Situation Update: Week 44

The flu virus is now spreading fast in Italy. The Italian Health Ministry has released data about week 44 from October 26 to November 1 (updated to 5 pm). The flu incidence has risen to 8.96‰ and it's already higher than the peaks in the seasonal epidemies from 2005/06 to 2008/09. In Campania the regional incidence is 14.66‰, in Lombardia it is 13.48‰, more than 11.5‰ also in Emilia-Romagna, Marche and Lazio. Almost all the cases are caused by A(H1N1) virus (98.8%).
The fatal cases are 21 (9 in Campania, 3 in Emilia-Romagna, 4 in Lombardia, 2 in Lazio, 1 in Sicily, Tuscany and Umbria each). Vaccinated people are 41,000.

New strain, old problem

It's becoming clear that many troubles caused by the pandemic in Italy are actually old problems of the national primary care service. For example, many local doctors don't know what to do, as Corriere della Sera has reported. They haven't been informed very well, but this lack of communication and technical updates from health authorities is often true for other illness.
Another problem is that it's difficult to ask advice to local doctors, even by phone call. So people rush to the emergency room (again Corriere della Sera). But this is a common occurrence in Italy, where it's hard to get a home visit by doctors.
And there's so much difference in flu vaccine campaign in the country, because each regional government has a different approach with a wide range of efficiency. If the strain of the flu virus is  new, the problems look old.

What the minister is asking

Another fatal case of swine flu occurred in Italy. A 37 years old musician died in Salerno, a city south of Naples. Italian newspapers keep track of the death toll, now 18, even though yesterday the Deputy Minister of Health Ferruccio Fazio asked the media to suspend it. Professor Fazio explained that this flu is milder then the seasonal one and that there is no need to worry. However, the Minister from now on will issue a daily update of the pandemic. So, maybe Professor Fazio himself doesn't think the uproar is going to be abated very soon. Actually, he pleaded everyone not to rush to the emergency room, but to consult first the family's doctor.

Vaccination program on time?

Can the vaccination program against swine flu be on time? According to a recent study, it can be expected “an autumn/winter wave in the Northern hemisphere strikingly earlier than expected”. In Italy the peak time of the pandemic will occur from 17 October to 23 November. “The analysis shows the potential for an early epidemic peak occurring in October/November in the Northern hemisphere, likely before large-scale vaccination campaigns could be carried out” write the authors. The simulations refer to a worst-case scenario, with no antiviral drugs used.
This is quite worrying. “The vaccine has been expected for the beginning of November” has said pharmacologist Silvio Garattini, interviewed by Agi press agency. “The trouble is that the pandemic has reached Italy earlier than expected, and if it carries on like, that the vaccine could be useless, because protection develops after 15 days from the shot”. According to the expert, it's necessary that all the Italians in the high risk groups get the shot by the middle of November, but this goal is "almost impossible".
This is a grim forecast, but for once it looks like based on sound science.

Death toll rises in Naples

Other two fatal cases of swine flu occurred in Naples, Corriere del Mezzogiorno reports. A 42 years old, overweight woman died today at Cotugno Hospital, while a 72 years old woman, with respiratory disease died yesterday at Cardarelli Hospital. So the death toll in Naples has risen to 8. Italian newspapers are reporting all the deaths caused by the H1N1 virus, and maybe this can be alarming for the general public. The Deputy Minister of Health Ferruccio Fazio keeps assuring that all the people who died were already ill, and that healthy people should not worry. Another big issue is the vaccine campaign: in the past days Professor Fazio has blamed on local authorities for the delays in the vaccine distribution, while praising the producer, Novartis, for having sent the first batch of two million doses in advance of a fortnight.

Quite surprisingly, nobody talks about antiviral drugs. Maybe this is good luck for the Ministry. According to a study, "the antivirals stockpiled in Italy are sufficient to treat only 7 million individuals, corresponding to the 12% of the population." 

Swine flu, first child's death in Italy

Today Italian media report about a child  who died in Naples on Friday after has been infected by A(H1N1) influenza virus. The child, a 11-years old girl, was cardiopathic. According to Il Mattino newspaper, it's the first child victim of the pandemic.
Anxiety is now spreading fast among population in Naples, while a lot of people in the high-risk list can't still get the shot of the vaccine. Censis, a public opinion research institute, has released a study about the pandemic. It says that more than 61 per cent of Italians aren't worried by the pandemic (but in South Italy only 51%). People were asked at the beginning of last August, so maybe someone have changed idea about the flu.

24 million doses of vaccine

The vaccination campaign against H1N1 virus has started. In some places it's just at the beginning, while in others it has already moved on the second stage. In Liguria the newspaper Il Secolo XIX explains that next Monday in Genoa doctors and other health workers will be vaccinated. Lombardia region is already at phase two of the process, so they will call pregnant women and people under 65 affected by chronic diseases.

Emilia-Romagna region is still completing stage one. Tuscany is operating at the second stage, while carrying out stage one, as Asca press agency reports. Abruzzo region doesn't seem to have received the vaccine against the pandemic flu.

In South Italy Puglia will start the campaign on Monday, first health personnel and pregnant women. The island of Sardinia too has to begin stage one

So, the campaign is on, but it has been carried on speedily in some regions and sluggishly in other parts of the country.

According to Agi press agency, the Minister has distributed one million doses of the pandemic vaccine. To vaccinate the health workers and other essential workers it expect to use 8 millions doses. At the end of the campaign it will distributed 24 million doses.

A diverse vaccine campaign

In Italy there're many differences in vaccine distribution at local level. Regional governments organize the health care services, so they are free to choose their organization. Adnkronos press agency has collected information about the vaccine campaign, about who will give the vaccine shot to people. Mb stands for “medico di base”, the family doctor. Asl is the local health center. Some Regions have decided that the vaccine will be available in Asl, some have asked doctors, some both, and some haven't still decided.

Week 43

According to the Iss data, the incidence in the 43th week of the year is 3,88 ‰ among all the people who got visited by doctors, and 13,02‰ among the 5-14 years old. The Iss released on October 28th also the local data, updated. In Campania (Naples and other cities) there is the highest incidence, but also in Lombardia (Milan) and Tuscany there are a lot of cases. Yesterday the Deputy Minister of Health Ferruccio Fazio said that in Europe only Spain has such an hign number of cases.
Piemonte 6,61 ‰
Val d'Aosta -
Pr. Aut. Bolzano 1,67
pPr. Aut. Trento 0,92
Veneto 0,88
Emilia-Romagna 3,06
Marche 4,86
Lazio 4,32
Molise -
Campania 12,37
Basilicata 1,33
Sardegna 0,55
Abruzzo 0,00
Calabria 1,08
Friuli vV.G: 0,93
Liguria 4,42
Lombardia 5,85
Puglia 1,75
Sicilia 2,13
Toscana 5,90
Umbria 2,64

More cases all over Italy

The H1N1 virus is spreading in Italy and it's more difficult to keep track of what is going on. Three fatal cases in North Italy: an old woman afflicted by pneumonia in Milan, a young man afflicted by TB in Ferrara, another woman in Rimini. A woman died in Rome and three men in Naples, a 64 years old doctor, a 50 years old afflicted by obesity, a 73 years old doctor already afflicted by pulmonary disease. All the news from Corriere della Sera newspaper. So, now the deaths caused by the virus are 12. On Monday the Lombardia health system will start the second part of the vaccine campaign, for pregnant women and young (under 17 years) people with chronic disease. In other parts of Italy the campaign is still focused on health care workers. This evening the flu news were on tv, on channel Rai 1 (link, in Italian). Health authorities continue to repeat that this flu is a mild one, and that it affects only ill people.
It seems to me that there's a lot of pressure to stop people panicking, and not such an effort to protect people with illness. Maybe I just find irritating, when someone infected by the virus dies, the comment: “the patient was already ill.”