Month: March 2020

Making sense of the Covid19 Italian numbers

Posted on by Daniele Nicolucci

As promised on Facebook (for the few who follow me there), here’s a look at the latest numbers coming from Italy about Covid19.

Those numbers are being used as a reference in many countries to warn people: look at how badly Italy is doing! And yes, it’s a mess, but not for the reasons that may seem obvious at a glance. Numbers mean nothing without some context, and that’s what I’ll try to provide here. Keep in mind that I’m not a statistician and this is all my own work, so any mistakes you may find are to be blamed exclusively on me.

First of all, this table in the official GitHub repository by the Prime Minister’s Office is updated daily, so it’s worth a bookmark. The field names are in Italian, so for those who don’t speak the language:

data date (Italian time zone)
stato country (always ITA)
ricoverati_con_sintomi hospitalized with symptoms
terapia_intensiva in intensive care
totale_ospedalizzati total hospitalized
isolamento_domiciliare isolated at home (under medical surveillance)
totale_attualmente_positivi current total positives
nuovi_attualmente_positivi new total positives (compared to yesterday)
dimessi_guariti discharged and recovered
deceduti deceased
totale_casi total cases
tamponi tests

Let’s first look at what we have. At the time of writing this, the latest data is from 21 March. There’s a handy table for that, further split by Region. We’ll only look at the bottom line, which looks at the country as a whole.

Covid19 Italian data as of 2020-03-21

  • The number of active cases is 42,681, of which:
    • 22,116 (~51.8%) are isolated at home, likely because they show mild or no symptoms
    • 20,565 (~48.2%) are hospitalized, of which:
      • 17,708 (~86.1%) are not in intensive care, likely because they show mild or non-life-threatening symptoms
      • 2,857 (~13.9%) are in intensive care

What the data doesn’t immediately say is that 6.6% of current registered cases (2,857 out of 42,681) is currently in intensive care, while the 93.4% does not require that. We clearly cannot tell how many currently in intensive care will die, or how many will worsen to the point of needing intensive care.
Let me put that another way: over 9 out of 10 registered cases are not in intensive care, and indeed half of them are not even hospitalized. Of those who are, about 1 out of 7 requires intensive care; if that’s scary, flip it into hope: 6 out of 7 people hospitalized do not need intensive care.

The total number of registered cases is 53,578, meaning that 10,897 cases are “closed”. Out of those, 6,072 recovered and 4,825 died. That is admittedly scary, and this is the part where people generally get upset, because it seems insensitive. So, before I even present some data, let me preface that by saying that I mean no disrespect to anyone, and that I have many relatives (including my parents) who are approaching the demographics I’ll discuss, so of course I am personally worried. With that disclaimer, let’s look at the numbers.

The National Health Institute keeps daily statistics here, another page worth bookmarking. The latest infographics shows that the average patient age is 63, with 36.2% of all cases being over 70 and 37.5% being between 51 and 70. Let’s flip the numbers again to get a better picture: confirmed patients of any age between 0 and 50 are 26.3%, while cases over 50 are 73.7%. That’s three times as much. And before we look at what that means, let’s throw in some other numbers: the extended report, last published 3 days ago, shows that the percentage of deaths by age group is less than 1% for each range up to 40-49, increases slightly to 2.7% for ages 50-59, grows to 10.2% for ages 60-69, then jumps to 35.8% for ages 70-79 and becomes a whopping 40.8% for ages 80-89. It then decreases to 9.4 for people over 90+, most likely because there aren’t as many people that old to begin with.

Before we make sense of all those numbers, let’s look at the general demographics of Italy. We only really need one dataset, that is the population pyramid. This is from the UN’s World Population Prospects:

Italian population pyramid for 2020

The median age in Italy is 47.3 years, but that alone doesn’t say much. You really need this graph to realize that there are more elderly people than young people. Italy is pretty old, and Covid19 attacks older people more easily. That is one of the reasons why our numbers are so high: it’s simply more likely for our aging population to be affected, and older people are also more likely to have pre-existing medical conditions — technically called “comorbidities” — that are exacerbated by Covid19 and ultimately lead to death.

If that weren’t enough, there are also some social and cultural factors coming into play: the “sense of family” is pretty strong here, and many people here live with their parents until they’re in their 30s or even later. Even if they don’t, family gatherings are a common ritual, so there’s a lot of inter-generational mingling. Other countries may have a more “compartmentalized” society, which may help reduce the risk of infection across different age groups.

One last factor complicating the Italian situation doesn’t affect just the numbers themselves, but also all the percentages being thrown around. Many people who test positive to the virus are completely asymptomatic, and testing centers across the country are already at capacity. As a consequence, in many areas only people with serious symptoms are tested, in order to move them to the newly created “Covid hospitals” (i.e. hospitals or parts thereof that have been dedicated exclusively to Covid19 patients, in order to aid in containment). Many people with mild symptoms are being told to isolate at home under medical surveillance, but are not counted as positive, simply because they are not tested unless necessary. Furthermore, it’s unclear how many people are dying at home from Covid19 complications, and those are not officially counted among the infected either, for the same reason: they were never tested.

Note that I said “many areas”. That’s because the healthcare system in Italy is run independently by each Region, so the choice on whom to test varies in each location. The decision is usually based on how dire the situation is, how many testing labs are available nearby, and ultimately how much money is available. As a side note, and I’ve said this before, it’s almost a blessing in disguise that the worst affected areas are in the north; had the epidemics started in the chronically underfunded south, things would be way, way worse.

Still, the net result of all this is that the numbers you see are making less and less sense as we go forward. Ultimately, we have no clear idea how many people are effectively infected, with some estimates saying that for each confirmed case there are at least five unconfirmed ones; we don’t know how many people are dying from Covid19 complications, because some may die before being tested; and, consequently, the mortality rate is also meaningless, since both the numerator (deaths) and denominator (infections) are unreliable.

So, is it just total mayhem? Sort of. As someone who’s living through this on a daily basis, I think that the best thing we can do, and I believe that this should be the case in other countries as well, is not to focus on the numbers. I know it sounds like borderline blasphemy, but hear me out. We saw this above: even in an old country like Italy, over half of all confirmed patients have symptoms so mild that they just ought to stay at home, and out of the other half that’s hospitalized, 86% is not in intensive care. And most of those who are more seriously affected and die are either older people, or those with serious pre-existing conditions. Once again, I am not dismissing that are mere statistics, and I’m well aware that each unit in those numbers is actually a personal tragedy and a broken family; really, I am not dismissing that in the slightest, but I think it’s important to look at the bigger picture if we want to get through this without going crazy.

The combination of being locked inside and being constantly exposed to growing numbers, especially as those numbers are thrown around by the media without absolutely any context or explanation, are freaking people out. It’s probably hard to explain to non-Italians right now, but it will start happening elsewhere as well. You can’t leave the house unless you have a valid reason due to the pandemic (something that’s been abused so much by some people that last night the government tightened that requirement even further), and all you hear about the pandemic is how every day more and more people are catching and dying from it.

It’s not just the evening news on TV, it’s the online news as well, that you can read in real time whenever you want; it’s the Google alerts, it’s the posts on Facebook, the tweets, the group chats and chains on WhatsApp. Italians in particular were hit like a freight train by the social media revolution in the last few years, but were not prepared for it. Most people simply fall for clickbait and fake news, often spreading it further in good faith. Even I struggle to make sense of all this, despite being quite well versed into reading through the lines and not taking raw numbers at face value, and with over six years of experience as a search engine evaluator. I find myself reassuring my parents that things are not as bad as the numbers suggest, and urging them not to fixate on the numbers they hear on TV, or the absurd titles such as “It’s a global war”. Is it really surprising that people feel hopeless?

Just yesterday I had to help a relative through figuring out whether an “call for action” she had gotten from a contact via WhatsApp was real or not, and it took me over 40 minutes of sifting through web pages to tell her what to do; and again, I’m someone who evaluates web pages for a living, and who’s been online for the last 24 years, long before Google even existed. Most people have no such tools or skills, get overwhelmed by all they hear, have no idea whom to believe, and either get depressed, or panic, or both. And they can’t be blamed.

But, once again, and this is for all my foreign friends who keep reading those numbers with even less context on their own national media: take them with a grain of salt and keep in mind that there’s always more to things than raw figures. Don’t let that freak you out. The situation is serious, and it will likely get serious in other countries as well. There’s no point in hiding that. But rest assured that, as bad as it is in some areas, this is not the apocalypse. There are no corpses piled up in the street, there is no shortage of groceries, and most people at home are simply bored at this point.

Do your part to prevent this thing from spreading. That’s the best thing you can do. You’ve heard this a million times but I’ll give a quick recap:

  • stay at least one meter / three feet away from others, even if you share an apartment… you can never be too careful
  • don’t go out unless absolutely necessary and always following your local regulations
  • wash your hands regularly and thoroughly with soap, or use hand sanitizer as an alternative
  • don’t touch your face unless you’ve just washed your hands
  • only wear a mask if you are showing symptoms, otherwise it’s useless or even counterproductive
  • keep in mind that the virus is not airborne
  • in case you develop symptoms, follow your local regulations on what to do; as a rule of thumb, call your doctor (don’t just go!)
  • when buying groceries, buy a little more than you normally would but for the love of all that’s holy, do not hoard anything! doing so simply prevents others from getting their fair share of things and is causing more trouble than the virus itself

And, if I may add one personal suggestion: stay away from social media and from the news, or at least don’t spend too much time on them. It changes absolutely nothing about what’s going on, yet it alters your perception and fuels the sense of gloom and doom and impending armageddon, and that’s really the one thing we should avoid. Mass hysteria never led to anything good. Things will get worse before they get better, but — and this is the one key takeaway — the more we stick to doing our part, the sooner that will happen. That’s really all there is to it. We’re in this together.

On a lighter note, the forced lockdown is pushing many social gathering to become streaming events, and that includes religious functions. However, not everyone is completely at ease with technology yet. For instance, this catholic priest accidentally celebrated his Sunday mass with face filters on, and the result is quite amusing…

Concerned, not panicked

Posted on by Daniele Nicolucci

I’m being asked by many people to post a follow-up to my previous post, especially as most news outlets abroad keep mentioning Italy as the place with most covid19 cases, without explaining in detail what’s going on. This is hardly surprising, considering that at this point most countries in Europe and beyond are starting to have their own considerable amount of positives and the media attention inevitably shifts to the local situation.

I will try my best to post more often, and to provide some additional information “from the inside”. I’m not committing to any posting schedule, however. As I said in the previous post, I’ve been working from home for years now, so at this stage nothing has changed for me; if anything, there’s actually more work than usual with one of the companies I work for, as the virus itself has become central to what we do. Time for writing, therefore, is limited.

A recap about the numbers themselves. As I’m writing this, at 11 pm on 19 March, the official figures report a total of 41,035 positives, with 4,440 recovered and 3,405 dead. The vast majority of positives (that includes those who recovered) are in Lombardia with 19,884, followed by Emilia-Romagna with 5,214 and Veneto with 3,484. For those who ask about me specifically: my Region, Abruzzo, has 385 positives.
The curve is still climbing, with the steepest 24-hour increase so far (4,400+ for the whole country). I’m not going to explore the numbers in depth, but anyone wishing to do so can use this official recap or even access the full dataset in this GitHub repository. Another source is Worldometers but keep in mind that day-to-day numbers across various sources may vary, as each dataset is updated at a different time.

To be clear, I do not have any new first-hand accounts of what’s going on around the country, or even in my town. Since I went to buy some groceries for both my parents and myself last Saturday, I haven’t gone anywhere other than for brief walks with my dog. As some know, I live in the outskirts of my town, where it basically turns into a countryside, so it’s hard to even tell that anything is different at all. Fewer cars on the road, sure, but you almost have to pay attention to notice that. The only thing that’s distinctly different, and kind of odd, is that after sunset someone blasts loud music, allegedly to cheer people up. I’m not sure how long that will keep happening because at some point someone is bound to force them to stop doing that — I can hear that from half a kilometer away, and I can’t imagine what it must be like to go through that every day when it’s coming from your same building. Especially as it’s terrible music.

Many asked me if it’s true that everything is descending into chaos. No, not exactly, but I suppose it depends on what your definition of chaos is. As the numbers show, there is a wild disproportion of infections across various parts of the country. It is worth pointing out that the big issue with this disease is not how much it kills, but how many people are hospitalized. Especially in a country full of elderly people like Italy, the situation can quickly become dire. Remember that hospitals always work on the assumption that only a certain amount of people will require a specific kind of medical care, and while there’s some wiggle room in terms of reorganizing wards, moving beds and acquiring more equipment, there’s only so much that can be done. What would happen if everyone withdrew all their money from the bank? The whole banking system would collapse. That’s pretty much the problem with this virus, and why everyone’s telling you to try and do your best to flatten the curve.

So, it is true that the healthcare system, especially in Lombardia, is at its wit’s end. New intensive care units have been built from the ground up, and temporary hospitals have been set up as well. The problem is that the actual medical hardware equipment needed to treat these people, namely ventilators and other similar tools, are simply not aware. There has been talk about the central government — each Region runs its own healthcare system — taking over at least for procurement, but I am not entirely sure how that effort is going, or whether it’s actually been implemented. As much as I love to stay informed, there’s a threshold beyond which even the best-intentioned brain just shuts down and everything turns to white noise. I’ll provide updates in upcoming posts. For now, the silver lining is that the most cases are in one of the best-equipped Regions, as things could have been much worse if the infection had started from the other side of the boot.

Some provinces, in particular Bergamo and Brescia (both in Lombardia), are doing pretty badly, objectively. The outbreak has flared up, and there have been several things that are just hard to stomach. Not only patients have to be moved across the country because hospitals are running out of bed, but the Army had to pick up coffins and move them elsewhere because the crematoriums just can’t cope. As I said many times, I live quite south of that, but seeing those images is suddenly making the whole thing a lot more real. There have also been specific gut-wrenching instances of people not being able to do anything about relatives dying inside their house, as was the case of actor Luca Franzese, whose 47-year-old sister died in Naples and he had to resort to calling for help on social media, since funeral homes were lacking specific instructions on how to handle potentially dangerous cases like that and were refusing. Ultimately the situation was resolved with a waiver, some hazmat suits and whatever else was needed, but that’s definitely not the kind of thing anyone should have to deal with right after a loved one passed away.

Still, that also made the whole virus more real, because while we patiently wait for the daily press releases or look for updates online, it’s sadly easy to forget how each unit in those numbers is a real person with a history, a family, a past and, unfortunately not always, a future. So, am I concerned? Yes. But am I panicking? No.

I know I described a pretty bleak situation, but then again, if I am going to do this, I’ll just be honest. And in all honesty, despite that subconscious sense of uneasiness which I dearly hope it’s not really just denial, I’m not panicking, not at all. I’m doing all I can to protect myself and others, and I keep telling my parents to do the same; it’s obviously them that I’m concerned about, more than myself, as they’re older than me. But panicking, what is it good for? There are no zombies in the street, food and water are available, and this is not the apocalypse.

Yes, the numbers are going up, and yes, it’s a little scary because people keep defying the lockdown, to the point that the government is considering even tighter restrictions. Thousands of people have so far been questioned and reported by police for being away from home without a valid reason, and more keep being caught every day (it’s an exponential curve of its own, the logarithmic graph of idiots). With the end of the lockdown nowhere in sight, I wouldn’t be surprised if all the edge cases that had been allowed are eventually cancelled and this were turned into a full-blown curfew.

This is why we can’t have good things, as the saying goes, but then again, it’s worth keeping in mind that the numbers we know about are only the confirmed cases. And a case is confirmed when a test was done, and tests are only done when symptoms show up. That means that there is likely a huge number of people carrying the virus with either no symptoms, or symptoms so mild that they may not even be aware of it. While completely asymptomatic patients are only slightly dangerous to the community, as they are unlikely to cough or sneeze, it’s those very mildly symptomatic patients who have the potential for spreading it further: a tiny sneeze here, a little cough there, and it turns into a mess. Sure, if we all stayed home and, when we absolutely must go out, kept our distance from one another, then it wouldn’t be an issue. Always keep in mind that this is not an airborne virus, so you can’t get it just by walking around. You either have to be sneezed or coughed on, or pick it up from some surface where someone had sneezed or coughed, and then touch your face. It would be easy to stay safe, it just requires us just staying home and limiting our exposure to others. Yet so many people are defiant, and come up with all sorts of excuses to just stay outside.

I really don’t get it, I mean— yes, it’s easier for me: I’ve worked from home for a long time now, and I’ve never been a particularly social animal. But is it really such a horrible hell to spend a few days at home, when you have running water, electricity, broadband internet, access to free video games, free books to read, free things to watch (Youtube, RaiPlay and Mediaset Play are all free; and most people have Netflix, Amazon Video and/or Sky on top of those), and there’s even free multi-way video calling available if you feel lonely. Is it really such a terrible nightmare to put up with it even for a few weeks? Especially when the alternative is the risk of spending weeks or months in a hospital with a pipe down your throat, potentially leading to life-long complications if not flat-out death? I honestly don’t get that kind of attitude, but that’s just how it is. As far as I and everyone I know are concerned, thankfully, we’re doing our best to control what we can, and just hope for the best for the rest.

The peak is expected to hit in a few days; don’t ask me why it’s been moved ahead, probably due to all these idiots thinking they’re being smarter than others. Keep in mind that “the peak” refers to the daily increase in new cases. After that, we’ll still have to be careful to avoid turning the descent into another climb. That likely means that the lockdown will continue for quite a while. Schools were supposed to reopen on 4 April, and it’s a given that it won’t happen. In fact, as I was mentioning, is likely that the rules will become stricter for the time being, and in general things will likely worsen a little more before they start getting better. It’s just the way it is.

So there you have it, a new recap on what’s going on. I realize the mood of this post is darker than the previous one, but to be honest I’m not that worried (yet?) and this would have been less bleak if I had written it during the day. I always become a little gloomy at night, and I have for as long as I can remember.

We ought to remind ourselves that in the end it’s a game of numbers: there have been 41 thousand confirmed cases so far, sure, but there are well over 60 million of us who are just fine. We all plan to keep it like that.

Stay strong, wash your hands and to my foreign friends: for the love of all that’s holy, stop hoarding toilet paper! After all, you can always do headstands in the shower. 😉

Tales from a country in lockdown

Posted on by Daniele Nicolucci

As everyone on this planet probably knows, Italy was put into lockdown as an attempt to limit the diffusion of SARS-CoV-2 (“coronavirus” for friends), and the related COVID19 infection.

As I write this, in the evening of March 14th, there have been over 21,000 confirmed cases in the country, with almost 18,000 active ones. The daily increase in new cases is still exponential and so far there seems to be no sign of hitting the inflection point yet, though the peak is expected to be around March 18th; that’s because the lockdown was enforced on the 12th, and the incubation period is 7±2 days according to most estimates. An increase especially in the South is also expected in the next few days, because the news of the impending lockdown last week led a bunch of idiots many people from the South who work or study in the heavily affected North to flee back to their hometown, taking the virus on a cross-country trip with them.

It is an interesting social experiment, that’s for sure. A few people are having a hard time adjusting to the new forced routine (or lack thereof), and are already struggling; personally, I’ve been working from home for years now, so the disruption isn’t as bad as it is for others. Others still seem defiant, but police forces have been stopping and fining anyone who’s out and about with a valid reason. And most people seem to be completely oblivious to the fact that the virus is not airborne: aside from the fact that masks and gloves often do more harm than good as people have no idea how to use them effectively, they only make sense if you’re around others. Yet you see people walking in the middle of nowhere wrapped up mummy-style as if they were trudging on through a haze of dark matter particulate.

Generally, though, people seem to be discovering novel ways of doing things online: the amount of catholic masses being broadcast via Facebook is starting to approach the amount of catholic saints on the calendar, actors of varying levels of fame have started live-streaming shows from their living rooms, and “flash mobs” events are encouraging people to “make noise” from within their houses… which makes sense if you live in a populated area to encourage others to stay strong, but at the same time sounds absurdly creepy if, like me, you live at the edge of town and someone suddenly starts clapping their hands or screaming at the top of their lungs.

It is also eerie to see so few people around. I went to buy groceries earlier today (and brought my signed self-certification with me, as required by authorities) and even though there were a few other cars here and there, it was strange to see virtually nobody on foot. The average age in my town is about two million years old, which generally translates to stopping at almost every zebra crossing to let the elderly crawl to the other side (I am allowed to joke about that because I plan to never become old). That didn’t happen today, and it just felt odd. Ironically, on my way home I had Siri play random music and the first thing she came up with, while I was still pulling out of the parking lot, was a live rendition of Dream Theater’s “Afterlife”, which seemed darkly coincidental. Being the cynical person that I am, I obviously raised the volume to eleven (cit. Scottish lift) and sang along on my way home.

In all seriousness, everyone I know is fine so far. So far there have been 112 cases in my Region (what Americans would call a “State” and Canadians would call a “Province”) and 25 in my Province (what Americans would call a “County” and Canadians would call an “Eh, not all our provinces have those”). I’ve not been following social media much as I’ve been dealing with a few personal things, but I’m in touch with people from all over the place and nobody I know is even panicking so far: some are more concerned than others, yes, but we know better not to give in to panic. It’s just a matter of waiting it out and doing our best to protect ourselves and prevent spreading it further to protect others.

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