No Name, Perfect storm: Lombardy's virus disaster is lesson for world

[Image]( EMAIL}/redirect Posted on Sunday, April 26th, 2020 By Nicole Winfield, Associated Press ROME (AP) — As Italy prepares to emerge from the West’s first and most extensive coronavirus lockdown, it is increasingly clear that something went terribly wrong in Lombardy, the hardest-hit region in Europe’s hardest-hit country. Italy had the bad luck of being the first Western country to be slammed by the outbreak, and its official total of 26,000 fatalities lags behind only the U.S. in the global death toll. Italy's first homegrown case was recorded Feb. 21, at a time when the World Health Organization was still insisting the virus was “containable” and not nearly as infectious as the flu. But there also is evidence that demographics and health care deficiencies collided with political and business interests to expose Lombardy’s 10 million people to COVID-19 in ways unseen anywhere else, particularly the most vulnerable in nursing homes. Virologists and epidemiologists say what went wrong there will be studied for years, given how the outbreak overwhelmed a medical system long considered one of Europe’s best, while in neighboring Veneto, the impact was significantly more controlled. Prosecutors, meanwhile, are deciding whether to lay any criminal blame for the hundreds of dead in nursing homes, many of whom don’t even figure into Lombardy’s official death toll of 13,269, half of Italy’s total. By contrast, Lombardy’s front-line doctors and nurses are being hailed as heroes f or risking their lives to treat the sick under extraordinary levels of stress, exhaustion, isolation and fear. One WHO official said it was a “miracle” they saved as many as they did. Here’s a look at the perfect storm of what went wrong in Lombardy, based on interviews with doctors, union representatives, mayors and virologists, as well as reports from the Superior Institute of Health, national statistics agency ISTAT and the Organization for Economic Cooperation and Development, which advises developed economies on policy. EMAIL}/redirect EMAIL}/redirect CAUGHT UNPREPARED Italy was the first European country to halt all air traffic with China on Jan. 31, and even put scanners in airports to check arrivals for fever. But by Jan. 31, it was already too late. Epidemiologists now say the virus had been circulating widely in Lombardy since early January, if not before. Doctors treating pneumonia in January and February didn’t know it was the coronavirus, since the symptoms were so similar and the virus was still believed to be largely confined to China. Even after Italy registered its first homegrown case Feb. 21, doctors didn’t understand the unusual way COVID-19 could present itself, with some patients experiencing a rapid decline in their ability to breathe. “After a phase of stabilization, many deteriorated quickly. This was clinical information we didn’t have,” said Dr. Maurizio Marvisi, a pneumologist at a private clinic in hard-hit Cremona. “There was practically nothing in the medical literature.” Because Lombardy’s intensive care units were already filling up within days of Italy’s first cases, many primary care physicians tried to treat and monitor patients at home. Some put them on supplemental oxygen, commonly used for home cases in Italy. That strategy proved deadly, and many died at home or soon after hospitalization, having waited too long to call an ambulance. Reliance on home care “will probably be the determining factor of why we have such a high mortality rate in Italy," Marivi said. EMAIL}/redirect EMAIL}/redirect Italy was forced to use home care in part because of its low ICU capacity: After years of budget cuts, Italy entered the crisis with 8.6 ICU beds per 100,000 people, well below the OECD average of 15.9 and a fraction of Germany’s 33.9, the group said. As a result, primary care physicians became the front-line filter of virus patients, an army of mostly self-employed practitioners who work outside Italy's regional hospital system. Since only those with strong symptoms were being tested because Lombardy's labs couldn't process more, these family doctors didn't know if they themselves were infected, much less their patients. With so little clinical information available, doctors also had no guidelines on when to admit patients or refer them to specialists. And being outside the hospital system, they didn’t have the same access to protective masks and equipment. “The region was extremely behind in giving us protective equipment and it was inadequate, because the first time, they gave us 10 surgical masks and gloves,” said Dr. Laura Turetta in the city of Varese. “Obviously for our close contact with patients, it wasn’t the correct way to protect ourselves.” The Lombardy doctors' association issued a blistering letter April 7 to regional authorities listing seven “errors" in their handling of the crisis, key among them the lack of testing for medical personnel, the lack of protective equipment and the lack of data about the contagion. The regional government and civil protection agency defended its efforts, but acknowledged that Italy was dependent on imports and donations of protective equipment and simply didn't have enough to go around. Some 20,000 Italian medical personnel have been infected and 150 doctors have died. LOST WEEKS Two days after registering Italy's first case in the province of Lodi, sparking a quarantine in 10 towns, another positive case was registered more than an hour’s drive away in Alzano in Bergamo province. Whereas the emergency room of the Lodi-area hospital was closed, the Alzano ER reopened after a few hours of cleaning, becoming a main source of contagion. Internal documents cited by Italian newspapers indicate the handful of serious pneumonia cases the Alzano hospital saw as early as Feb. 12 were likely COVID-19. At the time, Italy's health ministry recommended tests only for people who had been to China or been in contact with a suspected or confirmed positive case. By March 2, the Superior Institute of Health recommended Alzano and nearby Nembro be sealed off as the towns in Lodi had been. But political authorities never implemented the quarantine recommendation there, allowing the infection to spread for a second week until all the Lombardy region was locked down March 7. “The army was there, prepared to do a total closure, and if it had been done immediately maybe they could have stopped the contagion in the rest of Lombardy,” said Dr. Guido Marinoni, head of the association of doctors in Bergamo. “This wasn’t done, and they took softer measures in all of Lombardy, and this allowed for the spread.” Asked why he didn’t seal off Bergamo sooner, Premier Giuseppe Conte argued the regional government could have done so on its own. Lombardy’s governor, Atillio Fontana, shot back that any mistake ‘’was made by both. I don’t think that there was blame in this situation.’’ Lombardy has one-sixth of Italy’s 60 million people and is the most densely populated region, home to the business capital in Milan and the country's industrial heartland. Lombardy also has more people over 65 than any other Italian region, as well as 20% of Italy’s nursing homes, a demographic time bomb for COVID-19 infections. “Clearly, with the benefit of hindsight, we should have done a total shutdown in Lombardy, everyone at home and no one moves,” said Andrea Crisanti, a microbiologist and virologist advising the Veneto regional government. But he acknowledged how hard that was, given Lombardy’s outsize role in the Italian economy, which even before the pandemic was heading toward a recession. “Probably for political reasons, it wasn’t done,” he told reporters. INDUSTRIAL LOBBYING Unions and mayors of some of Lombardy’s hardest hit cities now say the country’s main industrial lobby group, Confindustria, exerted enormous pressure to resist lockdowns and production shutdowns because the economic cost would be too great in a region responsible for 21% of Italy’s GDP. On Feb. 28, a week into the outbreak and well after more than 100 cases were registered in Bergamo, the province's branch of Confindustria’ launched an English-language social media campaign #Bergamoisrunning, to reassure clients. It insisted the outbreak was no worse than elsewhere, that the “misleading sensation” of its high number of infections was due to aggressive testing, and that production in steel mills and other industries was unaffected. Cofindustria launched its own campaign in the larger Lombardy region, echoing that message, #Yeswework. Milan's mayor proclaimed that “Milan doesn’t stop.” At the time, Confindustria Lombardy chief Marco Bonometti acknowledged the “drastic measures” needed in Lodi but sought to lower the sense of alarm. “We have to let people know they can go back to life as it was, while safeguarding their health," he said. Even after Rome locked down all of Lombardy March 7, it allowed factories to stay open, sparking strikes from workers worried their health was being sacrificed to keep Italy’s industrial engine rolling. “It was a huge error. They should have taken the example where the first cluster was found," said Giambattista Morali of the metalworkers’ union in the Bergamo town of Dalmine. “Keeping factories open didn’t help the situation; obviously it worsened it.” Eventually, all but essential production was shut down March 26. Confindustria’s national president, Carlo Bonomi, has been urging that industry be reopened, but in safe way. “The paradigm has changed,” Bonomi said on RAI state television. “We can’t make Italians secure if we don’t reopen factories. But how do we make factories safe to secure Italians?” It's a tough sell, given Lombardy is still adding an average of 950 infections daily, while other regions add from a few dozen to 500 apiece, with most new infections registered in nursing homes. Italy is set to begin a gradual reopening May 4, leading with regions farther south where the outbreak is more under control. Lombardy probably will be last to fully open, with its 72,000 confirmed cases, 70% of Italy's total, and estimates that the real number could be 10 times that. A COSTLY FIELD HOSPITAL Perhaps no initiative better illustrates Italy's confused coronavirus response than the 200-bed field hospital built in less than two weeks on the grounds of Milan’s convention center. The hospital was unveiled to great fanfare on March 31, the fruit of a 21 million euro ($23 million) fundraising campaign headed by Lombardy’s governor, a member of the right-wing League party, to try to ease pressure on regional ICUs, which on that date were near capacity at 1,324 patients. The national civil protection agency opposed the plan, arguing it could never equip it with ventilators or personnel in time. Instead, the agency, which reports to the rival 5-Star-Democratic government in Rome, preferred smaller field units set up outside hospitals and a program to move critical patients elsewhere. In the end, the Milan field hospital was barely used, treating only a few dozen patients. Since it opened, Lombardy has seen pressure on its ICUs fall considerably, with just over 700 people needing intensive care today. Fontana, the governor, defended the decision and said he would do it again, telling Radio 24: “We had to ... prepare a dam in case the epidemic overcame the embankment.” NURSING HOME ‘MASSACRE’ While the regional government was focused on the field hospital and scrambling to find ICU beds, its testing capacity lagged and Lombardy’s nursing homes were in many ways left to fend for themselves. Hundreds of elderly have died in Lombardy and across Italy in what one WHO official has termed a “massacre” of those most vulnerable to the virus. Prosecutors are investigating dozens of nursing homes, as well as measures taken by local health authorities and the regional governments that may have worsened the problem. Lombardy has more nursing homes than any other region, housing at least 24,000 elderly, and it registered more dead at those facilities than others too. Of the 3,045 deaths from Feb. 1 to April 15 in the region, 1,625 were either positive for the virus or showed its symptoms, according to preliminary results from a survey by the Superior Institute of Health. Of particular attention to prosecutors was the March 8 decision by the regional government to allow recovering COVID-19 patients to be put in nursing homes to free up hospital beds. The region says it required the homes guarantee the patients would be isolated, but it's not clear who was responsible to ensure that or whether anyone checked. Even before that, staff at some homes said management prevented them from wearing masks for fear of scaring residents. A March 30 regional decree, again aimed at easing pressure on Lombardy's ICUs, told nursing home directors to not hospitalize sick residents over 75 if they had other health problems. The decree said it was “opportune to treat them in the same facility to avoid further risks of decline in transport or during the wait in the emergency room.” For the elderly at a nursing home in Nembro, one of the hardest-hit towns in Bergamo province, the decree amounted to a death warrant. But it wasn't the first or only one that gave the home's managers the sense that they were being abandoned. When management proactively barred visitors on Feb. 24 to try to guard residents and staff from infection, local health authorities responded by threatening sanctions and a loss of accreditation for cutting off family visits, said the facility's new director, Valerio Poloni. In the end, 37 of the 87 residents died in February and March. Its doctor, as well as Poloni's predecessor as director, also tested positive, were hospitalized and died. A nursing home resident couldn't get admitted to the hospital in late February because the ER was too crowded. The nursing home's health director, Barbara Codalli, said she was told to use her existing resources. “The patient returned a few hours later, and a few days later the patient died," she told La7 television. To date, none of the surviving residents has been tested. Poloni said tests were expected to begin in a few days. Two more residents died so far in April, but the situation seems under control. ‘’We are tranquil,’’ he said. ___ Colleen Barry in Soave, Italy, contributed. EMAIL}/redirect EMAIL}/redirect To get Exclusive Offers make sure you grab your cellphone (which you are probably doing right now) and join our VIP text messaging list (standard text and messaging rates may apply)to make it even easier, if you are on your cell phone now click this Button Below: [SIGN ME UP NOW]( © 2019 PTE.la PTE, LLC (publisher of PTE.la) is NOT registered as an investment adviser nor a broker/dealer with either the U. S. Securities & Exchange Commission or any state securities regulatory authority. Users of this website are advised that all information presented on this website is solely for informational purposes, is not intended to be used as a personalized investment recommendation, and is not attuned to any specific portfolio or to any user's particular investment needs or objectives. Past performance is NOT indicative of future results. Furthermore, such information is not to be construed as an offer to sell or the solicitation of an offer to buy, nor is it to be construed as a recommendation to buy, hold or sell (short or otherwise) any security. All users of this website must determine for themselves what specific investments to make or not make and are urged to consult with their own independent financial advisors with respect to any investment decision. The reader bears responsibility for his/her own investment research and decisions, should seek the advice of a qualified securities professional before making any investment, and investigate and fully understand any and all risks before investing. All opinions, analyses and information included on this website are based on sources believed to be reliable and written in good faith, but should be independently verified, and no representation or warranty of any kind, express or implied, is made, including but not limited to any representation or warranty concerning accuracy, completeness, correctness, timeliness or appropriateness. In addition, we undertake no responsibility to notify such opinions, analyses or information or to keep such opinions, analyses or information current. Also be aware that owners, employees and writers of and for PTE, LLC may have long or short positions in securities that may be discussed on this website or newsletter. Past results are not indicative of future profits. This table is accurate, though not every trade is represented. Profits and losses reported are simulated figures from virtual simulated portfolios. We are engaged in the business of advertising and promoting companies for monetary compensation. All content in our releases is for informational purposes only and should not be construed as an offer or solicitation of an offer to buy or sell securities. Neither the information presented nor any statement or expression of opinion, or any other matter herein, directly or indirectly constitutes a solicitation of the purchase or sale of any securities. PTE.la’s sponsored advertisements do not purport to provide an analysis of any company’s financial position, operations or prospects and this is not to be construed as are commendation by PTE.la or an offer or solicitation to buy or sell any security. Neither the owner of PTE.la nor any of its members, officers, directors, contractors or employees is licensed broker-dealers, account representatives, market makers, investment bankers, investment advisors, analyst or underwriters. Investing in securities, including the securities of those companies profiled or discussed on this website is for individuals tolerant of high risks. Viewers should always consult with alicensed securities professional before purchasing or selling any securities of companies profiled or discussed in our releases. It is possible that a viewer’s entire investment may be lost or impaired due to the speculative nature of the companies profiled. Remember, never invest in any security of a company profiled or discussed in a release or on our website unless you can afford to lose your entire investment. Also, investing in micro-cap securities is highly speculative and carries an extremely high degree of risk. To review our complete disclaimer and additional information, please visit . PTE.la makes no recommendation that the securities of the companies profiled or discussed in our releases or on our website should be purchased, sold or held by investors. PTE.la is owned and operated by PTE LLC. PTE LLC has not been compensated for this specific email, we do have advertisements in this email that we get paid if you click one of the ads (we have not investigated any of the advertisements). Any compensation received by PTE LLC constitutes a conflict of interest as to our ability to remain objective in our communication regarding the profiled company. A third party of PTE LLC may have shares and may liquidate, which may negatively affect the stock price. PTE LLC affiliates may at any time have a position in the securities mentioned herein and may increase or decrease such positions without notice which will negatively affect the market. Some of the content in this release contains forward - looking information within the meaning of Section 27 A of the Securities Act of 1 9 9 3 and Section 21 E of the Securities Exchange Act of 1 9 3 4 including statements regarding expected continual growth of the profiled company and the value of its securities. In accordance with the safe harbor provisions of the Private Securities Litigation Reform Act of 1995 it is hereby noted that statements contained herein that look forward in time which include everything other than historical information, involve risk and uncertainties that may affect a company's actual results of operation. A company's actual performance could greatly differ from those described in any forward - looking statements or announcements mentioned in this release. Factors that should be considered that could cause actual results to differ include: the size and growth of the market for the company's products; the company's ability to fund its capital requirements in the near term and in the long term; pricing pressures; unforeseen and/or unexpected circumstances in happenings; etc. and the risk factors and other factors set forth in the company’s filings with the Securities and Exchange Commission. However, acompany’s past performance does not guarantee future results. Generally, the information regarding a company profiled is provided from public sources which we believe to be reliable but is not guaranteed by us as being accurate. Further specific financial information, filings and disclosures as well as general investor information about the profiled company, advice to investors and other investor resources are available at the Securities and Exchange Commission (“SEC”) website www.sec.gov and the Financial Industry Regulatory Authority (“FINRA”) website at www.finra.org. Any investment should be made only after consulting with a qualified investment advisor and reviewing the publicly available financial statement and other information about the company profiled and verifying that the investment is appropriate and suitable. PTE.la makes no representations, warranties or guarantees as to the accuracy or completeness of the information provided or discussed. Viewers should not rely solely on the information obtained in this release or on our website. PTE Team 9 Downing street Newark NJ 07105 USA [Unsubscribe]( | [Change Subscriber Options](