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Expert: the epidemic in Italy has reached the inflection point. The national blockade helps to focus

The epidemic in Italy and Spain may be approaching its peak

On March 27, in Milan, Italy, soldiers in protective clothing transported the coffin from the begamo area to the chinicello Balsamo cemetery.

Italy hovers on the peak line

In a key hospital in Lombardy, northern Italy, all beds are occupied, the operating room has become a temporary ICU ward, and the corridors and administrative areas are also full of patients, but 60 to 70 patients pour in every day. Most of these patients are old and weak, and their conditions are deteriorating. Doctors need to make a continuous choice: is the remaining ventilator used to treat the 65 year old with respiratory failure, or is it reserved for the 85 year old patient with complications in the next ward?

Although some hospitals have greeted doctors and asked to prohibit media interviews, some anonymous Italian doctors have still published their first-line insights and observations in the New England Journal of medicine since March.

As of March 30th, the epidemic of COVID-19 has caused 101739 people in Italy infected, 11591 people died, the mortality rate ranks the highest in the world. But at the same time, Italy's "biggest crisis since World War II" may usher in a turnaround. On the same day, 4050 new confirmed cases in Italy fell for three consecutive days and hit a new low in the past two weeks.

The novel coronavirus pneumonia outbreak in Europe has seen some signs of stabilization, and the epidemic in Italy and Spain is likely to be approaching its peak, WHO said. The blockade measures launched in Europe a few weeks ago are beginning to work. WHO said.

Wu Jie, chief editor of the new European overseas Chinese newspaper, who is working as a volunteer translator for the Chinese aid medical team, told China Newsweek that now Chinese and Italian experts believe that the Italian epidemic is reaching the inflection point from the outbreak period, and the number of newly diagnosed cases per day may be further reduced.

Prisco & middot, epidemiological researcher of Mediterranean biomedical research institute and vice president of Italian Environmental Medicine Association; Pichtelli told China Newsweek: "according to our model, the peak in Italy is just at the end of March." In addition, if the number of newly infected people continues to decrease regularly due to the severe restrictions imposed by the government in the past few weeks, the epidemic may end in June 2020.

National blockade boosts the arrival of the "inflection point"

The two worst affected areas in northern Italy handed over two completely different answers.

As of March 29, there were more than 40000 confirmed cases and more than 6000 deaths in Lombardy, a region with a population of 10 million. In the neighboring Veneto region, about 8000 of the 5 million residents were infected and more than 300 died.

As the source of "patient 1" in Italy, Lombardy has a higher population density and faces a worse situation than Veneto in the early stage of the epidemic. However, some experts pointed out that the different public health decisions made by the two regions in the face of community transmission have had a far-reaching impact on the development of the epidemic.

The Veneto regional government began extensive testing around confirmed cases at the end of February, covering mild and asymptomatic people. According to the regulations of the region, all families and neighbors of confirmed cases shall accept the virus test conducted by professionals. If the test kit is not available at the moment, they also need to isolate themselves and wait.

Lombardy adopted a more conservative way of epidemic prevention. By March 20, the day before Italy implemented the most severe blockade, the actual number of people tested in the region was only half of Veneto, and no disease-free infected people were detected. The resource investment in case tracking, family isolation and monitoring was also very limited. Lombardy's epidemic prevention idea is "patient-centered", while Veneto's policy is a highly targeted "community epidemic prevention centered" epidemic prevention and control model of infectious diseases.

Obviously, Lombardy's conservative epidemic prevention is an epitome of the 'chaos' of epidemic prevention in Italy. Before the national blockade measures were taken, the Ministry of health, the Ministry of civil defense, 20 regions and more than 8000 cities and towns of the Italian central government issued a series of contradictory administrative instructions. On the issue of whether to close schools, bars and other gathering places, the policy has been repeated for many times.

Italy's medical system is divided into two main levels: Central and regional. After the amendment of the Constitution in 2001, the public medical services covering the whole people were transferred to regional management, and all regions almost had complete autonomy in medical affairs. The functions and powers of the Italian Ministry of health, which is nominally responsible for leading health affairs, were overhead.

In the case of disagreement in the region, Italian Prime Minister Conte chose to gradually increase the scope of the blockade area through decrees, upgrade restrictive measures, and finally expand the isolation and blockade system centered on community epidemic prevention to the whole country.

It is also considered to be a key measure for Italy to usher in a 'turning point' to block and isolate the heavily infected areas. Lu Shan, a professor at the University of Massachusetts School of medicine, pointed out that this is related to the viral load of critically ill patients. If the number of severe patients in an area increases, the people they spread are likely to be exposed to a large number of virus particles.

'why can young people also be infected? Because when the virus load is high, the human immune system can't resist it. " Lu Shan said that this will lead to a geometric increase in the number of severe cases in the region.

Wu Jie told China Newsweek that in view of the high rate of severe cases in Italy, the 'prescription' issued by the Chinese expert group is also 'early detection, early diagnosis, early isolation and early treatment', so as to avoid the patients from slowly developing into severe cases and causing a vicious circle.

However, before taking the national blockade measures, Italy's epidemic prevention policy fell into a state of "not stopping the spread of the virus, but following the spread of the virus".

In the first week after the blockade measures were taken in Lombardy and Veneto, 47000 Italian people were fined by the police for going out "without justified reasons".

George middot, Professor of Virology at the University of Padua; Palu pointed out that measures such as banning public gathering involve constitutional issues, and the closure of schools and public places needs to be coordinated with the regional government. The blockade measures taken by Italy have done everything they can. On March 21, the number of newly diagnosed cases in Italy reached a peak of 6557. Since then, the number of newly confirmed cases per day has hovered between 4000 and 6000 for ten consecutive days, and the growth rate has maintained a downward trend as a whole.

As of March 31, the epidemic situation in Italy was basically controlled in Lombardy, Veneto, Rome and piedmont in the north. Among the remaining 16 regions, the number of confirmed cases in 5 regions did not exceed 1000 and that in 13 regions did not exceed 2000.

The team led by Professor gutap of the Department of zoology of Oxford University pointed out in a paper released on March 24 that the realization of 'mass immunization' may boost the arrival of the 'inflection point' of the epidemic in Italy.

Based on the number of critically ill patients in Italy, the team estimates that by March 6th, 60% of people in Italy could have had access to COVID-19. However, the gutap team did not clearly explain whether 60% of people get antibodies, which means that 'mass immunization' can be achieved.

In this regard, Benjamin middot, Professor of epidemiology at the University of Hong Kong; Colin pointed out to China Newsweek that the key is not to focus on the specific proportion of 'mass immunization', but 'if there are people immunized in the population, the impact of any epidemic will become relatively small. The more people are immunized, the less the impact of the epidemic. "

Italy's epidemic prevention and control has not been lax. The Italian Ministry of Health said that all the blockades and restrictions currently implemented by the government will continue at least until Easter on April 12. Bocha, Minister of regional and autonomous affairs of Italy, also publicly said that it is inappropriate and irresponsible to talk about the reopening of schools and factories.

The dilemma of aging

On March 25, a China Eastern Airlines charter plane arrived in Milan, Italy. This is the third medical team and the fourth batch of aid sent by China to Italy since March 12. In addition to China, medical personnel from Cuba and Albania also arrived in Lombardy recently to join the epidemic prevention work.

At the beginning of the epidemic, Italy sought medical resources from the European Union. However, the French and German governments have issued export restrictions on medical materials such as masks and protective clothing, and other European countries have not responded to the appeal of the European Commission. The Italian government can only seek to obtain urgently needed materials from Russia, the United States and South Africa.

As for the EU's efficiency in the crisis, at a fruitless EU leaders' meeting, French President macron said frankly that the EU's political response in the crisis may mean the end of the EU.

When the total number of confirmed cases in Europe was about to exceed 100000, Member States finally reached an agreement and the EU announced the establishment of a strategic reserve of medical materials to "save Europe". The European Commission has also established an epidemic response team, headed by EU president von delaine, and announced the goal of "ensuring that there is sufficient supply of protective equipment and medical supplies throughout Europe".

In addition to setting up 37 billion euros of COVID-19's investment plan and convening countries to explore economic aid programs such as issuing bonds, the group has begun to regulate the border control of Member States. At present, the free circulation of basic goods in the EU has been restored. Germany and France suspended export restrictions on Italy and promised to deliver 1 million protective masks to Italy. Since March 24, some Italian patients have been transferred to hospitals in Germany for treatment.

Developed countries with serious aging face the risk of sharp increase in severe disease rate. As the highest proportion of elderly population in Europe, Italy has a better system to protect the elderly in the pandemic of infectious diseases than other European countries. Italy has a national influenza surveillance system, which continuously monitors the national influenza infection rate and severe rate based on the data reported by 1000 general practitioners serving the grass-roots level. The whole protection system relies most on vaccination. People over the age of 65 will be required to be vaccinated.

The biggest difficulty in COVID-19's prevention and control is that there is no vaccine. The European CDC's guidelines for the prevention and treatment of infectious diseases emphasize that in addition to vaccines, the way to protect the elderly from infectious diseases is personal protection.

Benjamin & middot; Colin described to China Newsweek that the best way is to 'cocoon' the elderly. As long as there is local communication, the elderly will be protected from exposure. This means that the government needs to arrange for the delivery of materials, guarantee drugs and cancel children's visits for the elderly to avoid them leaving home because of daily things.

K & aring, director of infectious disease prevention project, Institute of infectious diseases, Ministry of health of Denmark; re Mø The team led by LBAK has been tracking the mortality rate of European countries for a long time. He told China News Weekly that after the outbreak of COVID-19 epidemic, the mortality rate of Italy has not yet been significantly changed in the other European countries, as compared with the influenza epidemic. However, this does not mean that other European countries with aging problems have escaped, because 'death registration and death report are always delayed for several weeks'.

On March 27, in Milan, Italy, soldiers in protective clothing transported the coffin from the begamo area to the chinicello Balsamo cemetery.