Every morning, when I wake up in Cremona, Italy, I make myself a cup of tea, I sit at my desk by the window, peak at the grandiose Romanesque cathedral in the piazza and, before I start working, I quickly glance at the local news on my laptop. I say ‘quickly’ because nothing really happens in this quiet town that’s just about an hour south of Milan, in the region of Lombardy.
I know this for a fact. I was born here. And since, during my college years, I did work in the newsroom of the local newspaper, I am well aware of how deep you need to dig to find something to write about. Headlines here are all about agricultural commerce, dairy production and classical music events, since Cremona’s main business is centered around farming, local gastronomy and the violin making tradition, that dates back to the 16th century.
The title I least expected to see on the front-page February 21st was one about a case of coronavirus in the territory that surrounds my town. In Codogno to be precise, 24 miles away from Cremona.
Seriously? Here? Out of all the places where you’d expect a Chinese virus to spread, the countryside around my town seemed the most unlikely.
On the night of February 16th, a 38 year old manager shows up at the ER in Codogno with a fever and flu like symptoms. The manager confirms to the doctors that he hasn’t been to China and that he hasn’t had any contact with people coming from there. The doctors give him a therapy to follow and an option to choose from: he can either stay in observation or complete his treatment at home. He chooses the latter.
On February 19th, at 3.12 am, the manager’s temperature is still high, and he goes back to the ER, where this time he is admitted to the hospital. On the 20th, when he starts having respiratory symptoms, his wife remembers that he’s been out to dinner with another manager from Fiorenzuola, who came back from China on January 21st.
It’s 4 pm, and the coronavirus protocol sets in. The patient, his wife and best friend are put in isolation and the swab tests are sent to Milan to be analyzed. After a few hours, they all come back positive and the madness begins.
In the middle of the night, health authorities show up at the house of Patient Zero, the guy from Fiorenzuola who’s supposedly started the chain of infection. The man is not sick, nor has he been in the previous days, but he’s taken to Sacco as well, where he tests negative to coronavirus. The doctors hypothesize that he could be an asymptomatic patient who became a carrier of the disease, but when they test for antibodies, again they find nothing.
From Patient Zero back to ground zero.
In the meantime, the ER in Codogno shuts down, the health personnel who got in touch with the 38 year old manager, Patient One as they call him, are quarantined, and new patients are diverted to other hospitals.
On the morning of the 21st, health authorities show up at the factory where Patient One works, and they test all of the 160 employees. All schools in the area are immediately closed, companies send workers home and implement telework. Sport and public events are cancelled, as well as the farmers markets and the celebrations for the Carnival. Everyone is asked to stay at home and avoid social contact.
By the end of the day, 50,000 people who reside in Codogno as well as in nine other villages in its proximity, are put on lockdown to prevent the spread of infection. Police officers guard entries to the towns. Nobody can get in nor out of the city limits.
Fast forward a few days and 25,856 swab test later, Italy now has 2,502 cases in 14 regions, 1000 of which have zero to mild symptoms and are in isolation at home, 1034 are hospitalized, 209 are in ICU in critical conditions, 160 are fully recovered and of the 79 people who died all of them were elderly and had preexisting conditions (the data is updated every day at 6pm on the Italian Ministry of Health website and published here).
Not all those who are positive had contact with China or with confirmed cases of infection in Italy. And it appears likely that coronavirus arrived in Italy well before February 16th. It likely arrived at the beginning of January (SOURCE). And it has been circulating undetected since then. Those who caught it may have thought they had the flu, or they may have had symptoms so mild that they did not even go to the doctor. Therefore, it’s likely that some people already affected by COVID-19 may have eluded the network of controls, helping the virus to spread silently.
It’s only natural to wonder: what would have happened if the doctors in Codogno didn’t test a patient with pneumonia who had never been to China? How many others have gone undetected?And in how many countries has the same thing happened?
On the evening of February 15th, a woman from Solano County, CA with flu-like symptoms walks into NorthBay VacaValley Hospital, where she spends three days. When her symptoms worsen, on February 19th, she is transferred to UC Davis Medical Center in Sacramento.
While doctors are concerned about a potential coronavirus diagnosis, the test for it is delayed since the patient “did not fit the existing CDC criteria for COVID-19”. On February 23rd, the swab test is sent to Atlanta to get analyzed, and by the time it comes back positive it’s already February 26th.
I am a US resident married to a Californian, and since we were about to fly back to the States and go to Orange County to see my in-laws at the beginning of March, I have been following the events surrounding “Patient One” in the States really closely, checking the local press multiple times a day (“Sacramento Bee”, “San Francisco Chronical”, as well as the press in SoCal (“La Times”, “OC Register”). Knowing what type of tsunami shocked the local community here in Italy, I was expecting to see a similar reaction in California. But I was wrong. And I found the differences in how the two countries reacted was quite odd.
If you think about it, on the same day, February 19th, in two different parts of the world, an Italian manager and an American woman were admitted to the hospital in serious conditions.
The former was diagnosed with coronavirus on the 20th, the latter on the 26th.
The former caused an entire hospital to be put under quarantine, 10 towns (50,000 people) to be put on lockdown, the schools of 9 regions to be closed, over 25,000 swabs to be tested across the country and the economy to come to a halt, with tourists cancelling trips and airlines stopping to fly here.
The latter, as of now, did not provoke any of this.
Today, more than 120 cases of the COVID-19 have now been reported across the US. And after March 1st, when the official number of total tests reported on the CDC website was 472, on March 2nd that number is not public information anymore (source).
Walter Ricciardi, member of the WHO Executive Committee and now adviser to the Italian Ministry of Health for the coronavirus emergency, used these numbers to explain COVID-19: “Out of 100 people with the disease, 80 recover spontaneously, 15 have more serious problems but that are manageable in a healthcare facility, 5 are in very serious conditions and 3 of them die”.
But, in order to understand what these numbers really mean, we need to keep in mind that, while the seasonal flu, for which there is a vaccine, has a mortality rate of 0.001 (0.1%), coronavirus has a mortality rate of 3,4%, which rises to 14.8% for those who are above 80 years of age.
In an interview with “Il Corriere della Sera”, Fabrizio Fregliasco, a virologist from the University of Milan, talked about the contagiousness of this novel virus saying that, while “the basic reproduction number of the flu stands at 1.5 (one infected person can infect another and a half), the medical value for COVID-19 is roughly 2.5”.
Not only does the coronavirus appear to be way more deadly than the flu, but its contagiousness at 2.5 means that for every one person who is infected, they can spread it to an additional 2.5 people, provoking the exponential growth of the disease. And an epidemic of people requiring hospitalization can put a severe toll on our health care system.
The effects of these numbers are easy to grasp by looking at the situation of the local hospitals in the areas affected by the outbreak.
Let’s take a look at the hospital here in Cremona, for example. On March 2nd, Dr. Giancarlo Bosio, Director of the local Pneumology Department, defined the last two weeks as a ‘tsunami.’ “Now we have 60 people hospitalized in my department where last week there were 30. Now we have 18 people on a mechanical ventilator, while last week we had 6. And while we usually treat 4-5 pneumonia cases per year, now we’re treating more than 100”.
In the last few days, the hospital of Cremona has been flooded with cases of coronavirus. Doctors and nurses have been tirelessly working 13 hour shifts to handle this emergency, and they had to open three new departments to treat the 149 coronavirus patients in need of hospitalization, 11 of which are in ICU.
Yesterday, the region of Lombardy allocated €2,500,000 to the hospital of Cremona to make urgent investments (such as medical equipment and the recruitment of doctors and nurses), and today the Italian Ministry of Health announced that they will increase the number of beds in ICU by 50% across the country and those in the pulmonology and infectious disease units by 100%.
All this was NOT happening a couple weeks ago. And I believe that looking at how rapidly things have changed in the local hospitals is the real thermometer to evaluate the risks of this situation.
Today, it takes me a little longer to read the news. Not only because I need to keep up with the rising cases of COVID-19, but also because some of the things I read are quite unbelievable. Things like countries demanding a ridiculous “virus free” certificate to import Made in Italy products, airports sending planes with Italians passengers back to where they came from, and foreign TV channels making fun of Italians with derogatory videos which depict them as “plague spreaders”.
And as I sit at my desk and open the newspaper, I wish I could go back to February 20th, when Cremona was the same tranquil, (a bit too) quiet and sleepy town it’s always been.
If you enjoyed this article, please share it with your friends and family. And don’t miss my other articles about the First Month of Quarantine in the North of Italy and why Being Afraid Is a Good Thing and Giving Up Our Personal Freedom is an act of responsibility.