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On the Ground in Italy: Invisible Patients Are a Gap in Epidemic Prevention, 60% of Cases Remain to Be Uncovered

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On the Ground in Italy 01"The cunning virus is skilled at disguise, invisible patients are a gap in epidemic prevention, and 60% of cases remain to be uncovered

Since community transmission of the novel coronavirus (Covid-19) broke out in Italy in late February, confirmed cases have shot up in just over two weeks to 7,000. Although more than 600 people have recovered, it is still the country with the most severe outbreak outside Asia. In the early hours of March 8, an emergency decree was issued: without a permit, no one may enter or leave the Lombardia region and 14 other provinces, affecting about 16 million people, one quarter of the country's population.

Why is Italy's outbreak so severe? What lessons does Italy's experience offer? NewsMarket's correspondent in Italy brings an on-the-ground report, divided into two articles. This is article 01 of the series; to read 02, please click here.

After the soft lockdown, streets with no cars (photo / Zheng Jieyi)

"Invisible patients" are a gap in epidemic prevention; the average age of the deceased is 81

Called "the first recovered patient," 47-year-old Sara strongly disagrees. "Everyone says I've recovered. The problem is, I was never sick." Yet more than ten days ago, her novel coronavirus (Covid-19) test came back positive, and although she has not the slightest typical symptom of fever or cough, she is currently isolating at home.

Family doctor Marco has likewise contracted the novel coronavirus commonly known as "Wuhan pneumonia"; his only symptom is a bit of rhinitis. Sara and Marco are not a minority. According to statistics from Italy's Ministry of Health, half of those who test positive have no symptoms or only mild symptoms, and this is used to ease people's panic.

However, these "invisible patients" happen to also be a gap in the epidemic prevention net. Unaware that they have become carriers, they continue to live normally, move about and travel everywhere, and those around them are unprepared, allowing the cunning novel coronavirus to penetrate every corner of the world.

Compared with ferocious SARS, which had a fatality rate of 10%, the novel coronavirus, currently estimated by the World Health Organization (WHO) to have a fatality rate of 3.4%, appears milder. But not everyone is as lucky as Sara and Marco, spared too much torment by the virus. The novel coronavirus is more transmissible, and once the number of infected people is large, the final death toll is still worrying, especially as elderly people with chronic diseases are exposed to extremely high risk. In Italy, where those over 65 make up 23% of the population, the death toll has already passed 200, the average age of the deceased is 81, and 75% of the dead are over seventy.

The virus's disguise: many patients have no pneumonia symptoms

Wuhan was locked down on January 23, with people confined to their homes, but the virus could not be stopped from racing out into the world. On February 9, WHO Director-General Tedros Adhanom Ghebreyesus said there would be more and more cases of Wuhan pneumonia with no history of travel to China, "We may only be seeing the tip of the iceberg."

The words were still ringing in our ears when Italy hit a huge iceberg on February 20. In just two weeks, three imported cases surged to about 6,000 confirmed cases. Taiwan's customary term "Wuhan pneumonia" is increasingly unable to accurately describe the power of what is formally named "coronavirus disease 2019" (Covid-19); the disease does not occur only in Wuhan, and many patients have no pneumonia symptoms.

The novel coronavirus, skilled at disguise, evades the surveillance of the medical system, secretly crosses borders, and silently attacks human health. Some patients with mild symptoms rest at home or medicate themselves, and never see a doctor at all. Even if they go to the hospital, the common symptoms listed by the World Health Organization - fever, dry cough, fatigue, phlegm - are extremely similar to those of a cold or flu, and frontline doctors find it very hard to see through the mischief of the troublesome novel coronavirus. Not to mention that some people, like Sara, do not feel sick at all.

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