Coronavirus Episode 15: What’s Really Going On in Italy?

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During this crisis, Italy has been the country that all other countries want to avoid mimicking. We’ve heard macabre stories of ventilator rationing, not enough coffins, and general havoc. However, yesterday I came across a recent interview with an Italian ICU doctor who was right in the middle of the worst area. What I heard astounded me as it was VERY different than the media stories. Let’s dig in.

Italy by the Numbers

There was GOOD NEWS out of Italy yesterday (above). I’ve been tracking their new cases every day and if everything holds when they report their numbers later in our day today, then they have reached their peak of coronavirus cases (1). That’s both good news and bad news for the U.S., as it took about two weeks from their strict regional shut down and just under that from the national shutdown to come down the other side of the curve.

That information could be good news for the U.S. if we had a strict national shutdown like Italy, but we really don’t yet. For example, here’s data from a cell phone tracking company on which states are doing well with reducing the movements of their citizens (2):

The blue states all get A’s (the northeast, Texas, parts of the midwest, Colorado, Nevada, and California). The green states get B’s, and Wyoming (orange) has had NO drop in the movement of its citizens over the past week. 

The Italian Blackbox and Rumors

I’ve read lots of articles about the Italian coronavirus experience and they all seem to be the same:

  • The number of ICU beds and ventilators required is far more than the supply
  • Doctors are therefore rationing ventilators and only giving them to the young
  • The Italian healthcare system is breaking down right in front of us

Is any of this actually true? Likely not.

An Interview with an Italian ICU Physician

The Journal of the American Medical Association (JAMA) did us all a great favor by interviewing a leading Italian ICU physician in the middle of the worst area of Italy on March 13th. The video is below and I highly recommend you watch it:

Sometimes the video gets into “doctor speak” but it’s pretty clear on a number of points that everyone should be able to follow:

  1. The number of ICU beds and ventilators is keeping up with demand, although they are concerned about not being able to keep up if demand spikes
  2. There has been NO rationing of ventilators or ICU beds
  3. The Italian healthcare system is strained but has figured this out and is responding

First, this is when Italy was reporting about four thousand cases a day and since then cases climbed to about six thousand and now are back down to five thousand. Hence, an updated interview would be helpful.

Now make no mistake, this doctor explains being blindsided by this crisis and how they acted swiftly to get it all together. He also describes the difficulties and the personal toll this crisis takes on healthcare workers and how this disease is different from the flu in that it requires much more intensive ventilation (helping people breathe with a machine). Meaning he is describing something that US hospitals desperately need to get ready for and also is telling US doctors how to do that.

On another note, what’s the mean age of people in Italy’s ICUs? 65 years of age. Hence, Italy has a mix of the mostly older people in critical condition, but there are young people in those beds as well.

The Media and This Crisis

If covering this crisis as a blogger has taught me one thing, it’s cemented my belief that the primary purpose of our media is to sell eyeballs for advertisers. Yes, they can serve a critical role in helping to expose wrongs, but on balance, it’s their job to sensationalize what’s happening. This crisis and threat is VERY real and this virus will overwhelm our health system if we don’t shut it all down to flatten the curve and then smartly manage the situation. However, listening to this leading Italian ICU physician speak does one thing clearly, it shows how the media has taken some truths about Italy and blown them up into something that is not recognizable.

The upshot? I was floored by this interview. PLEASE TAKE 10 MINUTES AND WATCH IT NOW FOR YOURSELF. Also, we need to maintain our current shutdown and begin to call out states that are not getting with the program. Why? Like Italy, we need to have our own cases peak and come down the other side. We also need to prepare our ICUs and restructure how we care for the sick while we continue to ramp up testing. However, we also need to recognize that it’s the media’s job to sell us stuff and we all need to take everything reported with a BIG grain of salt.

_______________________________

(1) Worldometer. COVID-19 CORONAVIRUS OUTBREAK. https://www.worldometers.info/coronavirus/ Accessed 3/19/20.

(2) Unacast. Social Distancing Scoreboard. https://www.unacast.com/covid19/social-distancing-scoreboard Accessed 3/25/20.

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12 thoughts on “Coronavirus Episode 15: What’s Really Going On in Italy?

  1. Anna

    This is a great article! Well done, like always, Regenixx!

  2. derek

    I’ve enjoyed reading all your info on the corona virus. Thank you for publishing it!

  3. Peter Yard

    Italy’s numbers do not make sense. They are reporting a nearly 10% mortality rate while S Korea and the US and many other country’s are closer to a 1%. Germany is at one half of a percent. Maybe they are testing people that don’t show any systems. Some of Italy’s rate might be explained by an older population but not all. More likely they have 10 times the number of cases than they are reporting. To me it’s apparent that they are testing only the worst cases and so the number of cases is low and the mortality rate is high.

    1. Chris Centeno, MD Post author

      Yes, many articles have discussed that the different fatality rates are likely due to the fact that Germany and S. Korea’s numbers likely have many more asymptomatic positive cases. Even those numbers likley suffer from undetected positive cases. Having said that, this thing is SERIOUS based on the number and degree of healthcare resources it uses to keep the most affected from dying. Hence, we all need to take it seriously.

  4. Lorie

    In Italy it’s also important to note that the death reports don’t yet distinguish between mortalities “with corvid-19” and those “from corvid-19”. So most deaths are of people with comorbidities. In other words, cause of death, at this point, is not certain. That’s why the Italian mortality numbers may be misinterpreted. See, e.g. https://www.bloomberg.com/news/articles/2020-03-18/99-of-those-who-died-from-virus-had-other-illness-italy-says; https://swprs.org/a-swiss-doctor-on-covid-19/ (Regarding the situation in Italy: Most major media falsely report that Italy has up to 800 deaths per day from the coronavirus. In reality, the president of the Italian Civil Protection Service stresses that these are deaths „with the coronavirus and not from the coronavirus“ (minute 03:30 of the press conference). In other words, these persons died while also testing positive.); https://www.telegraph.co.uk/global-health/science-and-disease/have-many-coronavirus-patients-died-italy/.

  5. Shane

    I think it is irresponsible to speak to this issue as if it is in control. The issue is this is the type of virus that can take off like wildfire. Those people who initially down played this virus now realize it can be devastating. The media is not entirely to blame. Even local and state governments are putting out their own communications now becoming more concerned. Mark my words, this virus will become worse before things get better. We need to take it seriously and quit blaming the media for exaggerating the seriousness of this virus.

    1. Chris Centeno, MD Post author

      The issue in the US is definitely NOT in control. As I have written many times, including in this post, the US has not yet shut down uniformly like Italy.

  6. Carol Firkus

    Do you have any comments on why Canada’s situation is so different from ours – fewer cases there by far. Are they just behind us in the progression of the curve or are they doing a better job of suppressing the spread of the virus?

    1. Chris Centeno, MD Post author

      Not yet, but looking into it…

  7. Al

    Governments can order people to do anything they want them to do, but in a situation like this people must start acting responsibly, follow the guidance and not endanger others. In a country as big as the USA, no government at any level is going to control all the irresponsible people any more than gun control keeps criminals from getting weapons. The Brits have a word for it – bloody-minded, meaning that no matter what one is told, some people just don’t care, i.e., they refuse to be cooperative, and the USA arguably has more than its fair share of bloody-minded people. I suppose we will have to hope that people will wake up, but if it gets too much worse, I expect that some governors will start taking extreme measures.

  8. Fritz

    I would like to know, after Italy gives the “all clear” and people start moving out and about, won’t we just see a resurgence of the virus once again?

    1. Chris Centeno, MD Post author

      Yes, if there isn’t widespread testing. However, summer months are also less likely to be respiratory viral peaks, so that would be more likely to happen in the fall or winter.

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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