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.

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.

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.

Another dispatch from Milan

By virtue of being one or two weeks ahead of the rest of the Western world, Italy has been giving advance notices to other countries about what to expect in the covid19 epidemic. For this reason, friends from other countries have been frequently asking me some questions, whose answers I would like to share.

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.

(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.

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.

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.

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.