sigh in relief as all cases came from abroad and no local contagion seemed to show up.
The Alarm in the Middle of the Night
Then, quite abruptly, on February 20th at midnight, the Councillor for Welfare in Lombardy, Giulio Gallera, announced that Mattia, a 38-year-old Italian from the small city of Codogno, in Lombardy, was hospitalized for a severe case of atypical pneumonia and tested positive for coronavirus. He had not traveled to China nor had any contact with people coming from Asia. He was tested only because a young anaesthesiologist, faced with the worsening condition of the patient, broke protocol and asked for permission to test a patient with no apparent risk factors. Codogno was the focus of a local outbreak of the disease: new cases were identified in the following days and the whole area was put under strict quarantine for 2 weeks. But it was too late.
As of March 12th, Italy has 15,113 official cases, 1016 deaths and 1258 recovered patients. The whole country is on lockdown. Cities like Milan and Bergamo, in Lombardy, are facing an exponential growth of hospitalized people with COVID-19. Schools, universities, and most shops are closed (all except the ones selling basic goods like food, drugs, electronics, and warehouses) and the National Health System is trying to cope with the flood of patients needing ventilation support. Roberto Cosentini, head of the Emergency Department at Pope John XXIII Hospital in Bergamo, one of the most affected cities, has been living in the hospital for the last 3 weeks: “It’s like a wave,” he says. “We have now around 60-80 new COVID-19 patients per day coming to the emergency. Most of them are in severe conditions and they arrive all together between 4 and 6 pm. We learnt that the respiratory distress worsens at the end of the afternoon and we now know that we will have to deal with most of the severe cases showing up one after another in a short time, every day.” But Italy learnt from the Chinese experience: Italian experts looked at Wuhan’s management of the crisis and Foreign Minister Luigi Di Maio asked his Chinese counterpart Wang Yi for assistance with supplies. Other countries in Europe are looking at Italy in order to prepare for SARS-CoV-2, the virus which causes COVID-19.
Adjusting the Testing Strategy
“There is a huge debate about the way we test for the SARS-CoV-2 virus,” explains Giovanni Maga, director of the Institute of Molecular Genetics of the Italian National Research Council in Pavia, in Lombardy. “Many countries test only people with symptoms. At the beginning of the crisis, we decided to test everyone who was in contact with a person infected with the virus and this is what WHO also recommends. But in the long run it became impossible and now we test only symptomatic people with severe impairment.”
However, this makes the analysis of the epidemic trends quite challenging. “If you test everybody, you will find more positive cases, with mild symptoms,” says Maga. The strategy for testing might heavily influence the visible part of the epidemic: “According to many epidemiologists, other countries could be in the same situation as Italy was a few weeks ago,” continues Maga. “But since they do not check asymptomatic people, they just don’t know it.” The choice of testing strategies is a crucial one for preparedness. “There are pros and cons for any choice, but what is important is to try to be as consistent as possible on the criteria since the beginning of the outbreak,” he says.
Intensive Care Units Under Unprecedented Pressure
The COVID-19 outbreak is a stress test for health services. Italy’s Health Service, which provides universal coverage for the whole population, is national, but the organization is distributed to regional health authorities.
When the crisis became evident, the Government regained control of crucial decisions, such as the coordination of intensive care unit availability. Antonio Pesenti, the coordinator of the ICU network in Lombardy and head of the Crisis Unit explains how Italy is trying to cope with the situation. “Since the first days of the outbreak we established a protocol to transfer patients needing ICU for non-COVID-19 diseases to the regions in Central and Southern Italy using the Civil Protection CROSS system. We prefer not to transfer COVID-19 patients because they require special isolation.” Italy has around 6000 beds for intensive care, which the government plans to increase to 9000 in the coming weeks, partly by re-purposing and refitting operating rooms used for elective surgeries. According to Pesenti, the projected demand of ICU beds is up to 10 times the current availability: “The number of hospitalized patients expected by March 26th, in 2 weeks, is 18,000 just in Lombardy. Between 2700 and 3200 will require intensive care.”
The Chinese Experience With Intermediate Care
To face such a tsunami, Italy is learning from China. Intermediate care units will be opened both in the hospitals and in other areas, such as exhibition pavilions in the Bergamo and Milan Fair. They will be equipped with ventilators coming from China and with special helmets to facilitate non-invasive ventilation support that seems to be very useful for patients who can manage without invasive ventilation. “We need such tools because 33% of the people in intensive care are between 50 and 64 years old: they are fit people who do not have pre-existing conditions. If we put them in invasive ventilation, they occupy an intensive care unit for 2-3 weeks,” says Pesenti. “Any alternative is useful to relieve ICUs.”
Doctors also had to deal with ethical issues. The Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) published guidelines for triage when there’s a shortage of ventilators to help with decision making in a critical situation. The authors chose “the most widely shared criteria regarding distributive justice and the appropriate allocation of limited health resources” to draw their recommendations. “Informed by the principle of maximizing benefits for the largest number, the allocation criteria need to guarantee that those patients with the highest chance of therapeutic success will retain access to intensive care,” the document says.
Epidemiology and Data Collection
Epidemiological curves are the new weather forecast for citizens in quarantine. And policy makers rely on them to decide new policies for containment. “The available predictive models are based on data we got from China,” explains Paolo Vineis, an Italian epidemiologist based at Imperial College in London, who is consulting for the scientific committee supporting the Italian Government in the decision-making process. “They mainly use the SIR model, that consists of three compartments: S for the number of susceptible, I for the number of infectious, and R for the number recovered (or immune) individuals. Any of those components can change during the epidemic, because of the local development. That’s why data collection is extremely important for modelling.” Italy had to face a challenge due to the regional nature of its health system: different regions used to collect data in different ways, using different templates. Regions like Lombardy, that were overwhelmed by the epidemic, had trouble feeding the databases with all the details, like comorbidities. “Epidemiological analysis needs to be centralised and properly supported to help the decision makers” says Vineis.
How Lethal is COVID-19?
At first glance, the death rate from COVID-19 in Italy appears to be much higher than it was in China, but according to experts, this is likely to be due to a combination of several factors, ranging from the testing strategy to the advanced age and comorbidities of most patients. “The average age of deceased patients is over 80 years, but when one looks at the age-stratified data the lethality is very similar to China,” explains Giovanni Rezza, epidemiologist and director of the Department of Infectious Diseases at the Higher Institute of Health in Rome, who sits on the scientific committee advising the Italian Government. Based on the analysis of medical records, the first 100 deceased patients had an average of 2.5 concurrent diseases. Still, in the Italian system they are accounted for when calculating the lethality of COVID-19. Another confounding factor is the testing strategy, which was concentrated on people with serious symptoms, worth being hospitalized. Those who had mild symptoms were recommended to stay at home, but were not systematically tested for SARS-CoV-2. “This has likely kept the denominator very low,” explains Rezza.
New and Re-purposed Drugs Being Tested
Italian doctors followed the suggestions from China on the use of antiviral drugs that were already tested during the SARS epidemic, but are also working actively for new clinical trials. A phase III clinical trial with remdesivir, an investigational antiviral drug being developed by Gilead Sciences to treat Ebola, is being conducted on patients recruited in the main hospitals like Spallanzani Hospital in Rome, Pavia Polyclinic, Padua and Parma University hospitals and Sacco Hospital in Milan.
The drug is not yet approved for any indication globally but is provided for compassionate use. The US Food and Drug Administration (FDA) granted investigational new drug authorization to study it in February 2020. The same hospitals will be involved in the trial using the antiviral combination lopinavir/ritonavir as COVID-19 treatment. Paolo Ascierto, from Fondazione Pascale Cancer Institute in Naples, announced on March 10th to have observed good results on two very critical patients receiving tocilizumab, a monoclonal antibody used in rheumatoid arthritis acting on IL6 cytokine and on the spike proteins of the virus. The drug is also used to reduce severe side effects in chemotherapies. After this anecdotal report, a proper clinical trial is being planned.
Risks for GPs
General practitioners have been hit hard, acting as a first line to identify patients with symptoms suggesting COVID-19. And they are paying a high price for the lack of training, appropriate tools and a proper plan. Filippo Anelli, president of the National Federation of the Orders of Doctors and Dentists (FNOMCeO) sent a letter to Prime Minister Giuseppe Conte asking permission to stop all outpatient health activities. “By March 11th, 50 doctors were infected by the virus and three of them died,” he wrote. General practitioners face a shortage of protective tools like gloves, masks and disposable scrubs. And even when they have them, they are not trained to properly manage potentially infected clothes and tools, said Claudio Cricelli, president of the Italian Society of General Practice (SIMG).
Since the end of February, the hospitals in Northern Italy have been reorganized. Most of them have special areas for COVID-19 patients. In Milan, some hospitals are working as ‘hubs’ to collect patients with the same disease. Most of the outpatient clinics have been closed and non-urgent visits are postponed, to make resources available for the most severe cases. This was a good strategy to increase the availability in hospital wards but a very challenging and stressful burden on general practice. Protocols for patients with flu-like symptoms have been established by the Health Authorities. The first evaluation is done by telephone or e-mail. In case of symptoms suggesting a possible COVID-19 infection, the patient is invited to stay home, isolated from the rest of the family. The GP monitors the evolution of the symptoms while avoiding as much direct contact as possible with these patients. In case of respiratory distress, a special hotline number has been set up to dispatch a team that can transfer the patient to the hospital. “This is the only way to guarantee a proper care of the patients with other diseases,” says Cricelli.
PTSD and Psychiatric Diseases
A lockdown like the one Italy is experiencing, together with continuous news coverage on the epidemic risks, are not without mental health risks. On February 26th, the Lancet published a paper by Samantha Brooks and colleagues from King’s College in London, reviewing studies on the psychological effects of quarantine and how to reduce it. “Most reviewed studies reported negative psychological effects including post-traumatic stress symptoms, confusion, and anger.
Stressors included longer quarantine duration, infection fears, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma,” the review said. “Some researchers have suggested long-lasting effects. In situations where quarantine is deemed necessary, officials should quarantine individuals for no longer than required, provide clear rationale for quarantine and information about protocols, and ensure sufficient supplies are provided. Appeals to altruism by reminding the public about the benefits of quarantine to wider society can be favourable.” Enrico Zanalda, president of the Italian Society of Psychiatry (SIP) confirms: “Patients with depression and OCD tend to relapse,” he says. “And the general level of anxiety is very high.” Children and adolescents are particularly at risk of post-traumatic stress disorder, according to the review. “A proper planning for psychiatric support and for the diagnosis of PTSD is necessary.”
The Impact on Oncology
When the lockdown was extended to the whole country, the association of medical oncologists (AIOM, Associazione Italiana di Oncologia Medica) published a statement inviting specialists to reschedule all ‘non-urgent’ activities, such as cancer screenings and follow-up visits for successfully-treated patients, and in some cases adjuvant therapy.
“The rationale is to make sure that the oncology wards, especially in general hospitals that are also treating COVID-19-positive patients, can respect all the safety procedures, including social distancing, for cancer patients who are being treated or may need to start a new treatment,” explains vice-president of AIOM Saverio Cinieri, who is co-director of Milan’s European Institute of Oncology (IEO). “This also reduces the social interactions of immunocompromised persons who are at higher risk both of infection and of developing more serious symptoms.” AIOM recommended contacting patients via phone or e-mail, to verify which patients may need to be visited, and is developing an app for video consultations.