Italy races to contain COVID-19 outbreak

ASOLO, Italy — With 821 confirmed cases ofCOVID-19截至周五，意大利是全球第三次受影响的国家，并在欧洲看到了最多的感染。最多的案件是在伦巴第北部地区和威尼托 - 意大利经济的“发动机”。迄今为止，死亡人数已上涨至21人，大部分高级公民发生在70年以上，拥有预先存在的条件。

On Feb. 22, through a special government ordinance, 10 municipalities in Lombardy and one in Veneto, where clusters of the infection were identified, were put on lockdown. No one is permitted to enter or leave the areas in question, self-isolation is recommended and schools, museums, restaurants and shops are closed, except for grocery stores and pharmacies. Public and private events, including religious ceremonies, are suspended. All citizens have been submitted to COVID-19 testing.

2月23日，卫生部将这些紧急措施延长了伦巴第和威尼托的整个地区，后来到皮埃蒙特，利古里亚和艾米利亚罗马纳，遏制病毒的传播。

对经济的影响

大量相互矛盾的信息,conflicting opinions, fueled by television debates and social media, has been spreading anxiety and confusion among the Italian population. Fearing a quarantine, people have been stockpiling food, emptying grocery stores’ shelves. In usually crowded cities such as Venice and Milan, streets are empty and public transportation, shops, restaurants and cafes are deserted.

“The COVID-19 outbreak已被宣布为推荐了一个公共卫生应对世界卫生组织和遏制战略的国际担忧的紧急情况。然而，在意大利，我在其他地方没有看到过度反应，“Giorgio.佩ù，MD，FESCMID那former president of the European Society of Virology, said in an interview.

He expressed concern for the social and economic consequences of containment measures.

“政府限制正在推动我们的经济到停滞不前。意大利正在失去其GDP的一部分，每天储存50亿欧元，每天都在股市上丢失，旅游业在膝盖上，“他说。“出于政治原因，害怕以政治上不正确的方式行事，当他们应该在爆发开始时没有申请遏制措施，现在我们都在为封面进行追求，结果是其他国家正在推动我们隔离中。”

对意大利和来自意大利的旅行限制的国家数量正在增长，并且由于假期预订取消，局势已经造成了2亿欧元的酒店和旅行社。

让专家说话

根据Palù，有三种可能的解释为什么意大利是第一个，到目前为止，欧洲国家的爆发已经注册。

“First, it might be because we are carrying out more specific virus tests on more people,” he said. “Second, because we have been less efficient than other nations in detecting the first carriers of the infection while they were crossing our borders. Third, it could be a stochastic phenomenon, in that it arrived here by chance.

“然而，这个第三个假设似乎是不可能的。德国有一个十倍的经济关系，而不是与中国的关系，并且它们似乎不寻常，他们只有大约20例。只有使用Sentinel系统，许多Covid-19案件可能会误认为是流感，因为可能的症状范围从零到间质性肺炎。“

Pal Ha说，媒体覆盖范围有助于意大利误导和恐惧的蔓延。

“News is blown all out of proportion, with everybody feeling entitled to give ‘expert’ opinions,” he said. “When dealing with information that has an impact on public health, you cannot give the floor to sociologists, political scientists and the ‘man in the street.’

“让专家说话。与专家，我的意思是第一位真正的科学家，然后是专门的记者和政治决策者。我听说过太多所谓的病毒学家，卫生师和流行病学家，他们从未在同行评审病毒学期刊中发表过一个科学论文。“

高透射性，低致死性

Covid-19的致命性似乎低于SARS或MERS，这也是由冠状病毒引起的。从研究中发布的研究结果新英格兰医学杂志on Friday showed the case fatality rate was 1.4% among more than 1,000 Chinese patients with laboratory-confirmed COVID-19.

佩ùsaid a precise percentage is difficult to calculate because high concentrations of the virus are found in asymptomatic subjects. Thus, the actual number of infected people may be much higher than is known.

“我们知道分数器，这是发展症状的人数，但不是确切的分母，因为我们不知道有多少人签约病毒，已经开发出了特异性病毒抗体，并保持了无症状，”他说。“如果分母增长，并且死亡率和事件案件的数量甚至降低，那么我们可能最终发现我们的担忧被夸大了。”

Covid-19是由新的冠状病毒引起的，其对人类主要宿主细胞受体具有高亲和力的血管紧张素转换酶2（ACE2）。

“Ace2也是SARS的受体，但Covid-19的结合亲和力越高，这解释了新病毒的较高传播性，”Pal Hab表示。

在科学证据中有一些保证，即病毒越传播，致命的病毒就越少。这就是为什么患者为患者零的捕捞是一个不可能的任务，而患者零时则迅速发现更致命的SARS。

“低致死的病毒难以追踪，并且往往与宿主生存，逐渐失去毒力。可能，Covid-19可能像其他冠状病毒一样转化，在人类的内源性病毒中，“Palù说。

'病毒没有界限'

Hospitals have adopted strict protocols for triage, admission and care of patients with COVID-19, and have intensified protection measures for the safety of personnel.

Giorgio.Zanardo.，MD，head of the ICU at a hospital in Castelfranco Veneto, said the situation is under control there.

“我们有一些未经证实的疑似案件。他们中的两个仍在重症监护，但测试是消极的，“他说。

他补充说，在威尼托地区死亡 - “比我们每年的受害者少得多，我们每年都会看到。”

一个76岁的女性受害者之一，在附近的特雷维索镇住院。感受到她的十名照顾她的医务人员为感染进行了阳性，并在家中自信，到目前为止没有任何症状。

“这是第一个案例之一;患者被照顾好像我们通常与肺炎一样。现在我们的守卫已经起来了，我们有关于如何保护自己的严格规则，“Zanardo说。

The geriatric ward, where the patient stayed, is now closed due to lack of personnel and other hospitals are currently facing the challenges of an emergency that disrupts the normal routine.

然而，威尼托地区有一个有组织的医疗保健系统，这在紧急情况下保持了效率。鼓励具有流感样症状的人们呼叫紧急号码，并在家进行预先定产。可疑病例在单独的区域中处理，并在特异性症状和症状的患者中进行测试。

“起初有一个过度使用的Covid-19测试。我们已经测试了被检疫的城镇的整个人口，也测试了许多涉嫌患有这种疾病的人，“Zanardo说。“不幸的是，一个结果是我们的实验室已经拥挤，无法在合理的时间内提供结果。现在我们在特定情况下进行测试，并且需要两个连续的正面测试来确认诊断。“

“Containing the infection is a key priority. Other countries will experience outbreaks, because viruses know no boundaries. However, irrational fears should also be contained, and we should not forget that we are still very far from the death toll of influenza, which is on average 8,000 people per year in Italy,” Zanardo concluded. –B.Y Michela.阳光镜

Reference:

关华NEnglJ Med。2020; DOI：10.1056 / NEJMOA2002032。

想要查询更多的信息：

Giorgio.佩ù，MD，FESCMID那professor of microbiology and virology and head of the molecular medicine department at Padova University and adjunct professor at Temple University in Philadelphia, can be reached atgiorgio.palu@unipd.it。

Giorgio.Zanardo.，MD，head of the ICU at Castelfranco City Hospital, can be reached atgiorgio.zanardo@iov.veneto.it。

Disclosures:Pal Hand和Zanardo报告没有相关的财务披露。