Why aren't cases in Italy going down?

[Flowersforpowers]

Genuine question. Italy went in to lockdown over two weeks ago (bars and restaurants closed on 11 March). Everything I read seems to be based on a maximum two week incubation period for the vast majority of people. So why aren't the numbers of cases starting to slow/plateau/go down? Should we be concerned that it means lockdown doesn't work? Or is it just too early to tell?

I think they are?
www.worldometers.info/coronavirus/country/italy/

If you look at the new daily cases chart...for the last four days the trajectory is down.

Although some one will probably be along to say I’m wrong...

As was pointed out to me on another thread the actual illness itself lasts for a couple of weeks and there are various points people would present to hospital. People will still only just be starting to show symptoms in some cases.

Because lockdown is a populist measure that doesn't actually work. We need to focus on testing and contact tracing like South Korea but that doesn't sound so exciting.

I don't think you can really read much into the levels of reported cases, as everyone's testing rates are pretty inconsistent.

Death rates seem to be levelling off and these track 2-3 weeks behind infections afaik.

Don't forget they locked down the north of the country first, it was spreading for longer in the south and the numbers there are probably still catching up.

StormyClouds I just can't see contact tracing working with something THIS infectious. Tracking down everyone who was in a particular Tube carriage on Tuesday morning, say...

Maybe if we'd caught it really, really early, but that ship has very much sailed.

Because people raced down to the south to escape the lockdown in the north and took it with them. Now the repercussions are being seen in the south. You can pretty much follow this virus around by the death rate.

@StormyClouds

South Korea has been efficient at contact tracing because they have not relied on people's memories of where they have been and who they came into contact with. Instead they have laws in place to use people's phone data.

Would you like to swap your right to privacy for the ability to deal with a pandemic that nobody could predict would happen.

South Koreans appear to be very obedient people and socially considerate given the high use of face masks if they have a cold or similar, or think others may have.

Given the awful actions of a significant amount of people in the UK crowding together to get into and strip supermarket shelves and the thoughtlessness of those out and about last weekend just because it was sunny, ramping up testing will not make a difference.

If people feel well but are asymptomatic, too many people will not change their ways unless penalised into doing so. That's the increasing nature of our society unfortunately.

It’s worth noting that cases in Lombardy appear to be dropping but cases around Naples are rising, so there’s some regionality here too...

I think situation would have been worse if there was no lockdown in Italy (Mind..I’m not claiming to be an epidemiologist)

@SoloSolow

We have already given up the right to leave our houses. South Korea does not have a lockdown and citizens are allowed to go about their lives as they please

@StormyClouds I do agree that people seem to be desperate for lockdown, the more extreme the better! I don’t know the science of different approaches but Im interested.

I wonder if the particularly demography of Italy means Italian lockdown was a bit dangerous. They shut the universities in the north and people then went home to the south when they were more likely to live with their elderly grandparents thus younger people who would have recovered well if they had just spread amongst each other have spread it to the more vulnerable population because Italian social structures mean they are more likely to live together.

That does not mean lockdowns do or do not work but there were elements that were perhaps not thought out that I think the U.K. government has thought about eg keeping schools open for key worker childcare so that they are not left with grandparents which is more risky than them being at school.

Only time will tell of course but I spent the longer term narrative will be more complicated than lockdowns working or not working but depends on the specific of the societies involved and what a “lockdown” means in practice.

Just over 1% of Italian families live with the grandparents compared to 1.3 million British families.
Or, virtually the same.

Italy hasn't yet reached peak contagion (expected Easter week give or take) and peak number of deaths will come after that.

As pp said, the increase in contagion is slowing though, as a result of the lockdown restrictions.

Also true that more cases are now coming to light in the south due to the mass exodus on the night of the 7th from Milan. These weren't students by and large, universities had closed about a week or so before. Only the hotspot towns and their immediate vicinities were locked down earlier and only Lombardia was locked down on the 8/3 (leaked news of which prompted the exodus)

Italian children are not being left with their grandparents- they're at home with their parents who aren't working obviously because of the lockdown. The Italian list of keyworkers is very short: frontline health, people who produce or sell food or medicine, law and order. Very few families will have both parents working right now.

It’s worth noting that cases in Lombardy appear to be dropping but cases around Naples are rising, so there’s some regionality here too...

Probably because of what BluePheasant said -northerners fled south.

I don't know but two thoughts are that compliance may not have been high enough, especially at the beginning. Also I think the lag would be more than two weeks because it would have to cover not just the potential incubation but the time it takes to develop severe illness and to die, including time on hospital for some. So could be a further lag of around three weeks. Bearing in mind that the incubation period is often shorter than 14 days you would think there would be a bit of improvement after four to five weeks.

Because lockdown is a populist measure that doesn't actually work.

It worked in China. If we are “locked down” and can’t infect each other, it will work!

In terms of numbers.... It takes an average of 5 days to show symptoms, but another week or so for the illness to progress to the point of requiring hospitalisation (which is when testing would occur). On the basis that those infected at the point of lockdown would be passing it to their family, who in turn would be symptomatic after a further 5 days on average, it is unfortunately to be expected that identified infections will not drop for 2-3 weeks, and it’s about that long since Italy went into lockdown. I’d expect numbers of new infections to drop soon though, as they did in Wuhan. There will be a lag of a week or so before deaths fall.

We have already given up the right to leave our houses. South Korea does not have a lockdown and citizens are allowed to go about their lives as they please

South Korea were all over it far quicker, so they could so this.... even they haven’t sorted it entirely though.

Because lockdown is a populist measure that doesn't actually work.

Why?

It wasn't lockdown that worked in China, it was rigorous testing and quarantine of possibly affected people. They were incredibly strict about quarantine.

A healthy person might take 3-4 weeks to be so ill they need hospital treatment. It will take a while for numbers to peak.

It's only a temporary fix anyway, it will just reappear once lockdown lifts

If everyone caught it at the same time then it would be done in two weeks. However diseases are transmitted from person to person and as one person can on average infect 5 others within 3 weeks they will have passed it on to 100s. So clearly as it progresses it could be months and months before lock down can be repealed. Its progressing through a whole population not hitting everyone at once and the same will happen here. Be prepared for the long haul.

Some useful thoughts, thanks all. Particularly on having to add potentially a week to the 14 day timeline for the illness to be serious enough to be tested/reach hospital and therefore show up in figures.

The rate of increase in cases is going down over the last few days

Aggressive, massive EARLY testing and isolating along with less.stringent social distancing ( eg banning big events , working feom.home if possible but not closing schools or businesses ) does work and has worked in S Korea , Singapore, Hong Kong etc

However if you don't do the former ) aggressive testing and isolating) well enough and early enough , then you have to implement far more stringent social isolating measures to control things .

I expect the rate of increase in numbers in Italy to continue to fall over the next week.

It's only a temporary fix anyway, it will just reappear once lockdown lifts

Surely we have learnt that at this point we will need to implement mass and aggressive and fast testing and isolating, combined with less stringent social isolating measures until we have an effective anti viral treatment or a vaccine

And what would you be basing that assumption on? Do we seem to be learning much so far? Did we learn much from China and Italy? Have we got round to ordering that equipment yet or did we miss another email? (Is there any money left?)

If lockdown is working in Italy then I would expect from tomorrow that the death rate my go down albeit slowly. I’m going on the assumption that people show symptoms within 5 days. And if it’s critical then it could be up to 14 days in ICU (from previous reports in Italy) So 19 days. The 19th day is today I believe. I’m praying for Italy. It’s a terrible situation and I think a continuous dip there at least gives them some light at the end of the tunnel