On virus containment as dieting

The Protezione Civile, the Italian equivalent of FEMA, holds a daily press conference to announce coronavirus data from the previous 24 hours. Today they had relatively good news, of which we hope to hear more soon. The Protezione Civile puts a lot of data online every day, on github, which allows any interested party to monitor the situation and will allow people in other countries to see the effect of our various restrictive measures over time.

The graph below, which is courtesy of Carlo Lucibello, shows the number of deaths in Italy on a logarithmic scale, compared with data from China from 36 days before.
90441248_574660963135651_9199184881282711552_n
(Image credit: Carlo Lucibello)

At the start, Italian deaths rose like in China, at the same exponential rate. About twenty days after the lockdown of Wuhan, the Chinese data started deviating from the exponential rate and leveled off. In Italy, about ten days ago, there was a slowdown, which followed the institution of the “yellow zone” by about 15 days. The “yellow zone” measures closed schools, universities, museums, cinemas, and clubs, and restricted hours of bars and coffee shops, in Lombardy. Apparently, although these measures made a difference, they still allowed the spread of the virus to continue at an exponential rate.

On March 8, Lombardy was put on a stricter lockdown, with travel restrictions, and on March 10 the lockdown was extended to the rest of the country. So we may hope to see a stronger slowdown and maybe a leveling-off two or three weeks after these measures, that is, any day now. It may seem premature to ask this question, but what happens next?

Today the Italian government announced additional measures to facilitate “social distancing,” halting all “non-essential” manufacturing and other work activities, forbidding people from leaving the house to walk or jog (even alone), and further restricting the cases in which it is allowed to travel between different cities.

These measures, which apply nationwide, are meant to be in place for two weeks. They will be economically devastating (even more so than the already devastating nationwide lockdown of March 10), and they will be difficult to keep in place for longer than the expected two weeks.

When a nationwide “lockdown” was first instituted, the prime minister announced it by saying “let’s be distant today in order to more warmly hug each other tomorrow”. In general, the spirit of these measures has been to suffer for a short time and then return to normal.

This feels like the national mood in general, and the government took today’s further restrictive measures somewhat reluctantly, because there was strong popular support for them.

Here I am worried that we are approaching this crisis the way many people attempt to lose weight: by going on a starvation diet, then losing some weight, then celebrating and finally gaining back more weight than they lost.

The point being that I worry about what will happen once the worst is over and these restrictive measures will be lifted. Until there is a vaccine or a cure, we will not be able to really go back to normal, and we will have to make some sustainable “lifestyle changes” to “maintain” what we got, just like people who maintain weight loss for a long time do so by making sustainable changes for the long term.

Concretely, we will need a very efficient system to monitor new cases and trace contacts, perhaps similar to Taiwan’s, and to follow the kind of stricter hygiene precautions in public places that have been common in East Asia since SARS. Let’s hope that we will have to worry about such problems soon.

What is next?

Greetings from the future! The progression of covid-19 in Italy is running about eight days ahead of France and Spain and about 16 days ahead of the United States. Here in Lombardy, which is about ten days ahead of NYC, we have been “sheltering at home” for 13 days already.

How is social distancing working out for me? I thought that I was well prepared for it, but it is still not easy. I have started to talk to the furniture, and apparently this is perfectly normal, at least as long as the furniture does not talk back.

As I have been telling my dining table, it has been very dismaying to read news from the US, where there seemed to be a very dangerous complacency. I am relieved to see that this is changing, especially at the state level, which makes me much more hopeful.

I have also found media coverage to be disappointing. Apparently, many highly educated people, including people whose job involves understanding policy issues, have no idea how numbers work (source). This is a problem because a lot of issues concerning this epidemic have to do with numbers, which can be misleading if they are not reported in context.

For example, before the time when Trump decided that he had retroactively been concerned about a pandemic since January, conservative media emphasized the estimate of a 2% mortality rate, in a way that made it sound, well, 98% of people survive, and 98% is approximately 100%, so what is the big deal. For context, the Space Shuttle only exploded 1.5% of the times, and this was deemed too dangerous for astronauts. This is the kind of intuitive reference that I would like to see more of.

Even now, there is a valid debate on whether measures that will cost the economy trillions of dollars are justified. After all, it would be absurd to spend trillions of dollars to save, say, 10,000 lives, it would be questionable to do so to save 100,000 lives, and it would be undoubtedly right to do so to save millions of lives and a collapse of the health care system (especially considering that a collapse of the health care system might create its own financial panic that would also cost trillions of dollars).

So which one is it? Would doing nothing cost 10,000 American lives? A million? How long will people have to “shelter at home”? And what is next? I can recommend two well-researched articles: this on plausible scenarios and this on what’s next.

Kristof’s article cites an essay by Stanford professor John Ioannidis who notes that it is within the realm of possibilities, given the available data, that the true mortality rate could be as low as 0.05%, that is, wait for it, lower than the mortality rate of the flu. Accordingly, in a plausible scenario, “If we had not known about a new virus out there, and had not checked individuals with PCR tests, the number of total deaths due to “influenza-like illness” would not seem unusual this year.”

Ioannidis’ essay was written without reference to data from Italy, which was probably not available in peer-reviewed form at the time of writing.

I would not want professor Ioannidis to tell me how to design graph algorithms, and I don’t mean to argue for the plausibility of the above scenario, but let me complement it with some data from Italy.

Lombardy is Italy’s richest and most developed region, and the second richest (in absolute and PPP GDP) administrative region in Europe after the Ile de France (source). It has a rather good health care system. In 2018, on average, 273 people died per day in Lombardy of all causes (source). Yesterday, 381 people died in Lombardy with coronavirus (source). This is spread out over a region with more than 10 million residents.

Some areas are harder-hit hotspots. Three days ago, a Bergamo newspaper reported that 330 people had died in the previous week of all causes in the city. In the same week of March in 2019, 23 people had died. That’s a 14x increase of mortality of all causes. Edited to add (3/22/2020): the mayor of Bergamo told Reuters that 164 people died in Bergamo of all causes in the first two weeks of March 2020, versus 56 in the first two weeks of March 2019, a 3x increase instead of the 14x increase reported by Bergamo News.

Bergamo’s hospital had 16 beds in its intensive care unit, in line with international standards (it is typical to have of the order of an ICU bed per 5000-10,000 people, and Bergamo has a population of 120,000). Right now there are 80 people in intensive care in Bergamo, a 5x increase in capacity that was possible by bringing in a lot of ventilators and moving other sick people to other hospitals. Nonetheless, there have been reports of shortages of ICU beds, and of people needing to intubated that could not be. There are also reports of people dying of pneumonia at home, without being tested.

Because of this surge in deaths, Bergamo’s funeral homes have not been able to keep up. It’s not that they have not been able to keep up with arranging funerals, because funerals are banned. They just do not have the capacity to perform the burials.

So coffins have been accumulating. A couple of days ago, a motorcade of army vehicles came to Bergamo to pick up 70 coffins and take them to other cities.

It should be noted that this is happening after 20 days of “social distancing” measures and after 13 days of “sheltering at home” in Lombardy.

My point being, if we had not known that a news virus was going around, the number of excess deaths in Bergamo would have not been hidden by the random noise in the number of deaths due to influenza-like illness.

I have been practicing for this my whole life

As the coronavirus epidemic advances in Italy with a 25-30% growth rate (meaning that the numbers are doubling every 3-4 days), and after two weeks of “lockdown-lite” in Northern Italy seems to have made no difference, the Italian government imposed on Sunday morning a stricter lockdown on the region of Lombardy and some cities outside the region including Venice. Several people have reached out to ask how things are going, so here is a brief recap.

Continue reading

Lies, damn lies, and covid-19

In the past two weeks, in Italy, we have been drowning in information about the novel coronavirus infection, but the statistics that have been circulating were lacking proper context and interpretation. Is covid-19 just a stronger form of the flu or is it a threat to the world economy? Yes.

Now that the first community transmissions are happening in my adopted home in the San Francisco Bay Area, I would like to relay to my American readers what I learned from the Italian experience.

Continue reading

This year, for Lent, Milan gave up nightlife

Greetings from Milan, in Italy’s “yellow zone” of areas bordering clusters of coronavirus infections. This week, all schools, universities, museums, theaters are closed, bars have to close by 6pm, and fairs and conferences are being postponed. The “red zone” of small towns with the clusters of infections is on lockdown.

Milan has been unseasonably warm and sunny in the past few days, and walking through the city, with very light car and pedestrian traffic, has been lovely. This is apparently what the city usually looks like in August, but without the heat and humidity.
Continue reading

Postdoc Position at Bocconi

I am recruiting for two postdoctoral positions, each for one year renewable to a second, to work with me at Bocconi University on topics related to average-case analysis of algorithms, approximation algorithms, and combinatorial constructions.

The positions have a very competitive salary and relocation benefits. Funding for travel is available.

Application information is at this link. The deadline is December 15. If you apply, please also send me an email (L.Trevisan at unibocconi.it) to let me know.

So you want to move to Milan

Ten weeks into my move to Italy I am feeling more and more settled. I even eventually got a Milan bus card, which proves that if you really believe in yourself you can achieve anything. I held a midterm for my theoretical computer science undergraduate class, and there were zero students asking for special accommodations and zero students complaining to me about their grade.

According to our national tradition, I like to complain, but Bocconi is really not giving me much to work with.

But enough about me, let’s talk about you. I am going to assume that you want to come to Milan, because, really, why not? Here are some ways in which this can happen:

  • You are a high school senior and you would like to study computer science in college, but you like math as well: next academic year, Bocconi is starting a new undergraduate program on math and CS
  • You are an undergraduate or masters student applying to PhD programs and you would like to work with me: next academic year, Bocconi is starting a new PhD program on statistics and computer science
  • You are a theory PhD student and you are looking for what to do next summer: I would be interested in hosting graduate students for part of next summer, especially during the month of July. Ask your advisor to contact me if this is something that you would be interested in
  • You are a graduating theory PhD student and you are looking for a postdoc next year: I will have one or two openings for postdocs next year. The call for applications will be up soon. The tax-free salary will be very competitive and Bocconi has exceptionally well-functioning processes to get non-Italian-speakers settled in, help them do the immigration paperwork, look for housing, finding English-speaking primary care physicians, etc.
  • You are (or might be tempted to be) on the job market for a faculty position: in light of all the new initiatives on computing, and the current staff of one computer science professor, Bocconi would like to hire at all levels, preferably at the levels of Associate Professor or Full Professor, in computer science, especially in theory and in AI. Salaries are very competitive, they are essentially tax-free for six years for people who have not lived in Italy in the past two years, all teaching is in English, and the university makes it very easy for foreigners to settle in.
  • You are a professor and your sabbatical is coming up, or you arranged your teaching to have a semester without teaching to do some traveling: contact me if you are interested in visiting for any length of time.

I am in Baltimore for FOCS through Tuesday morning if you want to talk to me in person.

What’s New

It has been six weeks since I moved to Milan, and I am not yet completely settled in yet.

For example, although, as of yesterday, I finally have working wired internet access in my place, I still do not have a bus card (obtaining the latter has been one of the most stubbornly intractable problems I have encountered) and all the stuff that I did not carry in two bags is still in transit in a container.

Meanwhile, the busyness of handling the move, getting settled, trying to get a bus card, and teaching two courses, has meant that I did not really have time to sit down with my thoughts and process my feelings about such a major life change. If people ask me what I miss about San Francisco I will, truthfully, say something like UberX, or Thai food, or getting a bus card from a vending machine, because I still have not had a chance to miss the bigger stuff. Similarly, this post will be about random small stuff.

Continue reading