L'Italo-Americano

LIFE PEOPLE PLACES HERITAGE THURSDAY, APRIL 16, 2020 www.italoamericano.org 14 L'Italo-Americano C oViD-19 pan- demic as of 13 April 2020: In the world - Con- f i r m e d C a s e s : 1 , 9 0 0 , 0 0 0 + ; F a t a l i t i e s : 115,000+. I n o u r b e l o v e d I t a l i a - Confirmed Cases: 157,000+; Fatalities: 22,500+. I n t h e U S - C o n f i r m e d Cases: 570,000+; Fatalities: 16,250+. In California - Confirmed Cases: 24,000+; Fatalities: 700+. In Los Angeles County - Confirmed Cases: 6,500+; Fatalities: 175+. Sun Valley, where Villa Scalabrini is located, has 22 c o n f i r m e d c a s e s ; a n d C h i n a t o w n , w h e r e o u r church of St. Peter is located, still not reported. (for individual cities and neighborhoods within LA, c h e c k a t : p u b l i c h e a l t h . lacounty.govThe US reacted to the CoViD-19 threat too late! N e w Z e a l a n d p l a n o f reaction was exemplary. Norway's response was fantastic, but neighboring Sweden totally botched its facing SARS-CoV2. Northern Italy acted too slowly, but Southern Italy faced the situation well. What does this all mean? What are the criteria that determine if a country is fac- ing well, correctly, appropri- ately? What do experts mean when they talk about flat- tening the curve? The fundamental princi- ples that underlie these state- m e n t s a r e q u i t e s i m p l e : viruses, bacteria and para- sites don't just appear out of thin air. A person is exposed a n d i n f e c t e d u s u a l l y b y another person (or some- times by an animal – e.g., mosquito bite, bat). In the case of a virus, like influenza o r t h e c o m m o n c o l d , a n infected person can infect one, or maybe two, or maybe m o r e t h a n t w o p e o p l e b y direct contact (i.e., coughing or sneezing, or shaking hand) o r i n d i r e c t c o n t a c t ( i . e . , sneezing into one's hand, and then using a door knob – the virus will be deposited on the knob and passed on to the next person that opens or closes that door). If we could estimate the total number of people who might be getting infected in each epidemic, and we'd pre- sent it on a graph, it would be a curve that rises sharply at first, then plateaus, and then decreases as the threat of infection in the population d i e s o f f : i t w o u l d b e a n i n v e r t e d U - s h a p e d c u r v e with a rather sharp peak. Now, if we could decrease the rate at which the infection is spread, we'd keep the total number of persons infected a b o u t t h e s a m e b u t w e ' d s t r e t c h o u t t h e p e r i o d o f infection: in other words, we'd retain the inverted U- shaped pattern of infection, but extend it over time, thus decreasing the height of the curve, flattening the peak of the curve. In brief, when we speak of f l a t t e n i n g t h e c u r v e , w e m e a n t h a t , y e s , t h e t o t a l number of people becoming infected will probably remain the same, but that will hap- pen over a longer period, because we have – by some means (vide infra) – been able to reduce the aggressive- ness of the infection. That is really very important when, a s i s t h e c a s e f o r S A R S - CoV2, the virus responsible for CoViD-19, infection can lead to such serious disease as requiring ICU and ventila- t o r - a i d e d b r e a t h i n g : I C U beds and ventilators are of l i m i t e d s u p p l y i n L o s Angeles, in California, in the US, world-wide, so it is criti- cal that we flatten the curve. If we do not flatten the curve, then we can expect a l a r g e c o h o r t o f C o V i D - 1 9 patients requiring an ICU bed and a ventilator all at once – our health care sys- tem will be overcrowded, overwhelmed, and patients will have to wait or to be denied their ICU bed and ventilator. Many will die as a direct consequence of this lack of essential care; and l a r g e n u m b e r s o f n u r s e s , doctors and hospital staff will be in despair for not being able to care adequately for their patients. That is the sit- u a t i o n w e w i t n e s s e d i n Northern Italy, in New York City, and all too many places around the world. If we are successful in flat- tening the curve then, yes, the same number of patients will end up in the hospital needing an ICU bed and a ventilator, but that will hap- pen over a longer time. The number of critical patients will, as a matter of speaking, be diluted during a longer p e r i o d : b y f l a t t e n i n g t h e curve, as it seems we have been able to do in California, and they seem to have been able to do in Germany and in Southern Italy, the health c a r e s y s t e m i s n o t o v e r - stretched and hospital staff can treat patients without being overwhelmed, and con- sequently more patients are saved, and fewer die… and the mental health of the hos- pital staff, patients and fami- lies is preserved. Unquestionably, flatten- ing the curve is good. The Per Saperne Di Più: CoViD-19, a word with Francesco Chiappelli Issue 2, Holy Triduum 2020 question remains: how do we flatten the curve, how do we reduce the aggressiveness of infection? Here too, the answer is quite simple. Many of my generation remember when we were sick with the flu or a cold, our mother would tell us to stay home: "stay away from school and your friends", she would say. The principle a t w o r k w a s t h i s : s t a y away. Keep your friends at a distance while you are sick; help them not to get sick. Physical distance helps keep infection away, and helps reduce the aggressiveness of infection. P r o f e s s o r G e o r g e Macdonald (1903-1967), Scottish medical doctor and epidemiologist, formalized that common sense rule in h i s s t u d i e s o f m a l a r i a i n 1952. Following in the foot- steps of his former mentor R o n a l d R o s s , M a c d o n a l d characterized the replication and propagation rate of the malaria parasite, which he called the pathogen's repro- duction rate, Z 0 Today, we still use this parameter, but we now call it R 0 , the repro- duction number. In virology, R 0 represent the number of people one p a t i e n t c a n i n f e c t o v e r a given period. We express R 0 s i m p l y a s t h e n u m b e r o f infection-producing contacts, c, times the unit time, t (R 0 = c X t). I t f o l l o w s t h a t w e c a n lower R 0 – the number of people one patient infects over a time - by reducing c (the number of contacts by an infected patient), or by d e c r e a s i n g t ( t h e t i m e o f exposure). That is to say: we lower the risk of infection by reducing contact - physical distancing, or by reducing the time of contact - quaran- tine. O f c o u r s e , t h e g r e a t e s t success in reducing R 0 will b e o b t a i n e d w h e n w e a c t decisively and early in man- dating physical distancing and quarantine: that is why countries like New Zealand that acted immediately and Continued to page 16

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