A double-digit death rate in Italy

In America’s heartland, one can sense virus-fatigue beginning to set in, as it was bound to do. Even as social distancing efforts continue to ramp up with mandates from state and local governments, folks who were obediently compliant — and even embraced — those efforts in the beginning are now starting to question whether they’re needed.

The reason is simple: Two weeks after the World Health Organization declared it to be a pandemic and the distancing efforts began here at home, the coronavirus itself just hasn’t had much of an impact in large swaths of the United States. There are still counties — sometimes clusters of counties — in virtually every state, particularly in rural America, where the virus hasn’t been detected.

Even in this digital era, where we have the entire world at our fingertips, with unprecedented access to information, it’s hard sometimes for us to see what’s happening beyond the geographical boundaries of the places we call home or are familiar with.

But beyond our boundaries — indeed, even here in the U.S. (more on that in a moment) — the virus is having a terrible impact, one that is worth every bit of the hype that has been lavished on it since its spread began.

Let’s start with the place (China withstanding) where it all began: Italy. I’ve blogged repeatedly about how the death rate in Italy is climbing. It was just over 6% about two weeks ago. It has steadily climbed since then, and it’s now broken double-digits, at 10.1%. Keep in mind that this isn’t a true death rate, but a calculation of the number of diagnosed cases that have ended in death. So far, there have been more than 74,000 confirmed cases in Italy, and 7,503 deaths.

The good news for Italy, where the health care system has been completely overwhelmed, is that the rate of infection seems to have peaked. The bad news is that there’s no sign of recovery beginning yet. Italy is still reporting in excess of 5,000 new cases and 700 deaths per day, and there were more of each yesterday and today than on Monday.

There has been so much that has been written about what’s happening in Italy, yet I still talk to people on an almost daily basis who haven’t read any of it. Start here. We try to comfort ourselves by saying that this virus only kills a tiny percentage of its victims, and that’s true, or that it mostly kills the elderly and those who are already sick, and that’s true, too — even if our perception on the latter point needs a lot of fine-tuning. But the fact remains that’s what is happening in the world’s hardest-hit areas is heartbreaking. The fact that this isn’t killing younger, healthy people like the 1918-1919 Spanish flu outbreak did is hardly comforting. Remember, the Spanish flu killed only a tiny percentage of its victims, too, but history has remembered it very well … and for good reason. As for the coronavirus victims, they may be older, and they may have type 2 diabetes, or heart disease, or COPD, but they’re still fathers, mothers, grandparents and etc. They aren’t just faceless, nameless, easily-forgotten victims.

That’s why I’ve been obsessed with Italy. It was Italy that first convinced me this was a threat in the U.S. And the realization that it could happen here has stuck with me ever since.

Italy, of course, isn’t alone in this fight — not even within Europe. As I wrote yesterday, Spain has quietly become just as much of a coronavirus war zone as Italy, while we weren’t paying attention.

In Spain, which just joined Italy in passing China’s death toll, the death rate is 7.4% and climbing. It’s on pace to join Italy with a double-digit death rate within the next week or so. While Italy may or may not (but hopefully) have reached its peak, Spain has not; its rate of increase continues to rise.

As was the case in Italy, the health care system has been overwhelmed in Spain. And it happened in just 18 days. As the total number of infections hits 50,000 and the number of deaths approaches 4,000 in Spain, soldiers are being used to go home-to-home in an effort to disinfect them. Inside some of those homes they’re making grim discoveries: elderly people, left alone and dead.

Outside Europe, Spain hasn’t gotten nearly the media attention that Italy has gotten. So if there are people in the U.S. who have no idea how bad things have gotten in Italy, you can imagine that they really have no idea what’s happening in Spain.

But this is reality. Folks have accused me of adding to the “panic.” (On the flip side of the coin, folks have accused me of not writing alarmingly enough when the pandemic is mentioned.) But sharing the truth — even hammering it home — should never be considered the wrong thing to do. Less information rather than more is never a good thing.

That doesn’t mean that what has happened in Europe will happen in the U.S., of course. Spain didn’t begin its social distancing efforts until March 11, just a couple of days after Italy had done the same. March 11 is also the same day that the NBA suspended its season and the NCAA announced it would play March Madness without fans in attendance here in the U.S. Over the next 48 hours, social distancing efforts were continually ramped up across America.

So we can hope that we were far enough ahead of Italy and Spain that our social distancing efforts will pay off much more than they have. And, if they don’t (or even if they do), we can also hope that our health care system is better prepared for this than theirs was.

In some ways, we already know the latter to be true. Although Italy has more hospital beds per capita than the United States, the U.S. has far more ventilators (18.8 per 100,000 residents) than Italy (8.3 per 100,000 residents). Yet, we’re hardly saturated with these important mechanical breathing devices that are literally lifesavers for people who are battling pneumonia and severe respiratory illness caused by the coronavirus. And a lot of doctors and experts within the field are warning that the U.S. still doesn’t have enough ventilators to properly combat this virus. Additionally, it has now been revealed that hospitals are privately debating the implementation of “no resuscitation” orders for patients who code, regardless of their families’ wishes, because of the risks of spreading infection.

Will the former be true, as well? We’ll soon know. President Trump wants the nation to be back to normal by Easter. That seems like a pipe dream, but I’d be willing to bet that we’ll have a pretty good idea by then whether we’re doomed to repeat Europe’s fate or whether we acted quickly enough — and strongly enough — to prevent an outbreak of that magnitude.

The picture being painted in New York, though, isn’t a pretty one — which is the next lesson for those of us in rural America who are convinced that the coronavirus isn’t a big deal. You don’t even have to leave our own country to find horror stories. What’s happened in New York is simply amazing: more than 30,000 cases, and the city is on a trajectory to surpass both Italy and Spain with its infection and death rates.

Not surprisingly, the death rate is climbing in New York. It’s now at 1.1% — obviously far behind the European nations that we’ve already discussed, and it seems unlikely to catch either one of them. But there are now 366 deaths in New York, including 199 in New York City. There is no peak in sight. And it’s incredible just how quickly the disease spread there.

To put it into perspective, New York reported its first fatality on March 14 — just 11 days ago. The first case was reported there on March 1.

The good news for New York is that the increase of infection has slowed. As Gov. Andrew Cuomo said today (taking a break from criticizing the Trump administration), hospitalizations in the state were projected to double every two days on Sunday. Just three days later, the doubling rate has improved to 4.7 days.

But new infections are still rising quickly. Cuomo has said the state needs 30,000 ventilators and it only has 4,000, though more are on the way. Doctors there are going to start using one ventilators for two patients, on a trial basis. And things have gotten so bad that Vice President Mike Pence is now urging Americans who have recently returned home from New York to self-quarantine for 14 days. Just days ago, officials said they didn’t foresee a scenario where any part of the U.S. would have to be treated as such a high-risk area.

Several other American states have been hit hard, as well — none moreso than Washington, particularly the Seattle metro area. It was there that coronavirus first appeared in the U.S., and the death toll stands at 132 now. If there is promising data from Washington, it is that there are only 2,600 cases there, even though the outbreak has been going on for nearly a month. But the situation is hardly under control; Washington is still reporting double-digit increases in the number of new infections each day — although that number has not exceeded 11% since Saturday.

While the coronavirus has been well-documented in New York, Washington and even California, it is quietly having a surprising early impact in some other states. In Louisiana, there were another 19 deaths reported today, bringing the total to 65. Nearly 4% of the known infections there have ended in death. In Georgia, the death toll rose to 47 today; nearly 3.5% of diagnosed patients have died there. Those two southern states are among the states where death rates are well above the national average, but this virus is beginning to rapidly spread in a number of other states, as well — like Michigan, Florida and Illinois.

Ironically, there have only been 784 cases confirmed in Tennessee, even though the state’s governor, Bill Lee, has taken flack for not implementing a shelter-at-home order or ordering non-essential businesses to close. There have been 3 deaths in Tennessee. Surprisingly, only four new cases were reported in Nashville/Davidson County on Wednesday. That’s the state’s hardest hit area, with more than 3 in every 10 new infections being diagnosed there.

As for that notion that this is only a disease that impacts the elderly, that is obviously not the case. Yes, those 65 and older are by far the most at risk. But anyone with an underlying medical condition like diabetes, high blood pressure, heart disease, and others, is at risk — regardless of their age. In Washington, where the U.S. outbreak began, 2 in every 10 people who have died were under the age of 70, and 7% were under the age of 60. The U.S. also reported its first pediatric death this week, a teenager in California.

Ben Garrett

Ben Garrett is a journalist from East Tennessee. He is publisher of the Independent Herald, a weekly newspaper serving the Big South Fork region of the Cumberland Plateau, with a sideline in website development and digital marketing. He is also an erstwhile blogger.

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