Sunday, February 23, 2020

Italy: Emergency COVID-19 Decree Following 79 Cases & 2 Deaths


Yesterday afternoon, following my morning post of Italy: ANSA News Agency Reports 30 COVID-19 Case - 2 Deaths media reports of the number and location of new COVID-19 cases were all over the place, with very little agreement.
The Italian MOH website hadn't been updated in over 24 hours, leaving the `right' number anyone's guess. Rather than risk compounding a felony, I've waited for something `official'. 
This morning the Italian MOH has an case count update (which is probably already out of date), and details of an emergency decree, designed to help fight the spread of the novel coronavirus in Italy.

After you've had time to review the emergency decree, I'll return with a postscript.

Covid-19, Extraordinary Council of Ministers passes decree law
press conference
The Council of Ministers, on the proposal of President Giuseppe Conte, has approved a decree-law that introduces urgent measures on the containment and management of the epidemiological emergency from COVID-2019. The measure was outlined at a press conference by Council President Giuseppe Conte, with the Head of Civil Protection Angelo Borrelli, the Minister of Health Roberto Speranza, the President of the Higher Institute of Health Silvio Brusaferro. 
The point on the situation by the Head of Civil Protection: 79 people affected, of these 76 positive to the test, 2 deceased, one discharged (healed). Of the 76 positives in the test: 54 are in Lombardy, 17 in Veneto, 2 in Emila Romagna, 1 in Piedmont, in addition to the 2 Chinese tourists still hospitalized at the Spallanzani in Rome.
Minister Hope: "Measures to protect the health of communities, we count on the cooperation of all citizens."
Watch the press conference video
The decree intervenes organically, in the current international health emergency situation declared by the World Health Organization, in order to prevent and counteract the further transmission of the virus.
The text provides, among other things, that in municipalities or areas where at least one person is positive for which the source of transmission is not known or in any case where there is a case not attributable to a person from an area already affected by the contagion , the relevant authorities are required to take any appropriate containment measures and proportionate to the evolving epidemiological situation.
Measures include:
  • prohibition of removal and access to the municipality or the affected area;
  • the suspension of events, events and all forms of meeting in a public or private place;
  • suspension of childcare services and schools and educational trips;
  • the suspension of the public opening of museums;
  • the suspension of competition procedures and the activities of public offices, except for the provision of essential and public services;
  • the application of quarantine with active surveillance to those who have had close contact with people affected by the virus and the provision of the obligation for those who entered Italy from areas at risk of epidemiological to report it to the Department of Prevention responsible health company, for the adoption of the fiduciary home stay measure with active supervision;
  • the suspension of work for certain types of business and the closure of certain types of business;
  • the possibility that access to essential public services and businesses for the purchase of basic goods is conditional on the use of personal protective equipment;
  • restricting access or suspension of freight and people services, unless specific exemptions are.
In addition, the ability for the relevant authorities to take additional containment measures is introduced in order to prevent the spread of the virus even outside the cases already listed.
The implementation of the containment measures will be arranged by specific decrees of the President of the Council of Ministers, on the proposal of the Minister of Health, heard the Ministers and the President of the relevant region or the President of the Conference of Ministers regional presidents, in case the events affect multiple regions. In cases of extreme need and urgency, the same measures can be adopted by the regional or local authorities, under Article 32 of the Act 23 December 1978, no 833, until the decree of the President of the Council of Ministers is adopted.
For sanctioning purposes, the decree stipulates that non-compliance with containment measures is punishable under Article 650 of the Criminal Code.
Finally, the text stipulates that the Prefect, informing the Minister of the Interior in advance, will ensure the implementation of the measures using the police forces and, where necessary, the armed forces, hear the relevant territorial commands.
After cruising along thinking they only had 3 imported cases of COVID-19 - all safely tucked away in hospital isolation wards - over the past 48 hours Italy has come to realize the virus has been circulating - unnoticed - in their country for several weeks. 
The incubation period of COVID-19 is often 1 to 2 weeks, and it usually takes another week after symptoms appear for a patient to get sick enough to seek medical care.   This built in 3-week time lag makes is very difficult to know exactly when community spread begins in any country. 
And while it is happening this weekend in Italy, South Korea, and Iran, this rude awakening is likely just weeks away for many other nations of the world.
 COVID-19 appears embarked on a world tour, and no nation is likely to go untouched. 
We've been talking a lot about what mitigation steps during a pandemic would look like (see CDC COVID-19 Briefing - Feb 21st (Audio)) -  and while we've seen the draconian response by China's government - Italy provides us with our first look at the response by a `Western' nation.

Although responses may vary by country and region - and hopefully will moderate over time as we  come to understand the threat better - people need to be prepared for `business not as usual' in the weeks and months ahead.
The mantra of this blog (for over 14 years) has been preparedness.  For earthquakes, for hurricanes, for floods, and yes . . . even for pandemics.  
As the WHO talks about the `window of opportunity narrowing' to contain this virus, you should be hearing that your window of opportunity for preparing is narrowing as well.  While you'll find dozens of essays on pandemic preparedness in this blog, you might want to start with Jan. 25ths:

Not Too Soon To Be Thinking About Preparedness