The unpleasant guest arrives in Italy: prevention vs. alarmism

The new episodes of contagion in the Italian peninsula have alarmed the population, thanks to unclear media reports that served the purpose of shocking rather than informing. With the help of Dr. Stefano Rusconi, we’ll try here to clarify the nature of the virus, its spread, the WHO directives and those from Italian authorities. And finally consider the likely short-term scenario.

In the last few weeks in Italy there has been a lot of talk about the Coronavirus. After a first media tam-tam, following the hospitalization of two Chinese tourists at the Spallanzani Hospital in Rome, the alarm seemed to abate because it was limited to a few cases. Unfortunately, the new cases detected in Lombardy and Veneto have been followed by a new wave of alarmism, which goes far beyond the reality of today’s situation. Faced with the non-crystalline media reporting, Dr. Stefano Rusconi, Associate Professor of Infectious Diseases at the University of Milan and physician specializing in infectious diseases at the ASST-FBF-Sacco in Milan, analyzed in our brief interview the scientific data and medical practice to be properly followed in the case of Coronavirus — i.e. the only criteria to rely on in case of possible epidemics and mass contagion.  

What is the Coronavirus?

Looking first at the nature of SARS-CoV21, Dr. Rusconi explains that the Coronavirus is present in many animal species, but that in this case the infection started in a species of bat present in the Chinese region. SARS-CoV2 is part of a rarely dangerous family of viruses, but in some cases, the virus can evolve by jumping between species (from animal to animal). The so-called species jump is a focal eventuality, as the virus accelerates its evolution and its resistance when accepted into a new organism, changing its nature to accommodate the host organism.

Later, however, Dr. Rusconi points out that transmission between animals is more difficult than inter-human transmission. Compared to the SARS virus, protagonist of the worldwide epidemic between 2002 and 2003, SARS-CoV2 is less lethal but more aggressive, thanks to its mutagenic propensity. In fact, the data confirm what Dr. Rusconi said: that to date, the infectivity of the virus seems to be in decline, including in China where there is a constant decrease in new cases of contagion2. In any case, the WHO Director General makes it clear that this should not lead to a decrease in precautionary measures or exclude possible new cases. Day after day, the medical research activity allows a better understanding of the nature of SARS-CoV2 and its transmission methods, with WHO data estimating that 80% of the world population has a mild and curable form of the disease, concludes Ghebreyesus3. At the national level, the truthfulness of the latter statement can be found by looking at the cases detected in Italy. The most severe patients are those people with chronic or cardio-respiratory diseases, or in higher risk categories such as the elderly or other people who are persistently immunocompromised. In fact, the man who died in Veneto from Coronavirus is among those in the most at-risk categories.

Transmission methods and symptoms

With regard to the possible methods of transmission, Dr. Rusconi advises checking the specific WHO sources and those of the Ministry of Health. Referring to the scientific reference information, we understand that the Coronavirus is transmissible in the following cases: through body fluids such as saliva, cough and sneezing; through direct personal contact, or indirect personal contact such as contact between contaminated hands and mouth, nose and eyes. More rarely the infection occurs by fecal contamination, which is presumably among the reasons for the first outbreak in Wuhan (where there is bat guano). 

As for transmission of the virus through food, Dr. Rusconi denies the possibility of direct contagion from food, but clarifies that the possibilities of this are still related to the health and hygiene standards being observed in the restaurant. If, for example, the surfaces of the restaurant are regularly cleaned with disinfectant agents, there is no reason to be concerned. The most common transmission method, Dr Rusconi specifies, is by means of saliva droplets, i.e. body drops slightly larger than those of an aerosol. For this reason there are the FP2 and FP3 masks, which are necessary only for health workers, allowing them to continue their work without running the risk of contracting and spreading the virus. For those who are neither healthcare workers nor residing in areas of the outbreaks, the surgical mask may be sufficient.

The symptoms (described also on the WHO and MoH portals) include fever, flu, sore throat, headache, dry cough and a general feeling of discomfort. Being a respiratory disease, contagion can occur through these common symptoms, only in rare cases resulting in pneumonia, serious breathing difficulties, and such. The presence of these symptoms should be checked in those who have had contact with a person who has stayed in China in the 14 days prior to the onset of symptoms, or those who have traveled in regions near China. The specificity of the 14 days is linked to the incubation of SARS-CoV2: over a period of time between 2 and 14 days4 the virus can remain incubated in the human body. During this period, however, there may be no symptoms and the possibility of infection cannot be detected.

Prevention and the importance of health directives

From the very first cases, Italy has implemented preventive measures by checking passengers arriving from China and suspending flights to that region. Such measures, Rusconi explains, paid off in 2002 during the SARS case. By enforcing strict screening from the outset, Italy has identified a relatively high number of infections. However, unlike the measures taken on the Italian peninsula,  many foreign countries maintain a policy of quarantine and voluntary screening. In this way, it is much more difficult to get an idea of the number of actual infections outside Italy. For now, the tone abroad seems to be gentler, less urgent — in Germany, for example, the state agency has warned the population of an increase in the seasonal flu infection rate. In any case, Germany has warned the population about a virus, the seasonal one, which claims far more victims than the Coronavirus.

Dr. Rusconi explains that as far as Italy is concerned, the preventive measures have been applied according to protocol, in a timely and correct manner. Prevention is fundamental to containing the virus, but it also allows the sharing of knowledge in Italy among different doctors with different specializations. Prevention and research are important in this case, says Rusconi, also because the knowledge of SARS-CoV2 is still incomplete, and the international contagion is accelerating the research process and the knowledge network among doctors all over the world. As far as the restrictive measures taken in Lombardy and Veneto are concerned, they are in line with the health directives suggested by the WHO, which are aimed at reducing the possibility of contagion in outbreaks, but they must not be implemented with alarmism. In other regions, such as Calabria and Puglia, the regional administration has invited people in transit from Northern Italy to contact the reference telephone numbers. But that is entirely voluntary screening and “self-disclosure,” similar to what’s being done in some foreign countries as mentioned above.

The preventive measures are in line with common sense and normal rules of hygiene: requiring the washing of hands after having been in crowded places or public transport, and avoiding contact with eyes, nose and mouth with hands that are not clean. Dr. Rusconi comments that those in Asia are much more diligent in the prevention of contagions. The use of the mask is ordinary in Asian culture, not only for reasons of climate pollution, but also to limit the transmission of fluids through sneezing or coughing. The Chinese community specifically is very proactive when it comes to common health. In Milan, says Rusconi, many Chinese have placed themselves in self quarantine out of respect for the city and the people who live there. 

The blockade closure of ethnic Asian restaurants, as happened in Pavia, may be a voluntary and respectful decision, but it does not mean that there may be food contamination. As Dr. Rusconi explained, there is no direct transmissibility through food, although there can be indirect transmission in restaurants or places of catering, if surfaces are not regularly cleaned with disinfectants.

These are the preventive measures being implemented in the case of SARS-CoV2, a virus with what is still poor medical mapping, but rapidly growing, as evidenced by new vaccination attempts registered in London, Sydney and the USA. What is likely at the moment, Rusconi explains, is that there could be benefits through passive immunization, i.e. the transfer of plasma from a convalescent patient to a hospitalized one — an immunotherapy procedure already practiced, for example, with the transfusion of specific immunoglobulins.

The difference between prevention and alarmism

The rapid and dramatic precautionary measures implemented in Italy have, however, triggered alarmism among the population. The change in daily routine — from the limited hours imposed on business owners and the closure of public places in the most serious cases — has destabilized Italian life. As Dr Rusconi said, he deliberately avoided giving interviews on the Chinese case of Spallanzani in order to avoid hysteria, which he felt could lead to creating an exaggerated sounding board on the current state of the situation. Rusconi also praised the Italian media for avoiding sensationalism and leaks of information. Unfortunately, as the days go by, his praise is no longer apt. 

By providing updates that were not always very clear, the media have contributed to the scaremongering in Italy, also due to the lack of critical receptivity of the audience. The preventive measures have not been well understood, creating panic and overwhelming the hospitals in the region. Paradoxically, the wrong response of the population to the arrival of the virus can be one of the riskiest consequences for the country. If people with trivial flu symptoms clog up first aid and first aid stations, it will overload and slow down the healthcare system. Given this, says Dr. Rusconi, we need to rethink the methodology for detection of the Coronavirus. Test swabs in hospitals in large towns in the Lombardy Region are becoming scarce, often used for cases that would not require it. 

While this mechanism of immediate control is understandable, it requires the collaboration and common sense of the population. In spite of the still partial medical mapping, even the new cases detected confirm that the so-called fragile target groups, i.e. over 65 years of age or with previous pathologies, remain the most at risk.

Finally, with respect to the criticism being leveled at the modus operandi of the Italian Minister of Health by the population, and the growing concern of the WHO, Dr. Rusconi remains optimistic. While Italy is being tested by the virus — having had more cases than other European countries, due in part to its higher population density — it’s responding positively. The country’s health system, it seems, is resisting well the attack of the virus. It is reacting proactively to the situation, setting control thresholds that are not foreseen in other, albeit advanced, foreign countries.

  1. Thus renamed by the WHO, it stands for “severe acute respiratory syndrome – coronavirus 2”. Also renamed nCoV-2019 or Covid-19: []
  2. As claimed by Tedros Adhanom Ghebreyesus, WHO Director General: []
  3. []
  4. Where the latter represents the maximum precautionary limit: []

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