Not only am I not a doctor, I've never even impersonated one on TV. That said, I live 25 miles away from the epicenter of the Covid-19 breakout in the Western World, so what I know is first-hand, not filtered by politics or economic interest. At the time of this writing, three people I knew contracted C-19 and have died from it. So what I am writing here in my hopes may be of some use to you.
1. What is COVID-19
It's like pneumonia, only worse. The usual symptoms are fever (in almost 90% of the cases) and cough (70%); other symptoms of course may occur. The resulting sum can lead to death, especially if gone untreated for too long.
However know that it's a virus, and like everything else in the Universe, its existence follows a bell-curve: from zero it spikes, flattens out, retreats, and is gone. This is what we have to get through. The first case in Italy was identified in the town of Codogno, like I said 25 miles from here, in the region of Lombardy, on Feb. 21. Cases spiked immediately, and almost exactly one month later, the curve apparently has finally started to retreat, certainly thanks to the containment measures. So, if the diminishing of cases is confirmed, at this time it appears that we're looking at at least two months of this stuff, from beginning to end - depending of course on how effective the containment measures are (I'll get to those in a minute). That probably means three months between outbreak and some return to normalcy.
2. Why was northern Italy hit so hard
Our Patient Zero was a German guy who met with a lady who proved positive. This guy then came to Codogno for business and left, unfortunately forgetting the virus behind. Interestingly, the outbreak in Codogno was far more rapid and deadly than in the German guy's hometown.
Why? The reason has to do with geography, population, and industry. Most of the populated areas of northern Italy are in the Padana Valley plains, which have mountains on three sides and the Adriatic on the fourth. Lombardy, which is situated in the middle of this virtually windless valley, is home to 10 million people and if you include the Piedmont, Emilia and Veneto regions, millions more people and just about all of Italy's industry.
All of these people heat their homes in winter and drive their cars, while industry does what it does, including heavy transport. One of Italy's largest steel mills is practically within sight of my home. And to top things off, in winter there is usually an atmospheric inversion layer trapping all the emissions close to the ground. The result, if you look up an air pollution chart of Europe, is that the Padana Valley has by far the worst air pollution situation in all of Europe, primarily formed by NoX and microparticulate matter in suspension. Pm10 in particular often goes past over 100micrograms/c.m. in Cremona (the "watch out!" amount is 50).
Air pollution obviously affects peoples' lungs, and that's where C-19 comes into play. It has fair game of those with any chronic lung condition.
3. How bad is the coronavirus?
A small percentage of those infected show no symptoms at all. A majority have mild issues and just staying home is enough to get over it. A smaller percentage need hospitalization, a smaller yet intensive care. So far in the Province of Cremona (population 360,000) we've had 332 deaths.
Regarding the prognosis it must be said that while almost nothing works in Italy, we do have an excellent health care system. While the virus has strained resources to the limit, the limits are barely holding, also thanks to additional equipment and doctors from the U.S., China, and even Cuba. Some overflow patients are now being sent to Germany.
The thing is, everyone in Italy access to doctors, medicine, tests, and hospitals (with very limited or even no co-pay), and almost unlimited paid sick leave. In addition, the government stepped in to allow business owners like myself to close up shop and still ensure salaries paid to employees. Under these conditions, it is clear that risks of contagion were reduced drastically because everyone can stay home and not infect one another. For those of you in other countries, this might not hold, and thus the bell-curve might cover a longer timespan.
4. How do you get it?
The virus is transmitted via water droplets in the air: someone infected who is breathing, coughing, sneezing. So you can pick it up through your lungs. If the virus lands on a surface - such as the handlebar of a shopping cart - it can be picked up by your hands and enter your body via your mouth, eyes, or nose if you touch them.
5. Who is most vulnerable?
The older you are, the more dangerous it is (fatality rate is only 0.2% for those age 0-20). Men are more affected than women. The average age of the death of people having C-19 in Lombardy is 81. I stress however that in 2/3 of the cases, the victims had pre-existing pathologies, including cancer. Pathologies that are complicated by C-19 seem to be especially cardiovascular diseases, lung issues, diabetes and immune deficiency.
6. What to do
China successfully contained C-19; South Korea did an excellent job, and even in Codogno there have been no more new cases in the past three days. Europe is working on it (but we have no idea what's going on in Russia). What to do at this point however is clearly is proven:
I'm sure I've forgotten something, but I wanted to write this as soon as I could. Feel free to share with your loved ones. Good luck everyone, and may the Supreme Being bless us.
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Thank you for your insight and sensible advice . I hope you stay well.
Thank you Dimitri M., for making this effort. It's well organized, and I believe you.
Thank you for this front-line report, Dimitri!
Thank you Dimitri for the first habd information! Wish you and your family safety and good health.
Dimitri - how accurate are the death and sickness counts in Italy? In the United States, the numbers are not at all accurate. There are sick people who show all the signs of the virus but can't get tested. There are people who have died showing all the signs of the virus but again haven't been tested so are not showing in the statistics.
My health provider has right on its website that they will not test people who have mild cases. Someone in my meditation class went to the emergency room yesterday with fever and shortness of breath. She was tested for many things but not COVID-19. The hospital said they had too few tests to test her and to go home and quarantine for 10 days.
My condolences for your losses and hope that you have no more deaths.
Thank you Dimitri, those are sage words. I do worry for those who live pay-check-to-pay-check with next to zero savings here in Canada, which seems to be the norm nowadays, many of whom are now income less. It's only been over a week or two to speak of but the end of the month bills are now coming in, so only god knows how this will end up in a month plus. Younger generations are still in denial ignoring governments directives, which isn't helping the situation much. Hopefully your story will hit the right note with some of us.
Dear Dimitri, I'm so sorry that you lost friends to this terrible plague. A very dear friend of mine died last week -- not from COVID-19 -- and there's never a good time or a good way to lose someone you love.
I appreciate your heart-felt and well-meaning advice. However, I prefer to adhere to the advice given by our local, regional, state, and federal health professionals. They have NOT advised ostensibly healthy individuals to walk around wearing masks. You have specifically stated that we should not listen to them, citing the "common sense" notion that a mask will offer a means of protection if someone sneezes next to you. I understand the sentiment, but the point of science is to inform us when "common sense" isn't right, and to help us guide our decision-making through rational, dispassionate means.
The following comes from the World Health Organization:
* If you are healthy, you only need to wear a mask if you are taking care of a person with suspected 2019-nCoV infection.
* Wear a mask if you are coughing or sneezing.
* Masks are effective only when used in combination with frequent hand-cleaning with alcohol-based hand rub or soap and water.
* If you wear a mask, then you must know how to use it and dispose of it properly.
The problem with individuals using masks is that then there are fewer available for medical professionals who, quite obviously, need them. In short, a healthy person going for a walk around the pond wearing a mask is a waste of a precious mask. If a medical professional gets sick or needs to be quarantined, then there are fewer of them available to help those who are sick. 3M, the leading manufacturer of N95 masks, is working with vendors and distributors to ensure that mask inventories are directed toward health professionals who need them, NOT to retail outlets where lay consumers can buy them. People who have supplies of masks should find a way to donate them to their local hospital. I am a chemistry professor and all of our PPE supplies (gloves, safety glasses, etc.) are being given to use in hospitals.
Finally, a shout-out to Cuban doctors. They seem to show up everywhere there is a medical crisis, don't they? And by the way their training is typically top-notch.
I may just sew up some basic masks for the family to wear to the grocery and then throw in the wash. (Anyone have a pattern?) No, such a mask would not protect me if I were a nurse or a caregiver to an infected person. But it does provide a basic barrier and it keeps you from touching your face after you’ve touched the can of beans, etc. It’s getting pretty intense around Los Angeles; I only go to the grocery (as little as possible) and for neighborhood walks.
Heck, if you already have a mask, wear it. It also protects medical professionals if you do not become another vector in this outbreak. People have stopped being so judgmental about the masks around here, where things are beginning to get pretty real.
Dimitri, thank you for providing this invaluable perspective, wisdom and advice. In America we are only beginning to wake up to what is going to happen I’m the coming weeks, and your description paints a very real picture. Wishing you wellness and fortitude to get through this. Wishing that for us all!
here’s a set of directions for making a cloth mask.
Thank you everyone for your kind words.
RE the accuracy of the numbers in Italy, since in this country there is free medical service, paid sick leave, and compensation for lost salary, I believe that the numbers are more accurate than in those places where a) the government fudges the numbers for political reasons, b) people go to work while sick because they need the money to get by, and c) medical treatment is not available to everyone, or is too costly.
To Paul, I must underline that every point of advice I gave is distilled from authorities' recommendations (except the part regarding what politicians say, but even that is proven by fact!). I didn't invent a single word. These are the guidelines of the so-called "Italian System" which is now being adopted in other European countries.
The WHO is saying not to buy masks in order to protect doctors' supply: I understand that, because 12% of the infected people in Lombardy ARE doctors.
However what I said is what our regional authorities said: if you have an industrial-grade mask, use it, don't leave it in a drawer!
Certainly the wisest lay article I've read on the subject - thank you Dimitri! If I can note one small "reason to be cheerful" it's that the overall death rate per head of population in Cremona seems to be about 0.1%. This will surely increase to some extent when the final figures emerge, but is likely to be quite small as compared with the Spanish flu outbreak in 1918 which it is estimated killed between between 1% and 6% across the entire globe. Individually, therefore, most of us have little to fear. However, COLLECTIVELY we have a duty to protect vulnerable individuals from a potentially fatal illness and also our health systems from potentially catastrophic overload. In order to achieve this we have to make some long-term economic sacrifices, the consequences of which are unfortunately completely unclear.
THREE THINGS which in my haste I should have added to my post. Thank you to those members who have pointed them out, directly or indirectly.
1. The advice I gave is what the Lombardy Region and Civil Protection health authorities are implementing. No creativity on my part (except for not trusting politicians or slanted press).
2. The incubation time of the virus is between 1 and 15 days, with an average of 5-6. It is not yet clear if those who have the virus in that stage are already contagious, but some evidence points to it being so.
3. Young people! I'm talking to you now! Follow these rules too. You probably won't suffer much from COVID-19, but you could pass it on to Grandma, and that will be a different story. A rest home near Cremona had a third of its patients die from C-19, and someone brought it in.
Thanks for this timely article! Hope everything will be okey soon.
Dimitri and Laurie, yes I understand that different areas and regions may need different sets of rules according to their circumstances. I'm glad we can have a civil discussion even about sensitive topics. One thing I do regret, however, is that it's considered "judgmental" or even "rude" here in the US to call out behavior that is diametrically opposed to the recommendations of qualified officials. My comments are not for people who have a few masks in a drawer somewhere to use when they absolutely must go out, but for those who have hoarded dozens or hundreds of them, and for those combing the shelves at Lowe's hoping to buy more. If you go to your retailer and you see masks for sale, you should ask the manager to box them up and take them to the nearest hospital or clinic where, I can tell you, here in the US, they are likely badly needed. I see folks walking around wearing masks, and I understand the desperation that might be felt by a single elderly person needing to go to the grocery store for a few things, or the international student who is 10,000 miles from home in a strange country with a demonstrably pathetic public health system and failed leadership. But I also wonder if they are doing themselves more harm. If the mask is not well-fitted, then particles could become trapped and have more time to enter the person's airway. The latter is entirely conjecture on my part, an attempt to rationalize WHO's cautionary recommendations regarding the proper care and use of the device.
I have nothing but love and unqualified respect for Dimitri and I hope one day to buy one of his beautiful violin cases.
Paul, your point is well taken. The reason I had the 3M masks to begin with was because they are required in my atelier by law. Before closing, I distributed the remaining ones among my employees. From an open box they cannot be donated. As they can only be used a few hours, we are all now out of them.
I personally think the WHO is making a case to safeguard the health professionals, which makes sense. Let it suffice to say that my wife Raffaella is a volunteer ambulance paramedic. So I cannot but agree.
I’m just saying that in the early days people were looking askance at those wearing masks, but now most people at the grocery are wearing them, at least in my area. I’m wishing I had one!
Dimitri, thanks for this post. As a practicing physician and violinist, I appreciate the words of wisdom you have shared. Also, if you are the one responsible for making my Lievessima case, double thanks! Fine work!
I would also suggest wearing disposable gloves (if you can still find them - hopefully).
Below is a link with questions and answers about covid-19. Also a link from Joann Fabrics on how to make your own mask.
Question and Answer regarding the coronavirus
Joann Fabric how to make your own facemask
To Dimitri, thank you for sharing your experience. I have 2 of your beautiful cases. My hope is your business flourish even more once this pandemic is over, and that you and your family stay safe and healthy.
Thank you Dmitiri, for helping disseminate information to the rest of the world, where information can be sparse or filled with disinformation.
Your first-hand account is invaluable with guidelines and recommendations learnt from that experience.
I was in Asia/Singapore for Chinese New Year. I saw the initial response of by Thai and Singapore governments to keep the virus in check. It was methodical and there was a sense of preparedness, at least in Singapore. Nonetheless, there was still panic buying of hand sanitizers etc.
I have been home in the States for 3 months. I am stunned at lack of urgency. There is reaction instead of proaction.
I am concerned for when we will hit a peak.
My patients came in to clinic, kinda lackadaisical, and states “oh i got tested for the virus last week” I am like - “why you here” in my mind.” My whole team had to take necessary steps and precautions.
The test result wasn’t back until a week later (a week!!!) and it was negative for that patient.
Lack of knowledge or choosing to not believe science and medicine is a sad choice.
We need more of Mr. Dmitri’s first hand stories out there.
And Laurie - Joann Fabrics website has video for sewing masks using cloth.
I have to sign off for now, to have telephone visit (telemedicine is a new thing for me) with my patient. Necessity demands creativity
on a violin note - i’ll having my first online violin lesson soon. It will be different from usual face-to-face. Embracing the changes!!
Laurie, yes, it's a "new normal".
The Atlanta Opera Costume Shop Producing Masks for Hospitals It looks pretty good!Thanks for the links to mask patterns, everyone! :) Anyone know of where there might be a pattern for this one?
Laurie: here is another post about sewing masks. Not the Atlanta Opera one though. It does have some things to think about though. And is ties rather than elastic. My quilt guild a bit ago said elastic is currently in short supply.
Things in Australia don't seem to be much better than the US, especially since there have been such enormous cuts to our health facilitates over the past decade or so.
One of my students' mums works in a local hospital and has told me they are already out of swabs for testing (among other things), and are only just taking cv19 isolation seriously, which is pretty scary given the number of cruise ships currently docked in our harbour...
I agree that medical supplies need to be saved for medical and emergency workers, workers in aged care and transport etc, so we shouldn't waste them on everyday use.
Having said that, I'm a teacher and schools are still technically open, so I'm going to make a set of washable masks cause I have about 90 mins on public transport to get to school.
To the many people who posted patterns, thanks very much, and maybe this study about appropriate materials will be helpful.
If you've unexpectedly found yourself homeschooling, I passed it onto Maths (graphing), science (How to conduct experiments), and textiles (choice of materials) teachers...
Oh, and thanks enormously Dimitri for reminding us that there's light at the end of the tunnel. I really needed it today!
John Ioannidis are wrong to support Trump's talk of wanting the country "opened up and just raring to go by Easter." Not to get too down about it, but I think most experts believe this may draw out a lot longer than the month or two time frame we seem to have in mind, not to even mention 2 1/2 weeks.Yes, thanks for your detailed account, Dimitri. I hope you will stay safe and healthy! Your report makes me think experts like
On this morning's news they were showing selfies sent in by health-care workers, faces indented, red and raw, some with dried blood from the chafing of wearing masks all day long. Adding to what Paul and Dimitri say, we really need to help our health-care workers on the front lines: https://www.theatlantic.com/ideas/archive/2020/03/were-failing-doctors/608662/. And the best way right now, they tell us, is to stay home. In the long run, we need to elect governments that will support a global health system all over the world, in every country, rich or poor, according to Alanna Shaikh (on TED).
The thing to keep in mind about masks is that we should not let them give us a false sense of security. The only thing slowing down the spread is self-isolation. And if we have to go out, follow the 6 ft distancing rule. According to Michael Osterholm, even hand sanitizers and hand washing is more busy work than intervention:
Joe Rogan Experience #1439 - Michael Osterholm
Transmission is respiratory. Hand washing is good practice for general hygiene. Hand sanitizers stop a lot of infectious diseases. These practices "kill the bad bugs." But "the data is actually very weak that [Covid19] is gonna be transmitted that way. So I wouldn't tell you to stop using hand sanitizers, but don't think it's gonna have a big impact on this bug."
"...the thought was that there are receptors around your eye...that actually this virus could get in and then get into your body. ...the data we have on this is so sparse to say that that's the case. I think the primary thing about hand-washing is legitimate, but ...we tell them, 'wash your hands often...to prevent this disease,' and I feel like we're not being really honest..." ...the data, and we've looked at this very carefully, really is about just breathing air... So keep doing the hand washing, but don't think that that's going to stop this disease."
Peter Piot, world-leading virologist on masks: https://www.ktvu.com/news/100-coronavirus-questions-answered-by-world-leading-virologist-peter-piot
56. TEDMED: How about masks? Are those blue surgical masks or an N95 facemask useful?
PP: Masks have very limited value except in certain specific circumstances. For example, depending on the type of N95 mask, just under 50% of inbound virus particles will be filtered out, but they may reduce spread from airborne droplets.
57. TEDMED: What are the advantages of masks when used properly and who should wear masks?
PP: The best masks, carefully fitted and worn properly, slow down the spread FROM sick people coughing. Meaning, the mask is not to protect you from other people; it is to protect other people from you. It is a courtesy to others to wear a mask when you get what you think is a cold, and you start coughing. Masks have an additional benefit: they make it less likely that you will touch your mouth, so it becomes less likely that if you have the virus on your hands, you will transfer it into your body. Masks provide benefits for healthcare workers. If you work in a healthcare setting or in elder care, masks are mandatory.
58. TEDMED: Is there anything I can do to prevent from becoming infected in a global pandemic outbreak?
PP: Washing hands frequently, not touching your face, coughing and sneezing in your elbow or a paper handkerchief, not shaking hands or hugging all reduce your risk. If you are sick, stay home and consult with a doctor over the phone to see what to do next, and wear a mask when seeing other people.
You can see the problem just by looking at those selfies of health-care workers. If the mask is not tight enough to create indentations around your mouth and nose, create a tight seal, you're letting in air through the sides. You let in air shared with an infected person and you're breathing the virus.
Jeewon, thanks for your thoughtful and documented intervention.
The issue of whether or not to wear a mask reminds me of a quandary in the 1990s. In Germany, automakers were in the forefront of adding ABS (anti-lock brakes) to their cars, for use on the speed-unlimited Autobahn. Statistics then came in demonstrating that cars with ABS were more prone to accident to those without.
Why? Because of the false sense of security that having the device instilled in some drivers. But ABS is useful and nowadays you can't buy a new car without it even if you tried.
According to Dr. Giorgio Palù, an Italian virologist, political correctness played a role in making Italy's situation far worse than it might otherwise have been:
"Political Correctness Doomed Italy’s Response to Coronavirus"
Run time: 11:50. Cut to 1:45 for relevant material. It runs 3 minutes -- from 1:45 to 4:45.
For corroborating articles on the Net, a Google search of "giorgio palu" "coronavirus" will bring them up.
The guy seems like a crackpot, Jim, sorry
Laurie, re "the guy": I believe you're referring to the YouTuber, not the virologist whose views he cited. The delivery style sometimes goes a bit over the top for my taste; but, crackpot or not, that doesn't invalidate the virologist's account he reported -- an account widely corroborated in print and broadcast media.
Jim, can you provide a link to an Italian-language non-politically-biased website that includes Dr. Palù's purported statements? I am so far unable to find one, and believe me, in Italy this would been NEWS.
Dimitri, I will try to find such a page sometime today. I believe there is some Italian-language material on the subject. Yesterday evening, before I posted, I saw at least one Italian-language link among the results that came up when I searched on the virologist's name. I didn't click on the link but will try again today. If it's a text page, I can read some Italian -- enough to get the gist of what the writer is saying. If it's a broadcast link, I will need subtitles, ideally in English; but if they are in Italian, I can read some of them, as long as I pause the video frequently. Again, I will see what I can do.
Fantastic. I am rather fluent in the language (I have published many articles) and can help.
Dimitri, I found three items -- 1 news article in English and 2 YouTube videos in Italian. The longer video has Italian captions. My grasp of the language is only rudimentary, but I believe I was able to make some connection between Dr. Palù's own words and what the American media have said he told to CNN reporters. I will be back this evening to add the links -- doing the html coding takes me a little time. It's now just after 6 PM here -- that's CDT, USA.
Dimitri, these are the 3 links I found -- 1 article in English + 2 videos in Italian:
1. Pluralist: "Fear of Being Called Racist Led to Italy’s Coronavirus Crisis, Top Italian Doctor Tells CNN"
2. Coronavirus, parla il virologo Giorgio Palù: "È potenzialmente un virus pandemico" / / Coronavirus, says virologist Giiorgio Palù, "is a potentially pandemic virus"
3. In collegamento su Skype il virologo Giorgio Palù: considerazioni sul Covid-19 / In Skype connection, virologist Giorgio Palù: considerations of (or on?) the Covid-19
Sorry -- my attempted translations are undoubtedly a bit off the mark.
The Skype video has Italian captions -- you need to click the subtitles button to see them. For the English-language article, I did a tryout translation into Italian of the first few paragraphs on Google Translate. If you copy and paste the English text into the left-hand box and then select Italian for the right-hand box, the Italian translation appears very fast:
Hope this helps.
Seems like the subtext in all of that is a message something like “being racist is okay because being politically correct caused this problem in Italy.” I don’t really buy it.
And, then we are left to explain why the problem is so bad across the rest of the world, and why it is absolutely the worst in the U.S.
It’s a virus for which no one had immunity and few do now. It’s going to spread like wildfire, everywhere there are humans.
Jim, I have found no trace of any article in an Italian newspaper in which Dr. Palù is saying anything of the sort, and that includes the right-wing Il Giornale and Libero.
Interestingly, it is the right in Italy which is pushing for more stringent closure and measures, while in the U.S. it seems to be the left doing so.
This to underline, it's better to use caution when criticizing a culture different from one's own (I'm referring to the YouTuber) in which even words like "politically correct" (or "right" and "left") can assume a completely different meaning.
Laurie, being racist ISN'T okay -- I'm sure we agree on that point; but imposing travel bans and closing borders IS okay -- and it's not racist. The president, thank goodness, ordered these restrictions put in place to help combat the spread of the virus in the US. But his detractors, predictably enough, called him "racist" for it.
The problem is worst in the US in total number of cases -- but not in number of deaths. The latest stats had 8 US deaths per 1 million people, while Italy's percentage is far higher -- 178 per 1 million.
Whether the virus is going to spread like wildfire remains to be seen -- even Fauci himself doesn't have a crystal ball; but the travel and border restrictions, the shutdowns, the social-distancing -- all this should help to slow it down and, let us hope, regain some degree of normal life before 2020 gets too far along.
Dimitri, I have no idea why there appears to be no trace of an article in an Italian newspaper to corroborate what Dr. Palù has said to the American media.
I found this article at the CNN website yesterday -- published March 19 -- which cites Dr. Palù's own words:
Italian doctors hope for a sign the coronavirus lockdown is working, because there's no plan B
When you get to the page, if you search for the character string "dr. giorgio" -- this will take you to the relevant part of the article. Starting with his name, there are 6 paragraphs containing his input on the subject.
BTW, here in the US, the left is pushing more for closures at the state level -- we see this in the actions of Democrat governors in New York, New Jersey, and California. On the right, the Republican president has ordered international travel bans and tighter border security measures, which are items we handle at the federal level.
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March 24, 2020 at 08:26 PM · Thank you for writing this, Dimitri. Wishing all in the region safety and good health.