Lessons learned from Italy’s COVID-19 response; as well, Harvard epidemiologist suggests some nursing home residents be moved out

A previous post is entitled:

COVID-19 testing is an absolute priority – including of asymptomatic individuals; not much testing is happening in Ontario right now

April 2, 2020 CBC article highlights lessons learned from Italy’s response to COVID-19

An April 2, 2019 CBC article by Megan Williams is entitled: “The lessons Italy has learned about its COVID-19 outbreak could help the rest of the world”

The subhead reads: “Nature of hospital admissions and testing policy among ‘mistakes’ in country’s coronavirus response.”

An excerpt reads:

Only carefully conducted epidemiological studies will bring to light exactly how and why COVID-19 took off in northern Italy with such speed. But in the midst of the emergency, experts say there are already lessons to be gleaned from Italy’s fatal errors — and urgent messages for other parts of the world.

“The biggest mistake we made was to admit patients infected with COVID-19 into hospitals throughout the region,” said Carlo Borghetti, the vice-premier of Lombardy, an economically crucial region with a population of 10 million.

“We should have immediately set up separate structures exclusively for people sick with coronavirus. I recommend the rest of the world do this, to not send COVID patients into health-care facilities that are still uninfected.”

March 27, 2020 Harvard Business Review overview of lessons learned from Italy

A March 27, 2020 Harvard Business Review article is entitled: “Lessons from Italy’s Response to Coronavirus.”

An excerpt reads:

Lombardy, one Europe’s wealthiest and most productive areas, has been disproportionately hit by Covid-19. As of March 26, it held the grim record of nearly 35,000 novel coronavirus cases and 5,000 deaths in a population of 10 million. Veneto, by contrast, fared significantly better, with 7,000 cases and 287 deaths in a population of 5 million, despite experiencing sustained community spread early on.

The trajectories of these two regions have been shaped by a multitude of factors outside the control of policymakers, including Lombardy’s greater population density and higher number of cases when the crisis erupted. But it’s becoming increasingly apparent that different public health choices made early in the cycle of the pandemic also had an impact.

Specifically, while Lombardy and Veneto applied similar approaches to social distancing and retail closures, Veneto took a much more proactive tack towards the containment of the virus. Veneto’s strategy was multi-pronged:

• Extensive testing of symptomatic and asymptomatic cases early on.
• Proactive tracing of potential positives. If someone tested positive, everyone in that patient’s home as well as their neighbors were tested. If testing kits were unavailable, they were self-quarantined.
• A strong emphasis on home diagnosis and care. Whenever possible, samples were collected directly from a patient’s home and then processed in regional and local university labs.
• Specific efforts to monitor and protect health care and other essential workers. They included medical professionals, those in contact with at-risk populations (e.g., caregivers in nursing homes), and workers exposed to the public (e.g., supermarket cashiers, pharmacists, and protective services staff).

April 6, 2020 Harvard Gazette article highlights suggestion to move some nursing home residents out and increase surveillance

An April 6, 2020 Harvard Gazette article is entitled: “Epidemiologist says COVID-19 may be more infectious than thought.”

The subhead reads: “Citing spread on ships and health care facilities, professor suggests moving some nursing home residents out and increasing surveillance.”

An excerpt (I have omitted embedded links) reads:

“I do think as many people as we can get out of these homes, [it] is probably better,” said Mina, also a Chan School associate professor of immunology and infectious diseases and associate medical director in clinical microbiology at Brigham and Women’s Hospital’s Pathology Department. “I think that this is an extraordinarily transmissible virus. I think it’s more transmissible than we recognize and actually preventing it from spreading within nursing homes is an extraordinary feat.”

The focus on nursing homes has heightened recently, in part due to revelations of 21 deaths at the Holyoke Soldiers Home since late March, of which at least 15 were due to the coronavirus. Test results in other cases are pending. A cluster of deaths at a nursing home in Washington that began in February highlighted senior citizens’ vulnerability to developing severe illness from the virus and, since early March, nursing homes across the country have restricted visitors in an effort to reduce risk to residents. In response to the growing threat, Harvard-affiliated Hebrew SeniorLife (HSL) on Friday instituted a self-shelter-at-home directive for 1,700 residents at five senior living campuses across Greater Boston. The organization has seen 36 COVID-19 cases and nine deaths among residents, as well as eight cases among employees.

April 7, 2020 Journalist’s Resource article

An April 7, 2020 Journalist’s Resource article is entitled: “Social distancing time frames: How our expectations affect compliance.”

An excerpt reads:

In a new National Bureau of Economic Research working paper, researchers surveyed nearly 900 Italian residents to explore what happens when expectations are shattered about how long social distancing measures, like self-isolation, would last. Participants were less willing to do more self-isolating when told that social distancing time frames would run much longer or shorter than they anticipated.

“In a context where individual compliance has collective benefits, but full enforcement is costly and controversial, communication and persuasion have a fundamental role,” the authors write.

The working paper to which the article refers includes a note that reads:

NBER working papers are circulated for discussion and comment purposes. They have not been peer-reviewed or been subject to the review by the NBER Board of Directors that accompanies official NBER publications.