This is a blog post I did not want to have to write.  A few weeks ago, I was hoping the COVID19 outbreak in Italia would just fizzle out on its own.  That has not happened, and Italia-my other home-has been absolutely devastated.  My family and friends there are all safe, but they are worried and confused, with things changing every day.

Yesterday, I overheard a group discussing the cancellation of NBA and NHL games and how that was ‘drastic, fear-mongering because more people die of the seasonal flu’ and ‘only sick people over 80 are dying’.  Most of you readers may not know this, but my ‘real job’ is at BC Childrens’ Hospital in Vancouver.  As a healthcare professional, I need to discuss the situation and present the facts.

COVID19 stands for ‘Corona Virus Disease 19’ and is in the same family as SARS.   Some of you may remember the SARS outbreak in Asia and Toronto in 2003?  SARS was more deadly (10% mortality), but COVID19 has far more cases and has been spreading like wildfire.  The coronavirus family cause disease in animals.  The genetic code for COVID 19 has been linked to bats.  It originated in Wuhan, China and likely passed to another animal before being passed on to humans.

The death rate for COVID19 about 3.4%, much higher than the seasonal flu. Death is not likely for those under 60 and healthy, but it can be spread to grandparents, parents, friends who are immunosuppressed or have other health issues.  Children do not seem to be affected, but can spread the virus. 20% of cases will develop severe pneumonia and ARDS (acute respiratory distress syndrome) needing oxygen therapy and possibly ICU and mechanical ventilation.

The situation in Italia-as of 13 March 2020, there have been 17,660 confirmed cases, 1,266 deaths, and 1,439 recoveries, leaving 14,955 active cases.  This data is updated daily here.

Why are there so many cases in Italia?  There are many reasons, including the fact the government has been transparent about reporting the #’s and facts from the beginning and they have tested over 60,000 people, revealing asymptomatic cases.  There is a large elderly population, the hardest group hit, and also the fact that Italians are probably the world’s most cuddly, affectionate population-which in any other situation is a positive thing.

For those of you who are not aware, restrictions started on Feb 22nd in Lombardia with the ‘red zone’ areas  being quarantined.  On March 4^th schools are closed for 2 weeks.  March 8^th the red zone is extended to include areas of Veneto and Emilia Romagna, Piemonte and Le Marche.

March 9^th the whole country is declared a red zone. 60 million people are in quarantine until April 3rd-including travel restrictions and a ban on public gatherings.  The hashtag #iorestoacasa (I am staying home) is started to encourage limited movement and social distancing. Travel between towns requires printing an online ‘autodeclaration’ form stating the reason-medical appointment/going to work/family emergency.  Everyone has to stay 1 m apart and bars and restaurant close at 6pm.  Meanwhile, cases continue to climb. ‘Smartworking’ is the buzz word for those able to work from home.

March 11 Prime Minister Giuseppe Conte extends the restrictions to what is basically a complete shutdown.  Only essential services are allowed to stay open –pharmacies and stores selling food and other essential items. In his words:

Rimaniamo distanti oggi, per abbracciarci con piu calore e per correre insieme piu veloci domani/Let’s keep our distance today, to hug each other stronger tomorrow.

March 11 the WHO declares a pandemic.  A pandemic is ‘the sustained and continuous transmission of a disease in 3 or more different geographical regions at the same time’.  This does not necessarily refer to how lethal the disease is.  In less than 2 months COVID19 has spread to 116 countries.

At the macelleria (butcher/meat shop) in Orsara di Puglia, my Zia reports that only 1 person is allowed to enter at a time and everyone else has to stand in line outside, 1m apart from each other.  Many shops have attached tape lines on the floor 1m apart. Below is a photo from my cousin’s store selling cleaning products.  They have sold out of hand sanitizer, alcohol and mascherine-facemasks, but have lots of toilet paper left.

The containment measures may seem drastic, and I guess they are, especially since it has  been only 20 days-but it is the only way to stop cross contamination.  Without hosts, the virus cannot spread.  It will be contained if people are isolated. In epidemiology lingo, intervening to try and slow the spread and prevent the # of severe cases is called ‘flattening the curve’.  This is also to prevent system overload and ensure that health care resources can keep up.  20% of cases will develop severe respiratory distress, possibly needing ICU and ventilation.  This is not the seasonal flu and will overwhelm the system.  In Italia on March 10^th there were 600 people in 55 ICU’s.  The median age is 65, meaning that there are younger people in ICU too.  An ICU physician in Lombardia calls it ‘worse than a bomb’. ICU beds in the north are full and doctors have to make decisions about resource allocation.

Many other countries are now where Italia was on February 22^nd and need to follow her example and implement measures early.  Today in Canada, our Prime Minister is in isolation as his wife has come back from the UK and tested positive. This is unfortunate, but has got people listening.  There needs to be a balance between staying calm to avoid panic and hysteria, but also being proactive and prepared.

COVID19 is not an airborne disease.  It is spread by droplet and close contact with an infected person. Respiratory droplets are produced by a sneeze or cough.  They can travel up to 1.8m (6ft) and directly enter the body through the eyes, mouth or nose.  Contact refers to touching an infected person or object such as doorknob or railings directly.  Unwashed hands contaminated with COVID 19 can introduce the virus into the body when touching eyes, mouth and nose.  With these facts in mind, here are the most important things to help prevent the spread of the COVID19:

• Wash hands! Soap and water or alcohol based hand sanitizers are both effective.
• Avoid touching the face
• Keep 2m away from sick people
• Cough and sneeze into sleeve/elbow
• If you are sick, stay home! There is no treatment for viruses-stay home, rest and drink fluids.
• Go to the Dr or emergency department only if you are truly unwell. Call your local public health service first to ask what to do/where to go
• Only wear a mask if you are sick. Masks will not prevent getting sick. They provide a false sense of security and may even increase chances of getting sick since you are more likely to touch face.  Do not stockpile masks and hand sanitizer-they are needed by hospitals.
• Depending on your location and the number of cases, follow the recommendations of the local health department re social distancing, travel, etc.
• Make sure you have 2 months supply of any medications.  There is no need to stockpile other food and supplies-and especially not toilet paper!

Short term pain for long-term gain.  There will definitely be short term repercussions to the economy, but health and safety have to come first.

Let’s hope that things settle down in a few weeks to a month.  Today, Friday the 13th at 6pm in Roma, Firenze and several other cities, balcony flash mobs occurred, with everyone banging pots and pans and singing out on their balconies!   Warmer weather creates a less friendly climate for viruses, so bring on the sun! These will be happening all weekend. Once this is all over, those of you who had to cancel trips to Italia will be able to rebook.  The economy will need you.  Remember #andràtuttobene-everything will be all right.  Forza Italia/Stay strong Italia!  Grazie mille to all of the front line health care workers!  Please read the next post: COVID19-Insieme ce la Faremo  Ciao, Cristina