So the question is what has caused increased deaths if there actually was an unusual increase compared to previous years at all? Was it something else, like a multiresistent hospital infection in nursing homes?
> Conclusions: SARS-CoV-2 infection was already circulating in Milan at the outbreak start.
It just means that the virus entered the region a few weeks or months earlier than thought so far (the study started on Feb-24), not that there have been COVID-19 waves in previous years.
This seems similar to the recent news that the first case in France was backtracked to December 2019, e.g. the virus was already spreading before the first cases were discovered:
If this is true, wouldn't that mean that the R is in fact not as high as we believe it is, because it was spreading for longer on a slower rate as opposed to spreading fast in a shorter time period? If we think that it is still highly infecious then the only other conclusion can be that we have a much larger population already immunonised?
Not necessarily. r0 can be much more reliably measured than severity. hospitalization and death rates give pretty clear picture of doubling time, but could represent wildly different percents of the overall infections
Well, probably there were no previous years for SARS-CoV-2. If you are referring to the increased deaths compared to other regions in Italy, there are many factors, the most prominent probably being (a) Lombardy's terrible healthcare handling and corruption; (b) being affected much earlier than other regions they were later on the lockdown; (c) deliberate/criminal mishandling of retirement homes; (d) fewer tests performed and containment (for example Veneto has been much more proactive on this front).
I don't think it has anything to do with corruption and terrible healthcare (mistakes were made, but as a resident there, I think the system works pretty well nevertheless, or at least used to be pre-crisis).
I think it has more to do with the route of entry of the virus in the territory, which hit hospitals first (not closing down Alzano Lombardo was a grave mistake), then retirement homes (an error shared with Lazio and elsewhere).
This meant that the newly-infected population was largely skewed towards the most vulnerable, and coupled with imperfect knowledge about treatment, the net result was a lot of deaths.
As another resident (Milano), I think corruption is endemic in the regional health system. This is, of course, not to deny Lombardy healthcare compares well relative to that of most other Italian and European regions. Still, it was clearly overwhelmed and mismanaged. In my opinion, this and the timing of the first response account for the many deaths. And those in charge of both need to be held accountable.
That said, I do think the numbers of the Policlinico study might well be representative, at least regarding Milano. It is just anecdotal, but I know a lot of people there that got sick, but where unable to get tested, or waited weeks before receiving any treatment.
Symptoms are quite different, though. And they are evaluated by the ‘medico di base’ (general practitioner) before requesting a viral test. So I am not clear on what could be confounding.
