Ask HN: How is actually Italy confirming SARS-Cov2 cases?

[dakrisht]

Italy is at 53,000+ confirmed cases of SARS-Cov2.

This would assume they have tested upwards of 200,000+ patients in order to get a 25% infection rate.

I'm using 25% as a conservative figure. If you liberally drop this down to 10% infected tested, we'd have to be at 500,000+ successfully administered, processed and reported RT-PCR tests.

Side note: Roche's best machines, for example, can process 4,100 RT-PCR tests in a fully automated fashion and this not just a machine on a desktop, but a full-blown assembly line operation.

Intriguing.

[dx034]

I'm not sure about the testing regime they use but they publish the number of people tested on a daily basis. The data is available on wikipedia [1], currently they stand at ~233,000.

As an orientation, Germany doesn't publish aggregated numbers but federal organizations said in an interview that at the moment, ~100-150k tests per week are performed, so the positive rate there should be <5%. But I'm not sure how reliable that number is. Local test centers don't have to report all tests (just positive ones) so I'm not even sure if the government has that info.

[1] https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_I...

[yash1th]

They also publish it on github [1]

[1] https://github.com/pcm-dpc/COVID-19/blob/master/dati-andamen...

[DrNuke]

The quick answer is any emerged, severe case or death with the suspected presence of bilateral interstitial pneumonia (which symptoms are now well known globally) is registered as a covid case. It is fair enough when hospitals are out of capacity and people just die at home. The underlying point is Lombardy is suspected to have x5-x10 active circulating covid cases, which would put mortality at the same and more coherent, global rate. The fact that co-morbidity cases are all put into the same coronavirus basket is what makes numbers so high, but please consider these are all people who would not die today without coronavirus, and there is really no allowed time or resources to make better classification when more and more cases come knocking at the door daily.

[easytiger]

> The quick answer is any emerged, severe case or death with the suspected presence of bilateral interstitial pneumonia (which symptoms are now well known globally) is registered as a covid case.

It's not really acceptable in a country than loses between 8-24k people a year to influenza strains anyway.

Are you sure this is true? Another post claims all dead are tested.

[nirse]

> It's not really acceptable

I think using these kind of terms is unwise in these troubled days, unless you are a professional in the relavant field, and if you are, Hackernews isn't the platform for the discussion.

An epidemiologist friend explained various things to me the other day: 1. hardly anyone dies OF covid-19 (cause of death on death certificate), people die WITH covid-19 (in which case it would still be mentioned somewhere on the death certificate). 2. A great many different statistics are generally gathered, but these are complex and need a lot of knowledge to interpret. These would include cases where Covid-19 was suspected to be involved, confirmed to be involved, prime cause of death (which is very rare, according to my friend). In the end, the general public is presented with a single number which indeed doesn't tell the whole story, but at least gives some indication of the situation.

[DrNuke]

Dead are all tested... when dead. If coronavirus accelerates the passing away of chronically ill or severely ill people, would you count that as a covid death? Italy does, that’s the point. And it is not influenza, please stop that, the particular pneumonia associated with covid is viral instead of bacterial, and there is no antibiotic for that, only drugs (experimental, allowed for compassionate use) mitigating the quick and deadly inflammation effects.

[easytiger]

I see your point.

Italy always fares poorly year on year on flu seasons

https://www.sciencedirect.com/science/article/pii/S120197121...

> We estimated excess deaths of 7,027, 20,259, 15,801 and 24,981 attributable to influenza epidemics in the 2013/14, 2014/15, 2015/16

> And it is not influenza, please stop that,

I never asserted that it was, if you read the comment you will see that I was asserting that they usually fare poorly in influenza seasonal outbreaks. For the same reasons it's faring poorly with cv19

[VladimirGolovin]

>> Roche's best machines, for example, can process 4,100 RT-PCR tests in a fully automated fashion

What's this number? Tests conducted per day? The number of DNA patterns known to the analyzer?

[dakrisht]

Roche’s Cobas 8800 can do roughly ~4100 tests per day and this is a massive full-room setup.

Many other RT-PCR capable machines exist out there (800 is the total number in Europe cumulative) but this assumes an efficient point-of test > courier > lab > results process which many countries simply lack.

https://news.ycombinator.com/item?id=22575661

[Jaxkr]

Based on symptoms and where the people were geographically.

One or two tests can confirm cases for a whole town. They simply (and safely) assume that all flu-like illnesses coming from a certain area are covid.

[ramblerman]

Wow really. Do you have a source for that?

Because if true, combine that with the facts that

- 87% of deaths occur at home and not in ICU [1]

- median age of deaths is 80 years old [2]

Are all deaths just being counted as Covid-19 (without test then)? I think it would be really interesting to compare baseline deaths in February/March from previous years to this one.

[1] https://www.tgcom24.mediaset.it/cronaca/coronavirus-in-lomba...

[2] https://www.epicentro.iss.it/coronavirus/bollettino/Report-C...

[acqq]

> I think it would be really interesting to compare

It is already compared. On

https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_I...

you can easily see:

https://en.wikipedia.org/wiki/File:Is_COVID-19_like_a_flu%3F...

and it's not flu and the number of people who can't breathe, have fever and die is orders of magnitude higher.

[dakrisht]

I see the data. There is a surge, obviously.

However, this assumes the current surge deaths are 100% SARS-Cov2 confirmed infections.

They aren’t. At least not 100%

Assumption can be made “atypical, bad flu season” but safer bet is on “newly discovered virus out of China that did x and y and z damage over there.”

While both theories are just that, theories. There is no empirical data which PROVES x-cases and y-surge is directly related to a confirmed SARS-Cov2 pathogen confirmed by RT-PCR and antibody test.

The Italian data is wrong period. Why or how is another debate.

[diracwasright]

All dead patients were tested and they were positive. The Italian ISS is reporting that those patients went full ICU with the most common symptoms associated with Covid-19, notably respiratory failure, then "danno renale acuto", "danno miocardico acuto" and "dovrainfezione", which I'm not going to translate for you, and this is happening regardless of their pre-existing conditions. There's no easy assumption except yours. Stop blaming italian professionals and I invite you to visit our government websites for the details, for which I'm not going to provide a link for you. Also, there is no guessing game as to who is affected by the virus. Again, you need not to mix your prejudice against Italians with the emergency we are having.

[easytiger]

> All dead patients were tested and they were positive

Good to hear. Is there an official statement on that?

> Also, there is no guessing game as to who is affected by the virus.

In what sense do you mean? No guessing about what?

[dakrisht]

This is another valid point and disturbing point.

Italians are most likely counting most if not all deaths as SARS-Cov2 deaths.

1) A large amount of the elderly are going to hospitals because of pre-existing conditions that might be flaring up or presenting as they normally do. They enter the clinic > get complications > get marked down as dying from SARS-Cov2. And/or they acquire hospital acquired pneumonia (HAP).

2) I’ve read the ISS report cover to cover and yes, nearly ALL deaths are due to 1) age greater than 70, 2) 75% showing 2 (two) or more per-existing conditions with a staggering 99% showing 1 (one) or more pre-existing conditions. Let’s not forget the above comment (HAP or other hospital acquired infections from SARS-Cov2, Influenza, whatever).

3) Seeing a death count YOY would be beneficial here indeed.

I don’t think ANYBODY will be able to answer my initial question here.

There is NO WAY in hell the Italians have tested over 200,000 patients for SARS-Cov2 in a matter of 2-3 weeks due to:

1) such capacity simply does not exist

2) Italians have been under quarantine and when they weren’t they were drinking coffee and not lining up for tests.

3) the time of test > result trajectory > reported data is impossible

4) such high throughout testing capacity simply does not exist

Where are these magic numbers coming from? :)

[lpinca]

> There is NO WAY in hell the Italians have tested over 200,000 patients for SARS-Cov2 in a matter of 2-3 weeks due to

See https://lab24.ilsole24ore.com/coronavirus/#box_6 that graphs shows the number of tampons per day.

https://lab24.ilsole24ore.com/coronavirus/#box_5 total tampons: 233222. The source is the Italian Ministry of Health.

Also in Italy, unlike what happens in other countries, all deceased people positive to the test are classified as "Covid deaths", regardless of the simultaneous presence of other serious diseases.

[liqu0rice]

> 1) such capacity simply does not exist

Germany is able to conduct more than 160,000 tests per week. I do not know the numbers for Italy, but why shouldn't they be able to reach that number over 2-3 weeks?

[dakrisht]

Apples to oranges. Can not compare Italy with Germany.

Germans are willingly being tested, there process, order, proactive testing. In Italy everyone is 1) quarantined for the past 2 weeks and 2) didn’t even give a crap about this prior to the quarantine.

Italy is triaging, out of hospital space, vastly over estimating numbers, and probably using models with some accuracy to report their numbers. Unless someone can PROVE this otherwise.

Their death rate is what it is due to a very elderly population, with 2 or more co-morbidities, in understaffed and overwhelmed hospitals full of chaos, and infection.

[dakrisht]

> One or two tests can confirm cases for a whole town.

What?

>They simply (and safely) assume that all flu-like illnesses coming from a certain area are covid.

So Influenza A, B are safely assumed to be SARS-Cov2.

Yeah... no.

[acqq]

If the average number of cases in some small area (e.g. a block or blocks of buildings, a part of town, a town) is e.g. two patients with symptoms X per MONTH, and the symptoms include FEVER and not being able to breath, i.e. something people can't just make up and can be easily measured, and THEN you get a patient from a block of buildings with symptoms X and THEN you test him and get a positive result and THEN you get ten more people from there with symptoms X, AND in the same small are some people have the same symptoms and are in such a bad condition that they need to be connected to the MACHINES and some DIE, you can be very sure it's a virus which never existed among the humans before generating these symptoms.

Otherwise, it would have to be some OTHER virus not known to humanity appearing at the same time, behaving unlike the viruses we know and watch every year, magically appearing exactly in the community where you verified the existence of the one for which you test.

[dylz]

You can rapid-test for flu. If it's an ILI and tests negative for flu, it's probably COVID at this point.

[dakrisht]

Ok sure. Still inaccurate to assume it’s SARS-Cov2.

This is not a game of assumptions.

Furthermore, Italy tested over 200,000 samples in a little less than 14 days? Don’t think so.

Numbers aren’t making sense. At all.

[erk__]

It very much is. When you are limited in every way you have make some cuts. This is just the cut that says that it is probably covid if it is not flu and they are from an area with test confirmed cases. And in by far most cases it is going to be correct. Probably as correct as the current test for covid.

[dakrisht]

So 200,000+ people under mandatory lockdown went to a clinic (not a drive through test, a physical clinic), lined up and waited to get tested for Influenza which was assumed to be SARS-Cov2?

Or maybe Italy tested 200,000+ samples with RT-PCR technology with machines and labs and tests / swabs they don’t have?

Not trying at all to spin conspiracy theories here but these numbers simply do not add up.

As a corollary: there are a myriad of infections that can present as fever and cough: rhinoviruses, influenza, bronchial infections, gastroenteritis, auto immune flare ups, sinusitis and season allergies, the list goes on.

We are all speculating btw.

[ecesena]

As of today they did 275,468 tests: https://docs.google.com/spreadsheets/d/1xAyDSpzEp3n4iiu54_XL...

This is a post (sorry, in Italian) that describes the "strategy" adopted to test people, that of course varies by region. tl;dr: in regions like Lombardia (the most affected) they can almost only test people who really show severe signs, therefore the rate is around 38%.

https://www.ilpost.it/2020/03/20/tampone-test-coronavirus/

Official data is here: https://github.com/pcm-dpc/COVID-19, I just put it in a spreadsheet for easier consumption.

Edit: forgot a link

[lurquer]

The answer is obvious and not fairly deniable.

But, one isn't permitted to voice it.

[scusely]

What is it? I have no idea.

[lurquer]

The medical system in Italy sucks. The northern region sees a scandalously high number of elderly die every day in the winter. Upwards of 200 a day. The issue is political.

Covid is a convenient cover for the scandal. If you die in Lombardy -- for any reason -- you are listed as a covid patient. It's fraud.

Plain and simple.

(Incidentally, its not all of Italy... just the northern region.)

The number of tests is equally bullshit. As another poster in this thread alluded to -- and I think there is a link up there -- the number is an 'estimate'.

[denulu]

Normally it's 250 deaths > 65 years per week, which would make it 36 per day

https://www.epicentro.iss.it/influenza/FluNews18-19#mortalit...

[lurquer]

From the source, translated:

"During the sixteenth week of 2019 mortality was lower than expected, with a daily average of 190 deaths compared to the expected 200."

Read Italian news from the past few years regarding then northern region; the numbers of geriatric deaths -- far in excess of other EU members -- has been a long-running scandal.

More data here: https://www.sciencedirect.com/science/article/pii/S120197121...

I trust you've read the recent Telegraph article revealing that only 12% of reported Italian covid deaths could be directly attributed to covid.

But, I'm not that concerned about persuading you. If you wish to believe there is something unique about northern Italy -- while 100 miles to the south, east, west, and north the mortality rates are utterly different, so be it.