The first official death from Covid-19 was recorded in Tortona on 4 February, testifying to the fact that the virus, in the province and in the region, as elsewhere, was already circulating before the official cases. Tortona hospital, which has become a hotbed for the spread of the disease, is closed and declared a “red zone” by a regional ordinance. The reproductive factor of the freely circulating virus, or the famous R0 factor, is estimated at around 2.6: given the incubation times of the pathology, this implies that within a month an infected patient can get to infect other 310 people, about 80 per week.
The winning strategy to contain the epidemic is developed in Veneto by Dr. Crisanti, and is based on the use of the 3 t: test, trace, treat. Testing means early detection, through an adequate number of swabs, of the possible infected, even asymptomatic; Tracing means setting up an efficient territorial analysis network capable of tracing the contacts held by infected patients within the last week; Treating means isolating the patient, adequately protecting healthcare facilities and employees in order to prevent them from becoming, instead of treatment centers, outbreaks of the spread of the infection, preparing infrastructures and therapies able to cope with the outbreak of the epidemic.
In our region, and in the province, none of the 3 t is adequately transposed and adopted: missing swabs, laboratories and reagents (2 samples per 1,000 inhabitants are run in February-March, against 21 in the Veneto); the network of general practitioners and the regional health structure is unprepared to carry out the required tracing and the Sisp’s IT system goes haywire, subject to the amount of reports received, so much so that the emails concerning the patients to be monitored are lost; hospitals and medical and paramedical personnel, in the absence of adequate interventions and protective devices, become foci of infection. In these conditions, the epidemic rages uncontrolled and Alessandria becomes the first province of Piedmont by incidence of the disease.
The temporal evolution of the epidemic can be usefully examined with the help of a graph showing the daily dynamics of contagions, deaths, healings and infections in progress; in order to eliminate the accidents present in daily surveys, 7-day sliding averages are used. As can be seen, the red line of the new infections shows, in a manner different from the national and even regional reality, characterized by rapid initial growth, the achievement of a peak and a subsequent constant descent of cases, a swinging trend with 3 successive waves of morbidity. The first lasts until March 21, when it reaches a first peak of daily infections equal to about 90 cases on average; then the effects of the national lockdown, decided on March 8, seem to produce, with an inevitable delay in its effects, a reduction in the intensity of the infections, with new daily cases that drop to 40. Starting from April, however, the inauspicious decision to use the RSA as a place of hospitalization for convalescent Covid patients to lighten the load of hospital structures, determines a new surge in the infections, which reach a second peak of about 100 cases per day in the first week of April. Also in this circumstance, the surge of new infections follows a reduction in their intensity up to half a month, when a new, final, resurgence occurs, probably due to the intensification of the search process for the infected (in April the number of swabs for inhabitant is quintupled, compared to March).
Starting on April 20, a process of constant decrease in new infections begins, which fortunately does not appear influenced by the deliberations of gradual reopening of the economy and reduction of restrictive movement measures, operational since May 4th. In fact, after a historical minimum of 7 new daily infections on 21 May, despite a temporary rise at the end of the month up to 11 cases, a new trend decrease in average daily infections is experienced up to the current 4 cases.
The human losses caused by the epidemic have been huge, as the black line of the graph shows. Official deaths recorded by the Civil Protection rose gradually to a maximum of 20 units per day in mid-April. These official numbers, however, overlook the so-called “ghost” deaths, or the people who died in their homes or in the RSA, and that in the period of maximum spread of the epidemic and the collapse of the health and administrative structures were not officially registered. An estimate of these deaths can be made by comparing the official mortality statistics of the municipal registries in 2020 with the average of the values of the previous five years. The black dotted line in the graph therefore shows the dynamics of daily deaths that include this phenomenon: human losses go from an official peak of 20 people to an actual peak of 30, a peak that is anticipated on March 25th. To date, the Covid-19 epidemic in the province of Alessandria has caused 656 deaths, with a mortality rate of 16.5% compared to the cases detected and 1.6 ‰ compared to the population: these are the highest values of all Piedmont (which has corresponding averages of 12.8% and 0.9 ‰), and also of the Italian average (14.5%; 0.6 ‰). If to these official deaths were added those “ghost”, equal to 406 people, the mortality per inhabitant would reach 2.5 ‰.
The healing process of the disease in the province was rather slow, with the first recoveries that have only occurred since the beginning of April, and with a significant increase towards the middle of the month around 25 daily cases; however, a real change of pace took place only from the first ten days of May, with a first peak in the middle of the month of about 80 people a day, followed by a slowdown in the process and a new rise at the end of the month (75 people), in close addiction with the dynamics of new cases in the previous 6 weeks. In June, the number of people healed first slowed and then seemed to stabilize around the current value of 30 daily cases. The evolution of the number of people with an ongoing infection (the so-called positive ones) followed in a first phase (March-April) the trend of the infections and then above all that of the healings, for which we went from an average daily increase of people infected up to 80 cases to an absolute decrease in their number of about 70 cases in May, then reaching the current 25 cases. Overall, there are around 1,000 people today with symptoms of the disease, compared to over 2,500 at the peak of 8 May, with a decrease of 60%.
Ultimately, our province was particularly affected by the ongoing coronavirus epidemic, as evidenced by the fact that it is the eighth Italian province by relative incidence of contagions (0.94% of the population). The geographic proximity to Lombardy, the significant employment dependence on this region with consequent commuting mobility, the emergence of some territorial outbreaks, the high incidence of elderly people and RSA, the shortcomings of the basic health and administrative structures contributed to this. , the errors in the strategic choices to combat the emergency.
Lockdown measures, responsible individual behavior, use of individual protections, safety of health facilities, the advent of the heat with a greater number of hours spent outdoors have made it possible to significantly reduce the incidence of the disease, with results that for at the moment they proved resilient to the progressive easing of the restrictive measures imposed on the economy and civil society.
However, the persistence of the virus in many parts of the world leads to caution, also in view of the total opening of borders scheduled for June 15. There are also several unresolved issues, among which the first appears to be the reopening of schools in complete safety in the autumn. In the absence of a vaccine and targeted care, vigilance and caution are mandatory in order to avoid a second wave of infections: from a collective point of view it is essential to strengthen the country’s health, administrative and IT structures to fully implement the 3 t strategy, while from the individual one it is necessary to persist in behaviors aimed at avoiding the 3 c: closed places for long periods of time, huddles and close contacts without protection.
* The author of this study is Carluccio Bianchi (in the photo), professor of Macroeconomics of the University of Eastern Piedmont. Professor Bianchi was the precious author of a long series of analyzes on the trend of the epidemic – published between March, April, May and June on Il Piccolo – which allowed us to better understand the evolution of the facts.