Mar 19 2020
Italy has truly become a ground Zero for COVID-19 epidemics. The information coming out of Italy greatly influenced decision making around the world and brought Europe and the United States, amongst others, to a standstill. While everything we hear in terms of number of tested, severely ill, and victims of the virus is true when it comes to numbers, the interpretation of this information is crucial for understanding of the situation and forecasting its impact.
It dawned on me that I can get the firsthand account from my colleague and a great friend Prof. Giuseppe Petralia of the European Institute of Oncology based in Milan, Italy https://www.ieo.it/en/. Can anyone be closer to the epicenter than Giuseppe?
Q: What is going on the ground?
A: The number of severely ill patients is approximately 15% of all diagnosed with the infection.
Q: Does Italy have capacity to deal with that many critically ill people?
A: No. We are doing our best, but there is a shortage of physicians, hospital beds, equipment and supplies.
Q: Can the Italian military deploy military tent/temporary hospitals to match the need for beds as was done in China?
A: Yes, this is actually happening – we are building a hospital in one week - but they do not have enough ventilators and other equipment needed, yet.
Q: Do you agree with estimates that COVID-19 is much more deadly than known coronaviruses and other diseases?
A: No. While there is a large number of critical cases, the true number of people infected is likely to be at least 10 times higher than people actually diagnosed. The majority of cases are asymptomatic, light or moderate.
Q: What about mortality statistics?
A: The total number of infected is approximately 10 times greater than reported, therefore, fatality rate is not 3% as reported but it is likely 0.3%.
Q: Is this true that many deaths are due to other diseases, not the virus?
A: Yes, the average age of those who died is 81. At the same time life expectancy in Italian men is 82. Many of these people are dying WITH the virus not FROM the virus.
Q: Do you think the way we treat patients contributes to mortality? Specifically, ECMO (extracorporeal membrane oxygenation) has almost 50% rate of serious complications, such as venous thrombosis and bleeding. Is this a case of the remedy being worse than the disease itself? Would the fact that ECMO is widely used in Italy, increase death toll due to treatment complications?
A: Yes. It is possible.
Q: Did you and your institution workload increase?
A: Yes. Because all hospitals in the region were converted to deal with COVID-19, we are one of the very few “oncologic hubs” in the region for oncologic patients. We are expecting a huge influx of cancer patients who have nowhere else to go.
Q: Are you walking around the hospital in a “space suit”?
A: No. I use a surgical mask and gloves throughout the day, one a day, “if I am lucky”. We are paying the price for our own decisions to outsource masks and other essentials production and services to China.
P.S. by Prof. Petralia:
One important comment, that I have learned in these difficult days:
Mortality is N° of deaths / entire population (of Italy, for example)
Fatality is N° of deaths / affected people (largely underestimated in this case in Italy, because they test only symptomatic)
This explains why the fatality of South Korea is much lower than us, because they tested everyone, while we only test very symptomatic people! Therefore, we need to use the term “fatality”, and avoid using “mortality”, that is misleading.