WHO says COVID-19 is the first coronavirus pandemic faced by mankind. As of 10:00 on April 3, Beijing time, the epidemic has spread to 205 countries and regions, with the cumulative number of confirmed cases worldwide exceeding 1 million.
Among them, Italy is still one of the countries with the worst epidemic in Europe.
March 16, a cemetery wearing a mask was carrying a coffin from the hearse in a cemetery in Lombardy, Italy. The cemetery holds a funeral every half hour for those who die of COVID-19.
Data from the Italian civil protection department shows that as of 18:00 local time on April 2, Italy's cumulative number of confirmed cases increased to 115,242, making it the second most confirmed cases of new coronary pneumonia in the world; the cumulative number of deaths was 13,915, ranking first in the world; the mortality rate reached 12%, far higher than the global average mortality rate announced by the World Health Organization.
At 12:00 on March 31 local time, Italy lowered half of the flag to mourn all victims of COVID-19.
Life Times interviewed experts to interpret the current situation of the epidemic in Italy and uncovered the reasons behind the high mortality rate in Italy.
Interviewed experts
Professor of the School of Public Health of Fudan University Hu Shanlian
Author of this article丨This newspaper’s special mission in Italy, Germany, special correspondent Han Shuo Qingmu □ Our reporter Lei Yan
Edit this article丨Xu Wenting Wang Xiaoqing
There is insufficient medical care, insufficient hospital beds, and insufficient ventilators...
Since the appearance of "patient No. 1" in the early morning of February 21, the total number of infections in Italy has increased rapidly. An article published in The Lancet on March 20 showed that if this situation continues, the Italian bed gap will exceed 4,000 by mid-April.
Data from the Italian Ministry of Health shows that as of March 27 local time, 26,029 people in Italy were receiving treatment in hospitals, of which 3,732 were in intensive care. Due to the emergence of a large number of severely ill patients in the short term, the use of beds and ventilators in Italy's medical system, especially in the severely affected areas such as the Lombardy region, has reached almost saturation.
According to Italian media reports, before the outbreak, Italy, a population of 60 million, had a total of 5,300 severe beds equipped with ventilators; after the outbreak of the epidemic, there were insufficient ventilators in various parts of Italy. Milko Nakoti, an anesthesiology and pediatric emergency physician at Pope John Twenty-third Hospital in Lombardy, witnessed the current situation where patients had to wait for hours to have emergency beds: most hospitals were very crowded, and some patients were lying on mattresses with mattresses placed on the floor. Elderly patients died alone and could not receive cardiopulmonary resuscitation treatment, and there was no palliative therapy. After the outbreak of confirmed cases, the Italian government began to urgently purchase ventilators from the world. Siare, the largest medical equipment manufacturer in Italy, has sought help from the country's automakers Ferrari and Fiat, hoping to discuss the feasibility of automakers switching to ventilators. In addition, Italy has also begun to increase the number of severe beds, which has now increased to 7,200. In order to increase the strength of medical staff, the Italian government has also urgently recruited 300 medical staff and has arrived in the Lombardy region.
A front-line doctor in Italy described the epidemic and said: "It seems like he was suddenly attacked by a tsunami." Faced with the sudden outbreak, Italian medical staff not only endure double physical and mental fatigue every day, but also brings huge pressure to them.
Maria, a nurse in the Department of Infectious Diseases at São Paulo Hospital in Milan, said that they have been on duty for 12 to 14 hours a day, with only one hour of rest time in between. In Lombardy, some retired doctors and medical graduates were "recruited" to the front line.
On April 2 local time, the Italian Federation of Surgeons and Dentists issued an announcement stating that since the outbreak of the epidemic in Italy, there have been 69 doctors who have died of COVID-19. According to the Health and Medical Industry Association, there are currently more than 10,000 medical staff infected with the new coronavirus in Italy, of which 20% are front-line doctors.
The surge in patients and the hospital's ability to admit hospitals reached its limit, making Italy's crematoriums overwhelmed, and some of them had to consider stopping the receiving of bodies.On March 16, a video from Bergamo, Italy was circulated. The screen showed that many dead people who died of COVID-19 had no time to be cremated and buried. The church became a temporary morgue, and dozens of coffins were arranged neatly waiting for cremation.
In this epidemic, the group with the highest mortality rate in Italy is the elderly. According to data released by the Italian National Bureau of Statistics in February 2019, Italy's people over 65 years old account for 22.8% of the total population, making it the second largest country in the world in aging.
In order to prevent the epidemic from continuing to spread among the elderly, nursing homes and other institutions restrict visitors; Italy urgently issued a law that if a suspected case goes out without authorization in violation of the isolation regulations, causing infection of the elderly or other high-risk groups, and then becomes critically ill or die, he will be prosecuted and sentenced for suspected intentional murder.
htmlOn March 31, Silvio Brussfaro, director of the Italian National Institute of Health, said that the growth curve shows that the epidemic in Italy has entered a stable period, the cumulative number of cured people is increasing steadily, and the number of people receiving severe treatment is decreasing.However, many well-known epidemiological research institutions, including Imperial College London, UK, pointed out that Italy may have a considerable proportion of mild patients and asymptomatic infections that have not been found or confirmed.
At present, since the virus detection capability has reached its limit, Italy cannot guarantee active testing of all close contacts, and can only prioritize patients who have shown obvious symptoms. Why is the mortality rate of
still high?
"The actual mortality in Italy may be worse." Recently, the mayor of Bergamo, Italy, said that the official death data only contains confirmed cases. If the patient died at home before the diagnosis, it was not counted in the official data.
In the 2018 global medical system ranking released by the World Health Organization, Italy ranks seventh, but why are there so many deaths from COVID-19 and why are the mortality rate still high?
On March 23, the National Institute of Health of Italy published an article in the Journal of the American Medical Association, which analyzed and explained the patient's age, comorbidities and testing strategies. It believed that there are three main reasons:
1. In terms of the age distribution of confirmed cases, patients over 70 years old accounted for 37.6%; a considerable number of cases occur in people over 90 years old, and the mortality rate in this age group is as high as 22.7%.
Several studies have shown that the new coronavirus is more lethal to the elderly, so the age distribution may be an important reason for the high mortality rate in Italy.
2. The definition of deaths related to COVID-19 is unclear
The official statistics in Italy include all deaths of patients who tested positive for the COVID-19 virus, and do not exclude deaths caused by underlying diseases, such as heart disease, diabetes, cancer, etc.
So far, deaths related to COVID-19 have not been clearly defined internationally, which may be one of the reasons for the differences in case mortality rates in different countries.
3. Testing is mainly concentrated on severe patients
25 On February 25, the Italian Ministry of Health issued a strict testing strategy, giving priority to testing patients suspected and with serious clinical symptoms. Many asymptomatic or mild patients cannot be tested, so the mortality rate has increased significantly, from 3.1% on February 24 to 7.2% on March 17.
The author of the article pointed out that due to limited research data, it only reflects the first month of the outbreak in Italy, and may change in the future. Regarding the above analysis, Hu Shanlian, professor at the School of Public Health of Fudan University, said that "partial reasons are not reasonable."
He believes that even if deaths related to COVID-19 have not been clearly defined internationally, the statistics are based on whether the COVID-19 is confirmed, so the impact on the mortality rate is not large and should not be the main reason.
Hu Shanlian pointed out that the high mortality rate in Italy may also be related to the following two key factors:
Lifestyle
Italians emphasize "individual freedom" and there are many people gathering. Previous reports show that after the government implemented the "lockdown" measures for a period of time, the people still remained active.
Before March 10, although there were blockades between the "red zone" and other regions, people's lives and social methods in towns and communities within the "red zone" have not changed significantly. Many commercial venues are open as usual, and there are many customers. Many Italians even took to the streets to protest the "excessive" epidemic prevention restrictions.
At the same time, the Italians' refusal to wear masks has also accelerated the spread of the virus, and some asymptomatic infected people unknowingly spread the virus. Many dead patients were already in severe condition when they were diagnosed.
According to research and related surveys by the Italian Ministry of Health, 77% of the deceased had symptoms of high fever when they were sent to the hospital, 74% had respiratory distress, and their condition worsened very quickly. It took an average of 4 days from diagnosis to hospitalization, and the average time from treatment to death was about 4 days.
In sharp contrast, none of the 50,000 Chinese living in Prato, Tuscany, Italy were infected.
- It is reported that the local Chinese community has spontaneously entered a lockdown since the end of January, 3 weeks earlier than the first confirmed case reported in Italy.
- Before Italy took strict epidemic prevention and control measures, Chinese and overseas Chinese there consciously self-isolate and strictly control activities such as shopping.
- Most Chinese companies and businesses stopped their business more than 10 days before the government decided to "lock down".
- Chinese merchants operating supermarkets also began to provide masks and hand sanitizer to employees, customers, etc. early on, and asked everyone to maintain a safe distance.
There is insufficient medical resources
Official data shows that Italy has been forced to close 758 medical institutions of various types in the past five years, and the gap in Italian doctors and nurses in the past ten years is as high as 56,000 and 50,000 respectively.
Although the medical system is relatively perfect, it is still in a tense state under normal circumstances. After the outbreak of the epidemic, the number of suspected and confirmed cases has increased sharply in a very short period of time, resulting in the overwhelming burden of the medical system. Many hospitals have insufficient drugs, ventilators, oxygen supply and protective equipment.
Medical resources are scarce, resulting in the inability to diagnose and intervene in time for mild patients and the inability to treat severe patients in time. In the absence of sufficient safety guarantees, the risk of infection and death has greatly increased.
Germany is also aging, but the case mortality rate is ten times different from Italy
is also a European country with severe aging, and Germany's case mortality rate is much lower than that of Italy. As of 10:00 a.m. Beijing time on April 3, Germany has a total of 84,794 confirmed cases and 1,107 deaths, with a mortality rate of about 1.3%, only 1/10 of that in Italy.
Combined with media reports and opinions from experts such as German "Spirit Spectrum" weekly and there are four reasons:
1, Early prevention and early treatment
0, Professor Drosten, director of the Institute of Virology, known as "Zhong Nanshan" in Germany, believes that Germany realized that the new coronavirus may break out very early and quickly invested in research.
- Germany has dozens of virus research institutes and 4 P4 laboratories, second only to the United States. Its main task is to identify pathogens, study the possibility of treatment, and develop vaccines in a highly secure system.
- Germany also has an independent laboratory network, and virus testing began in January, with 12,000 samples being tested every day, allowing doctors to diagnose and isolate patients faster and more timely.
At present, Germany has entered the stage of large-scale testing, with 500,000 tests per week. In the future, it is planned to increase the testing capacity to more than 700,000 tests per week. In addition, before the epidemic began, Germany retained enough medical protective equipment.
2 and are sufficient for severe beds
At present, Germany has 2,000 comprehensive hospitals, 170,000 clinics, 20,000 pharmacies and 14,000 nursing institutions, 390,000 doctors and 28,000 critical beds. It is transforming ordinary beds into critical beds, and it is also learning from China to establish "standard hospitals" in various places.
There are also 7 national infectious disease treatment centers evenly distributed in Germany. No matter which city you are in, you can reach the nearest center in a few hours by car.
3 and infections are relatively younger
At present, 70% of confirmed cases in Germany are between 20 and 50 years old, and only 25% of patients over 60 years old account for.
The new crown pneumonia epidemic first broke out among young people, but German single families accounted for about 40%, which is less likely to spread the virus than Italy's "big family" structure.
4 and do not test the deceased for the new coronavirus
The current principle in Germany is that if the death toll is not confirmed before death, no death toll for the new coronavirus will be counted. This practice has been questioned by experts from other European countries, believing that Germany uses statistical means to reduce mortality and prevent social panic.
In addition, some experts believe that the epidemic in Germany is still in an upward period, while Italy is close to the "turning point", which may be the reason for the difference in case mortality rates between the two countries.
Hu Shanlian emphasized that in order to reduce the mortality rate, the treatment of critically ill patients is the primary factor. For Italy today, the shortage of medical equipment and medical staff is the first problem to be solved.
With the arrival of instruments such as ventilators, medical masks, testing reagents and other aid materials, as well as professional medical assistance teams, Italy will usher in a positive trend.
Italy should continue to ensure the effective implementation of existing isolation measures, curb the spread of the new coronavirus from the source, reduce the number of infections, and reduce the burden on medical institutions.
In addition, the detection of mild patients should be expanded, and timely intervention and treatment should be carried out to effectively prevent mild patients from turning to severe patients, thereby reducing deaths.
"From the current data, the daily new cases in Italy have declined, indicating that the peak has arrived." Hu Shanlian said that in two weeks, the number of new cases will drop significantly, and the epidemic control can begin to show results. ▲
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