Why Italy is hardest hit by Covid-19: ‘Social Contact Matrix’ may be the reason
Elderly Italian people, while most of them live by themselves, are not isolated, and their life is characterised by a much more intense interaction with their children and younger population compared to other countries.
— By Dr KK Aggarwal
Corona has general flu like symptoms with no clinical clues
THINK of Corona
Patient says ‘he or she’ has sudden loss of a sense of smell (American Academy of Otolaryngology–Head and Neck Surgery (AAO–HNS)
Sudden loss of taste
TLC shows low lymphocytes count. Viral fever must have high lymphocyte count.
Cough with exertional fall of SPO2 by > 4%
Sudden onset of fever and cough
Italy has 9% mortality because of elderly population
This is not the only factor. Italy has world-leading fatality rate of more than 9 percent. In contrast, in China, the mortality rate stands at 3.8 percent. In Germany, which has reported more than 24,000 cases and 94 deaths, it is at 0.3 percent. South Korea is 0.6%.
In Italy, 85.6 percent of those who have died were over 70, according to the National Institute of Health’s (ISS).
With 23 percent of Italians over 65 years old, but it is the second-oldest population in the world after Japan and not the first. Japn has done fairly in this pandemic.
Italy’s healthcare system itself, provides universal coverage and is largely free of charge.
Italy’s “social contact matrix” as another possible reason. Elderly Italian people, while most of them live by themselves, are not isolated, and their life is characterised by a much more intense interaction with their children and younger population compared to other countries,” said Linda Laura Sabbadini, central director of the Italian National Institute of Statistics.
Virtually every government with ‘universal’ health care restricts access in one way or another to control costs.
WUHAN lock down has been lifted
No. Hubei Province, where the coronavirus is believed to have originated, will begin to allow most of its 60 million residents to leave today — the end of a nearly two-month lockdown.
But the move raises concerns among epidemiologists about the possibility of a second wave of the outbreak in a country that has just barely contained it.
Wuhan, the city hardest hit by the virus, will remain locked down until April 8, though public transit will start back up again. Schools across the province will still be closed.
D Dimer can not guide treatment
Endothelial damage and subsequent clotting is common in severe and critical COVID-19 coronavirus, which may have implications for treatment.
Clots in the small vessels of all organs, not only the lungs but also including the heart, the liver, and the kidney,” were described by Bin Cao, MD, of the National Clinical Research Center for Respiratory Diseases in Beijing, who helped develop treatment strategies there from the beginning of the epidemic.
His group had reported March 11 in The Lancet that D-dimer levels over 1 μg/L at admission predicted an 18-fold increase in odds of dying before discharge among 191 COVID-19 patients seen at two hospitals in Wuhan, China.
D-dimer, a fibrin degradation product indicating thrombosis, can exceed 70 or 80 μg/L. Anticoagulation therapy should be initiated for severe COVID-19 patients [unless] otherwise contraindicated. If you see a high D-dimer like that, you have to give anticoagulation, regardless of the underlying mechanism.
BCG has no role in Corona
A team in the Netherlands will kick off the first of the trials this week. They will recruit 1000 health care workers in eight Dutch hospitals who will either receive the BCG vaccine or a placebo.
BCG contains a live, weakened strain of Mycobacterium bovis, a cousin of M. tuberculosis.
BCG may also increase the ability of the immune system to fight off pathogens other than the TB bacterium, according to clinical and observational studies published over several decades.
The vaccine prevents about 30% of infections with any known pathogen, including viruses, in the first year after it’s given. BCG is also regularly used in bladder tumor.
Lung ultrasound can not diagnose COVID
No, It can help in triage. University Hospital San Luigi Gonzaga, in Turin, Italy: Nurses classifying patients based on whether they have fever, cough, or labored breathing — just one of those symptoms is enough to prompt suspicion and the patient is moved into isolation.
After an examination, “the first thing we do is lung ultrasound.”
So many patients presented with a negative chest X-ray but a lung ultrasound that was positive for interstitial pneumonia.
Pneumonia can also be present…even in patients with mild or almost no symptoms — just a little bit of fever.
If an ultrasound is negative and emergency department staff continue their diagnostics. They swab nasal passages for testing with RT-polymerase chain reaction (rRT-PCR), then they send the patient home to wait for test results in isolation.
Viral load is maximum before symptoms
According toa study published in The Lancet Infectious Diseases, salivary viral load of SARS-CoV-2 was highest in patients during the first week after symptom onset and subsequently declined with time.
New York trends is same as in other parts of US
No. New York City is now the center of the coronavirus outbreak in the U.S., and the state’s case count is doubling every three days.
One factor is the density of the city. Twenty-eight thousand people live in every square mile of New York. Second is New York has been testing a lot of people.
It is true that New York has conducted more tests than any other state. However, even after you account for that, the number of cases in New York is much higher.
If you just compare the percentage of tests that have come back positive, it’s about 25 percent in New York, and in California it’s about 5 percent. That is a sign that the virus is probably more widespread in New York than in California.
May be this virus was circulating in the city for much longer and it spread before social-distancing measures were placed.
Only 2% of admitted patients require ventilators
No. experience in Italy has been that about 10 to 25% of hospitalized patients will require ventilation, in some cases for several weeks.
((The writer is President, CMAAO, HCFI and Past national President IMA))