The peak, the plateau, and the phase two

What has been happening in Italy in the last few days, and what can other Western countries expect in the next week or two?

The national discourse has been obsessed with “The Peak,” that is, the time when things reach their worst point, and start improving after that. For the last several days, all indicators, such as new cases, deaths, and ICU occupancy, have been improving. Apparently, then, “The Peak” is behind us. Virologists have been cautious to say that “peak” is the wrong mountain metaphor to use, and that we have rather reached a “plateau” in which things will change very slowly for a while.

Below is the number of confirmed covid-19 deaths in Italy updated with today’s data, showing that we reached the plateau a couple of weeks ago, meaning that the number of new cases started to plateau about a month ago, when the lockdown started.

italy-deaths

The data from New York City continues to track the data from Lombardy, so NYC should be just a few days away from its own plateau, if the match continues.

lombardy-nyc

lombardy-nyc-daily

Given all this, people have been wondering when and how we will get out of the lockdown, and reach what everybody has been calling the “Phase Two” of this emergency.

The lockdown is set to expire this coming Monday, and it is expected that tomorrow or Saturday the prime minister will announce new measures. (Perhaps, according to precedent, he will do so on Sunday night.) It is expected that the stay-at-home order will be extended to early May, or even mid-May, but that the definition of “essential activities” will be relaxed to allow some manufacturing to restart sooner.

Meanwhile, an infrastructure to isolate new cases and trace their contacts, which should have been frantically under construction over the last month, is still non-existent. Last week, the government nominated a committee of 70+ experts to “begin thinking about mapping out possibilities” for what such an infrastructure might be like.

To be honest, I am not too confident that the “Phase Two” will be organized with Taiwanese, or even Korean, efficiency, and my only hope is that the number of cases in Lombardy has been so under-reported that we may already be close to herd immunity.

This is probably not the case, but not by a wide margin. The Italian Institute of Statistics has released 2019 vs 2020 all-cause mortality data from a representative sample of Italian towns. Apparently, during the worst days of March, all-cause mortality roughly doubled nation-wide, while the reported deaths caused by covid-19 account for only about half of the excess deaths. This might mean that there have been 20,000 covid-19 deaths and maybe 2 million infected people out of 10 million in Lombardy. A study of the Imperial College estimates, at the high end, that 6 million Italians have been infected, and since Lombardy’s data has consistently accounted for half the national data on all measures, it would mean 3 million infected people in Lombardy, or 30%, which is within a factor of two of what might suffice for herd immunity. In any case we will not know until there is a randomized serologic study, which is something else for which experts are almost ready to begin mapping out ways of thinking about how to explore plans for …

What will life be like in “Phase Two”? If the epidemic continues at a slow burn, will we have to continue to keep a one-meter distance from strangers? Will trains and planes run with only every third seat occupied? Will tickets cost three times as much? Will beaches be open during the summer? Will there be riots if Italians are not allowed to go to the beach in August? Apart from the last question, whose answer is obviously yes, everything is up in the air.

What about me, after 32 days of lockdown? I was already in need of a haircut at the end of February, and lately the hair situation had become untenable, so I used my beard trimmer to blindly cut my hair. Mistakes were made, but I would not even rate it among my top ten worst haircuts ever.

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