Covid-19, four doubts about the anti-virus strategy: here are the ones

Four issues weigh on the credibility of coronavirus containment strategies desired by the highest national and non-national political and health authorities. Those like me (a doctor who has spent a lifetime in hospital wards always in contact with serious health problems) observe and think about these strategies, find it difficult to passively accept choices so fraught with consequences for everyone, without being able to discuss them in some way. Especially when the same issues are circumvented at every step and relegated to secondary problems by those who should be right. Instead they seem to me the central point of our possible interaction with the virus.

1) CORONAVIRUS DOES NOT KILL CHILDREN

The first question catches the eye even to the most inexperienced layman in infectious disease: this virus, unlike all other viruses that have ever existed, does not kill those who are completely devoid of immunity against it, i.e. children. Worldwide there are no reported cases of under-10 deaths (Chinese Journal of Epidemiology, February 11, 2020). Deaths under the age of 50 are very rare: 12 cases out of 2.500 total deaths in Italy (source: ISS). This observation has a very relevant implication, because it shows that the danger of the virus is not linked to the fact that the population lacks specific antibodies against it. In fact, the vast majority of those who come into contact with it are asymptomatic or not very symptomatic.

2) THE TYPE-VICTIM OF COVID19

The second central point in the problem of the virus concerns the very well-defined population at risk: 90% of deaths occur over 70 years of age, in people for ¾ male and generally with associated chronic cardiovascular and metabolic diseases. It is therefore clear to us who we must give all our efforts to preserve their fragility from the disease. The maturity of a civil society is measured by how well it manages to defend the weakest.

3) EXPERIMENTS WITH ANTI-FLAMMATOR

But the characteristics that we have recognized in COVID -19 do not stop here (third point): the viral lethality seems to be mainly due to an unbalanced defensive inflammatory response of the organism. And here hinges the attempt, never too praised, of some clinicians who, inspired by Chinese therapy protocols, have unfortunately still experimented with a few patients, a powerful anti-inflammatory obtaining flattering results. In the end, healthcare excellence is this: doctors who seek the best therapy, nurses who assist the patient beyond any work limit, healthcare professionals who support the organisation. In spite of the evident structural deficiencies, the result of choices that should never have interfered with medicine.

4) THE GEOGRAPHIC LOCATION OF THE CORONAVIRUS

But it is the fourth problem that troubles our sleep: the precise geographical location of this virus. From the outset, alongside the fairly uniform expansion of the various hotbeds, first in the areas adjacent to them and then gradually to the other regions, a trail of death has been traced which seems to follow a particular path: the provinces of Lodi, Piacenza, Cremona, Bergamo and the western part of that of Brescia. The data are accurate if we observe the epidemiological comparison between these provinces and the neighboring ones of Milan, Monza, Como, Varese.

Percentage of infected people out of the total population (source, Ministry of Health):

• Praises: 0,61%
• Piacenza: 0,374%
• Cremona: 0,57%
• Bergamo: 0,34%
• Brescia: 0,26%
• Milan: 0,07%
• Monza: 0,04%
• Como: 0,03%
• Varese: 0,02%

It seems like an epidemic within an epidemic, because the data for Milan, Monza, Como and Varese are practically similar to those of all the provinces of the Centre-North, where the virus has been circulating for quite some time now: Bologna 0,03%, Bolzano 0,05%, Venice 0,04%, Udine 0,03%, Turin 0,03%, Genoa 0,04%, Florence 0,02%.

And still relevant is the comparison between Sesto San Giovanni, an industrial city and an important junction north of Milan, and the province of Bergamo, just 30 km away.

COVID-19 deaths per 100.000 inhabitants:

• Bergamo: 23
• Sixth St. John: 5

Our nightmares are those of the inhabitants of these areas: what's going on? Is everything possible for the defense being done, beyond the generous implementation of all forms of intensive care which unfortunately does not seem able to change the prognosis? Are we trying to understand this rather unusual phenomenon of selective spread of the virus? It has been hypothesized that successive mutations have led to a more aggressive virus than the original one, but there has not yet been experimental confirmation of what or what can link territory and mutations. However, it does not appear that these observations are considered a priority.

THE CHOICES OF ITALY

The strategic choices in Italy for the fight against Covid-19 seem very rigid, almost obtuse: they do not recognize the geographical differences (it is clear that the situation in Bergamo, Cremona, Lodi, Piacenza and Brescia cannot be compared to the spread of the virus in the rest of Italy), they do not achieve the main result of defending the population at risk, which is the one really threatened with death, leave medical therapies to local initiative while a common protocol should have been started right from the start. Theorists of this approach will say that the restrictions are not yet enough, that a curfew must be implemented, that we must annihilate any form of movement. Of course, this would perhaps achieve important results, but I'm not so sure, because there will always be the risk that an asymptomatic person could escape mass rear-end collisions. But surely we will only have a pile of rubble.

AN ALTERNATIVE PROPOSAL

I think that an alternative can be proposed, an alternative that puts people at risk at the center of safety and that is that, while there is still time, as long as they are asymptomatic, they are protected and assisted from a health and social point of view at home, with costs that could also be high, but never as high as those of intensive care. And above all they would not be left to die in hospital isolation. A system based on ad personam assistance has never been tested, not even in areas with a high spread of the virus, where the total isolation of people at risk could be decisive in improving the prognosis. While instead in the areas where the situation is still under control it could allow the reduction of the restrictive measures for the remaining population.

But above all what is difficult for me to accept is that the whole country is led, on the wave of collective terror and on the thrust of scientific rigidities that condition politics and silence any opposing voice, to increasingly dramatic and destructive of the social and economic fabric with the risk of not even obtaining the pre-established results.