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Coronavirus in Italy, what should we expect from phase two?

There are several hypotheses on the plate for phase two of curbing the Sars-Cov-2 virus epidemic. We interviewed Walter Riccardi and Gianni Rezza to let us explain them

Coronavirus
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Pandemic coronavirus : finally, after almost a month of lockdown , you begin to glimpse the light at the bottom of the tunnel. China, where it all started, has just loosened the very strict measures adopted in January: the citizens of Wuhan are no longer subject to the ban on leaving the metropolis and timidly started to get back on the move, despite all the necessary precautions. The question we all ask ourselves here, of course, is when it will happen to us too (even if the numbers we have in hand are somewhat partial). And, above all, in which mode : it will start from North , the area where most of the productive activities are concentrated, the one affected first and which perhaps has a higher degree of immunity today? Or from Central South , where the infections would they seem to be more contained? What activities will be able to reopen immediately? Which ones will have to wait, and how long? These are entirely legitimate questions on which citizenship awaits answers from decision-makers, if only to prepare themselves better for what will come. At the moment, however, the only answer is that there is no answer . Not sure, at least: the experts we reached told us that decisions are made ad horas and that currently all hypotheses are being studied.

Let's start from the theory: according to the golden rules of epidemiology, to stop the spread of an infectious agent (that is, in more formal terms, to reduce to a value less than 1 the notorious R 0 ) first of all, the situation of zero infections and then extend all containment measures (lockdown, social distancing, medical supplies, hygiene) for a period at least equal to a whole virus incubation cycle – given that, among other things, it is not certain at the moment, but we can speculate about two weeks.

Which is however realistically impossible : “Getting to zero infections in reasonable time” , he told us Gianni Rezza , director of the department of infectious diseases at the Higher Institute of Health , “is not realistic. China has succeeded, but by applying extremely harsh containment measures that could not be replicated by us “. Having established this, the experts' mantra is that to hypothesize phase two it is necessary to “wait for the data” : what kind of signals, exactly, are we waiting to see? “A consolidation of what is already happening” , replies Walter Ricciardi , of the executive committee of the World Health Organization . “Or rather a turnaround characterized by the constant decrease in the number of infections. We must observe such a signal for at least two weeks, and take advantage of this time to properly prepare for the next phase “.

Ricciardi, among other things, is co-author (together with John Ioannidis , which we interviewed here on Wired ) of an interesting article just published on Jama Internal Medicine , entitled What other countries can learn from Italy during the Covid pandemic – 19 . In the paper, the experts identified the different factors that, they say, contributed to the Italian anomaly : disadvantageous demography (we are the second largest country in the world, after Japan), high number of smokers and of subjects with comorbidity , high sociality between young and old , cases very concentrated in relatively small areas, strategic errors of hospitals and decentralization of the healthcare system. Elements by virtue of which our country was caught off guard by the emergency and had to adopt the lockdown “as a last, blind desperate measure” , textual words of the authors.

If in the high pitch we had to resort to a desperate measure , it is reasonable to expect, however, that things now will change . And that phase two is managed with more lucidity and farsightedness : it is precisely on this that we have tried to ask the experts for further details. Ricciardi he explained to us what is the road he has in mind: “The reopening could take place in different speeds . Not for population groups, for example by continuing not to circulate the elderly or those most at risk, but in a more refined way, ad personam . To do this, however, we must first broaden the infill strategy : let's assume, for example, to take the temperature at all factory workers and then buffer all those with high temperatures. Or, more generally, to immediately subject anyone who complains to the swab even a single symptom . This strategy must be combined with a system of technological tracking (to which you adhere on a voluntary basis) that allows you to reconstruct the movements and contacts of those who test positive. These contacts will then be in turn subjected to the buffer , and isolated if positive “. According to Ricciardi, the system will be tested in the next two weeks and should be ready by the end of the month.

Other ideas, such as the diversified reopening in different regions of Italy, are in any case under consideration: “The hypothesis of loosen the measures in the North , the production center of the country, where it is assumed that there is more immunity, makes sense “, says Rezza. “But in the same way you can think of reopening the Center South , where there are fewer infections. Both hypotheses are on the table and must be studied with caution in order to guarantee maximum citizens' safety “. No imbalance in one direction or the other for now.

Another idea is to reopen first the less risky productive activities , such as working in the fields, and still leaving the others closed, such as dental offices. More likely, to be able to overcome the emergency it is necessary to put in place a weighed together of all these measures. And above all it must be done quickly, under penalty of incalculable repercussions on the economy and consequently also on the health of citizens: an analysis on the German situation, for example, conducted by the experts of Robert Koch Institut , shows for example that managing to stop the virus race by Easter the economic consequences of the lockdown would be similar to that of the depression of 2009 .

A terrible scenario, of course, but not the worst : in the event that the measures do not take effect, the experts calculated a decrease in the gross domestic product of the 32% and of the industrial production of 47%. In Italy, it could probably be much worse. And this situation, the authors continue, would have “social and political consequences difficult to imagine” . Which would generate, in cascade, disastrous consequences also on health , with increases in infant mortality , suicides And the incidence of all pathologies. A tragic spiral in which we cannot in any way risk being channeled.

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