The number of daily Covid-19 deaths in Italian hospitals continues to accelerate at the maximum rate – and significant numbers of deaths could be recorded until early June, according to a new analysis.
Analysis of Covid-19 data up to 30 March, by Professor Davide Manca, Professor of Process Systems Engineering at Politecnico di Milano, Milan, Italy, for the European Society of Anaesthesiology (ESA), suggests that the increase in numbers of patients in intensive care in both the Lombardy region and Italy as a whole are likely to have peaked.
However, numbers of deaths in hospital will continue to increase at the maximum rate for several days, he warns.
Models identify the maximum daily increase of deaths in hospital as most likely to occur during days 36-40 of the pandemic – 28 March to 1 April – in Lombardy and days 36-41 – 28 March to 2 April – in Italy as a whole.
Professor Manca explored the logistic and Gompertz modelling techniques to prepare his report and found that in the more optimistic logistic model, 98% of total expected deaths in hospital would have occurred in both Lombardy and Italy by 15 April.
However, the more pessimistic Gompertz model predicts 98% of deaths to occur by 3 June in Lombardy and 4 June in Italy.
As of 31 March 2020, Italy recorded 101,739 confirmed Covid-19 infections and 11,591 deaths, the largest death toll of any country in the world.
The data reveals that the maximum number of patients in ICU was reached on 15 March – day 22 of the pandemic – in Lombardy, and on 18 March – day 25 – in Italy. The difference between Lombardy and Italy is due to the social-distancing measures adopted first in Lombardy and then all over the country, said Prof Manca.
He said over the past few days, the number of patients in ICU has increased by less than 10 people a day in Lombardy, due to its intensive care units being filled to capacity, while in all of Italy the number of patients in ICU has increased by 50-75 patients per day compared with 180 to 240 patients per day between 13 and 23 March.
“We expect to reach the date on which there will be little or no further increase of Covid-19 patients in ICU to be around day 45 (April 6) in Lombardy and day 47 (April 8) in Italy,” he said.
“The data suggest that numbers of patients in intensive care should begin to fall across Lombardy and Italy after these dates, depending on the continued implementation and enforcement of Italy’s strict quarantine measures.”
His analysis also reveals that resuscitation and intensive care doctors are reporting extended periods of viral shedding, with one infected ICU doctor experiencing persistent virus shedding for more than 30 days, since his quarantine began on 23 February. Doctors are also reporting longer periods of virus shedding than average.
He found that about 15 days are needed to achieve an effective weaning from respiratory care in ICU. About one-third of patients worsen after the first extubation and need further, but not invasive, respiratory treatment.
However, he said not all the patients that require intubation treatment can receive it when required because of ICU beds saturation, which may cause deterioration in the patient’s pulmonary status.
His analysis also says that CPAP breathing devices may delay respiratory failure and help medical staff to avoid ICU admission when intubation is not feasible.
* The UK reported 381 new deaths yesterday, including those of two teenagers. In the USA a six-week-old baby died in Connecticut from the virus as states reported 1,046 new deaths, nearly half of them in New York.
France reported 509 new deaths, Spain 923 deaths and Italy 727 deaths.
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