Update from Italy: Saturday Night

Photo by CDC on Unsplash

Here in Italy, the situation continues to evolve. Italy first declared a Covid-19 outbreak on February 20. On February 23, the U.S.-based CDC raised the threat level to 2 (exercise caution and wash your hands); last night, it was raised to level three (cancel all non-essential travel) for the two most impacted regions (still Lombardy and Veneto in the north and northwest of the country). Then, this evening, the CDC again raised the threat level to 4 (in brief, get out, but it is still a voluntary restriction) for the most impacted regions.

The distribution of the 888 cases by region, per the Protezione Civile, (14 out of 20 Italian regions affected): 531 in Lombardy, 151 in Veneto, 145 in Emilia-Romagna, 19 in Liguria, 11 in Piedmont, 8 in Tuscany, 6 nelle Marche, 4 in Sicily, 4 in Campania, 3 in Lazio, 3 in Puglia, 1 in Abruzzo, 1 in Calabria, and 1 in the Province of Bolzano (Alto Adige). One of the Tuscan cases is a Norwegian student who attends the Architecture school of l’Università di Firenze just a couple of blocks from where we live.

However, Covid-19 is spreading quickly across Europe, with cases in virtually every EU member state now; about 60% of those traced back to the Italian red zone now under military quarantine. This virus is going to spread. Many of us will contract it. I continue to believe that, based on what I have read, protecting our older and more vulnerable populations is the most important thing we can do.

I noted also the first fatality posted from the U.S. in the past couple of hours in Seattle.

I am not usually on Facebook anymore, as many of you know; I gave it up a couple of years ago. It was like quitting tobacco. Dipping in and out of the site now reminds me why I don’t go there much. What a shoutfest. In particular, there seems to be a counter-press-release swell in which people resident in Italy claim that everything is fine, in fact there is no better time to come than now! To me this seems disingenuous at best, and largely motivated by concerns about the threat (truly ever-present here) of tipping into economic recession as the tourist and fashion industries in particular take a huge hit due to cancellations. Everything is not fine, but business is happening as usual, and people are doing a good job keeping calm and staying informed.

We went up to Gonzaga today help Jason and some of his staff say farewell to students (by “help” it may be more accurate to state, a mom and two small children tried out every piece of equipment in the gym downstairs). Washington state has indicated that people returning from affected zones will be asked to self-isolate for two weeks. I can’t blame them, since it seems the situation on the West Coast is going to ramp up here soon. Meanwhile, planes continue to take off and land at Florence Peretola airport, although it remains to be seen how the students from closing programs will all fly out next week. Talk of chartered flights is buzzing amongst the American program. Jason’s federal mole tells him that the U.S. government will not block any flights with passengers who have spent time in Italy.

There’s no CDC threat level above a 4, so I am not sure what new alert will wake us at midnight. (Spinal Tap comes to mind – “but this threat goes to 5!”) My instincts tell me to limit unnecessary super-social time, wash my hands, practice self-care during stress, and be careful, be watchful. And remember we are not in this alone. This outbreak might give the whole world a master class in community and interconnectedness. That would be a good outcome.

Photo by CDC on Unsplash

Stay tuned ….

Errata: Emilia-Romagna was not elevated to level 4 threat yesterday. All of Italy remains at Level 3, with the exception of Lombardy and the Veneto.

Update from Italy: Saturday Morning

Photo by Julius Rinke on Unsplash

The morning broke here overcast and nondescript. Like any other day on the threshold of February and March. The news, on the other hand, feels pretty out of the ordinary. I file this with the First Gulf War and, to a lesser extent, 9/11.

Jason was working overnight to manage the latest news: the CDC has raised Italy’s Warning Level to 3, “avoid non-essential travel.” You can read the full text here. I find most interesting this statement: There is limited access to adequate medical care in affected areas. Have the writers of this statement been to America? Further, the affected areas are under military quarantine. You can’t get in. Residents can’t get out. Italy quarantined those 11 towns a week ago with the Italian equivalent of federal marshals (carabiniere) and soldiers. If you want to gate-crash that barrier and demand medical care …. I am a bit at a loss for words. There is open access to medical care in Italy. Across the country. The stray cases here and there are being extremely managed. I feel safe in Florence, and I feel our family is safe in Florence. If this changes, I will update.

Italian health authorities continue to search for the index patient in Italy, but more news has come out about “Mattia,” the 38-year-old man in Codogno who is a probable super-spreader.

We’re headed up to the Gonzaga-in-Florence campus later on today to help send off some the students who are returning home. There were about 200 enrolled for this semester. Now that the CDC threat level has been raised from 2 to 3, campuses are calling home all U.S. students. And the study abroad programs that had not already announced closures are now closing: 7 today. The rest will close this weekend; they have to now, for insurance and legal reasons. The concern now with the American students, or for that matter, anyone, headed home from Italy (or China, or Japan, or South Korea) is that they may be placed in quarantine once they arrive by U.S. health authorities. Never mind that they are not originating from outbreak centers, but Tuscany. Not much at all has been happening in Tuscany, and we are a northern region. Of course, this could change. But it is not the case now.

Flights continue to arrive and leave from the Florence airport. It does seem like Italy is calming down. Rolling up shirtsleeves, dealing with reality. And the infection does not seem to be spreading with any speed through the country. It all remains concentrated in the north.

The news out of the U.S. is more concerning: that our president has said the pandemic is a hoax, that it originated with immigrants. I know enough to take a page out of the fiction turned reality. (See: Orwell.) I am extremely concerned in the U.S. that the “control” of information from the top, and the muzzling of an acknowledged medical and epidemiological expert like Dr. Fauci, will really take things to a different place. America has some very concerning complicating factors in this unfolding global plot.

As I wrote to American friends who are still stateside yesterday, if you don’t have to get on a boat to sail across the ocean next week, don’t.

More news to come as I have it.

Update from Italy: Friday Morning

Photo by Calvin Hanson on Unsplash

The Italian government has asked the Italian media to tone down their coverage of the virus, so infection statistics are no longer available on the website of La Repubblica, the Italian New York Times. I am continuing to check and get numbers from the Worldometer site which seems to provide a decent and sober aggregation of facts with no sensationalism, editorialism, or speculation.

I have been fielding questions from friends stateside about what is happening here. The main spreads of infection in Italy remain in Lombardy and the Venice region. A patient zero has not yet been identified. La Repubblica reports that a cluster of four patients seem to contain patient zero within the group. I am all eyes on this for more news.

Florence seems quieter, but business as usual. Our kids are in school and have been all week. We’re both working and going into our respective offices. The grocery stores are stocked. Pharmacies are open. Hospitals are on alert. This seems normal to me, given the news. What is less usual is the departure of hundreds of American students from Florence. It is not necessarily that they’ll contact the infection – many certainly will, either in Florence or at home in the U.S. The primary concern is the difficulty in isolating and quarantining a student-aged person, or a cluster of infected students. They live in shared housing of 40 to 50 students, or in apartment shares. It would be difficult for Italian hospitals to make space for medical quarantine when Italy (and think about this) has a significant ageing and vulnerable population. On the downside, most travel insurance excludes global pandemics – maybe something to think of the next time you purchase a policy. This is negatively impacting student return travel.

And people, note. Those floppy surgical masks only protect other people from your sneezes and coughs. They won’t protect you from infection. Those lawnmower mask things are also, and of course, not 100% effective. Make sure you’re covering your mouth when you sneeze or cough, do so into your elbow, and review your hand-washing skills. And dispose of dirty tissues toute de suite.

A word on symptoms: sneezing and sniffling are not noted as primary symptoms of this infection. It’s a flu bug; it will start with a headache, body ache, and fever, followed by a persistent, dry cough. From there, if the person’s immune system doesn’t beat it, it progresses to pneumonia. Respiratory failure. That is the cause of death, I suspect, in many of these cases.

Worth stating here again: this virus, like all flu viruses, is hitting the elderly and immuno-compromised much harder than younger and healthier people – 8% mortality in the over-70, and 14.8% in the over-80 crowd. I don’t think (touch wood) many of us would suffer gravely from this infection, but any one of us could easily pass it on to an older or immuno-compromised person who would suffer. There is no vaccine. They are the ones we need to think of and protect first.

Finally, for a little context (I personally like a lot of context), see this current global epidemics list from the WHO. We live on a busy and crowded planet. There’s a lot of stuff going on, always.

Update from Italy: Thursday Evening

A normally bustling and crowded Piazza San Giovanni in the center of Florence is quiet. The rain probably also had something to do with this, but it is still stark. Lone pedicab guy can't even find a fare in the freezing rain.
A normally bustling and crowded Piazza San Giovanni in the center of Florence is quiet. The rain probably also had something to do with this, but it is still stark. Lone pedicab guy can’t even find a fare in the freezing rain.

Florence is quieter than usual, but business – school, work – continue. The tourists have dropped off; I have been told we are down to 60%. In Florence this is notable, when high season happens year round. There is no low season in Florence. I ride my bike through Piazza San Giovanni and Piazza del Duomo multiple times per day, and I do not even need to part the crowd with a bicycle bell, or walk my bike. In fact, there is barely anyone around whom to maneuver.

The news is tough. It makes it seem worse than it is. Things really do feel like business as usual, for locals. But the tourists are gone. This emptiness has a real impact on the city’s economy.

Even more difficult, all around, is the decision of many US-based programs to shutter for the rest of the semester and to send their students home to America, in an abundance of precaution. It is hard to explain to Italians how American universities, with their General Counsel and Offices of Risk Management, make decisions. I suspect in Italy and France, in many places in Europe, these decisions rest with just one person. In any case, Florence typically hosts 8,000 US students a year who are enrolled in credit-bearing programs. But a few thousand of those will be going back to the US now to finish their semesters from there – with remote instruction from Italy – bringing up new issues in tech and Italian faculty, as well as parents who had expected their adult children to Be Having The Time Of Their Life in Florence, only to land back in their old bedroom due to pandemic. Listening to classes on their laptops with headphones. Turning in work on Blackboard. Tough for students. Tough for parents. Tough for faculty and staff based in Italy. Tough for the Italian economy. I get it.

Cases in Italy are now at 650. This virus is gonna roll round the world, y’all. Most of us will be just fine. But I continue to be very concerned about older populations and the vulnerable, immuno-compromised.

If you’re under 70, guidance seems to emphasize washing hands like a midwife and sneezing into your elbow. Over 70? Stay away from anyone symptomatic.

Symptoms are much like regular flu: fever, body ache, headache, and a quick, persistent cough at onset. Symptoms do not include sniffling, runny nose, or barfing, so … that’s helpful. Since our eight-year-old was barfing into a trash can from the sofa last month. I feel confident it was the normal flu. Of course no Covid-19 was even near Italy at the time. In any case, that wasn’t any fun either, since afterward he said, “Mamma? When I had that fever everything felt…. sideways.”

I am keeping an eye on EU news. UK seems ready to flip out. Other member countries do not yet seem to be proactively testing, and hence their reporting numbers may be well underreported.

Still super curious about the Italian index patient up north. I need some news about that, stat.

Update from Italy: Wednesday Afternoon

Photo by Brecht Denil on Unsplash.

An epidemic is like a web, though perhaps less symmetrical than this one. There are contacts and transmissions, points of encounter as the web grows. Florence has now confirmed 3 cases of Covid-19. (These are separate from the two tourists who flew through Florence early in February, and who have since made complete recoveries.)

Italy prohibited extracurricular school field trips late last week; the interdiction includes all academic programs, including study abroad programs. Sure enough, yesterday a well-doctored graphic started making the WhatsApp rounds that all schools in Italy would be closed. It was not true, as easily verified on the Italian Interior Ministry website.

Chatting a friend today who made the point, isn’t the virus now present in every European country? Yes, quite possibly, air travel and global mobility being what they are. Italy, as an example, has tested more than 8000 people – not just people known to have traveled and and returned from China in the centers of outbreak, but also everyone with whom they came into contact. France, about 400 tested, mostly the schoolchildren returning from the field trip to northwestern Italy. Higher testing, greater numbers. It’s basic stats. A couple of weeks ago China lowered the bar to confirm Covid-19, and the number of cases spiked the following day. But then they went down, and the news was, cases went down!

I did a little more reading about the incubation period. It’s about 3 to 6 days. The WHO stated that the very long incubation periods initially registered may have in fact reflected a subsequent exposure. The current official estimated incubation range is 2-14 days. The WHO has also estimated that evidence exists for human-to-human transmission has occurred among close contacts since the middle of December 2019. I am also reading up on transmission by asymptomatic carriers. This occurrence is new/unusual, as conventional wisdom holds that humans are contagious when symptomatic. But that does not seem to always be the case with this virus, making transmission hard to track – or avoid.

All of the EU is on this ride, and the US will be on it soon. Again, my main concerns here are that the majority of healthy people who will contract the virus will be carriers and transmitters of the virus to vulnerable populations, that healthcare facilities will be flooded, and true positives will facilitate cross-contamination. (This is why China built a few new hospitals dedicated to the crisis). A vaccine is 12-18 months away, at a minimum. (Maybe this will make some people rethink their opposition to vaccines and their reluctance to vaccinate.)

More news will be coming soon – this is going to be a heavy week.

Update from Italy: Covid-19 (Coronavirus)

Map credit: http://warnewsupdates.blogspot.com/2020/02/covid-19-outbreak-in-italy-news-updates_25.html

As my readers know, I live and work in Florence. My husband and I live here with our two children. I will resume posting here to keep my global friends and family up to date with our Italian news on the ground.

Two months ago, the word coronavirus wasn’t even coined, as far as we know. February has been a bit of a news ride, the headlines tugging at the back of the mind from China and the Diamond Princess cruise ship. Two Chinese nationals passed through Florence as tourists in early February; they were hospitalized in Rome with a third, and all have recovered. But now Italy feels like it may be reaching a tipping point.

No one knows how the outbreak (focolaio) began in northern Italy. What is known is that it became the nexus of the outbreak in the country, and been spreading. Lombardy and the Veneto are the most impacted, but cases are popping up in other regions of Italy, as well as in places where infected Italians have traveled – Austria, Croatia, the Canary Islands. The web of infection is expanding. I was kindly pointed by a French friend to a website that aggregates facts about Covid-19. She’s a mom in Paris staying abreast of quarantines for French schoolchildren who have returned from their vacances de printemps in Lombardy and Piedmont in far northwestern Italy. I have been checking and refreshing the website often as their facts and figure counting seem to be sober and reliable.

My layperson’s assessment of the situation here thus far: healthy younger people (say, under 50) who contract the virus are hospitalized and make a recovery. No fatalities have been reported in children under 9. However, it seems that older people (>60) and immuno-compromised people (upper respiratory, chemo treatment, cardiac crises) who contract the virus succumb more quickly. Is it because of the virulence of the virus? Were they exposed at a hospital where they were receiving treatment for their existing condition or illness? This is very likely why China built those dedicated outbreak hospitals (nothing similar in Italy in that time frame would even be possible, btw.) I wonder how much contamination is happening at hospitals. The long incubation period (up to three weeks) and asymptomatic carriers make transmission very hard to track.

I am, for now, less worried about my health and that of my family. I am more concerned that globally, millions will become carriers of a virus that proves very grave indeed for older and more vulnerable populations. I am also concerned about the unconfirmed news in circulation which seems to pop up and mutate like a separate virus itself.

Tourism in Florence is about half of what it normally is, and we are in low season here. I rode my bike through Piazza San Giovanni yesterday, in front of the baptistery, and it was fairly deserted. A lone schoolgroup was in Piazza Santissima Annunziata last night. Riding my bike close to them, I heard them speaking Spanish. They are not covered by the government injunction on school fieldtrips.

I am choosing my words carefully; I am not given to panic. I am so curious as to how the outbreak began up north in Codogno.

I give you this Atlantic article for context.

More to come. Stay tuned; March is going to be newsy.