More red zones like Italy’s are coming

Italian Prime Minister Giuseppe Conte’s decision to quarantine the entire country will perhaps be the beginning of a series of instances where health care systems are overwhelmed by coronavirus infection rates. The combustible situation in Italy, erupting out of Milan and spreading outwards, is radioactive enough to shut the country down. The increased restrictions will mean all public gatherings are banned across the country and movement will be limited other than for work or emergencies.

Conte addressed the young people in Italy who have continued to gather at night to socialize during the public health emergency. “This nightlife... we can’t allow this anymore,” he said. “Our habits must change, must change now. We must all give up something for the good of Italy.” This was a powerful statement requiring a change in behavior.

The quarantine measures imposed in the north of Italy now apply to the whole country. That means Italian authorities will allow travel to, from and within the country only if it is demonstrably necessary for work or health reasons. The nationwide quarantine also means employees are urged to take vacation and stay home, while bars and restaurants must close at 6pm and virtually all public gatherings are banned. In shops, churches and all gathering places, people must keep 1 meter’s distance apart. Now imagine that in your country — because such red zones are coming soon to all areas with similar outbreaks. Testimony from an Italian doctor stated that “an epidemiological disaster is taking place. And there are no more surgeons, urologists, orthopedists; only doctors who suddenly become part of a single team to face this tsunami that has overwhelmed us.”

The above testifies just how quickly COVID-19 can “bloom” among a population and its logistical lines of daily life. Application of the understanding of what constitutes contact in this particular pathogen environment is a human factors model that means a significantly altered way of life in order to contain the spread. Here, an approach using teleworking, or teleschooling, would help to bring about social distancing and could help buy time so that the pathogen does not spread so rapidly. This is not meant to instill any form of anxiety, but illustrates how scientists and practitioners must ask hard questions. These methods are already being instituted in the Gulf states as a result of the COVID-19 outbreak, and lessons learned from the ongoing disinfection treatment will be valuable.

As I notedin this column last month, the following needs to be repeated yet again: COVID-19 is a pathogen with a two-week incubation period, during which there are no symptoms. The ability to spread the pathogen by cough, sneeze and touch is proven. The COVID-19 cases in China appeared to be much more dramatic in terms of disease spread and issues of confinement and public response, including Chinese military troops demonstrating the requirements for maintaining order. Images of fog-spraying throughout Wuhan are raising questions about the Chinese techniques for treating what appear to be blocks of urban areas. Italy’s disinfection program is likely to get support from the World Health Organization as well as from Arabian Gulf states, which are undergoing their own treatment programs, with daily reminders of sanitation and necessary behavior adjustment.

The Italian program will likely be used across red zone countries or urban areas and specifically infected “pathways,” or routes through which humans may carry the pathogen. Seattle comes to mind. So does the disaster in Qom. COVID-19 could infect 60 percent of the global population if unchecked, according to one expert. Everybody now seems to be aware of the pandemic, as amply demonstrated compared to a month ago. Italy will be damaged greatly during next month’s Easter holiday season.

Japan, South Korea and other countries come to mind when considering COVID-19 forced containment methods aimed at stopping transmission. Islands are good examples of containment. Japan’s Hokkaido is known for its ski resorts, natural hot springs and rolling hills, making it a major tourism magnet, but it is in lockdown after an upsurge in coronavirus infections forced local authorities to declare a state of emergency. That lockdown began on Feb. 28. Why is Hokkaido important? The rapid spread of the virus there due to its popularity as a winter tourism destination illustrated how disease spread can occur. The famed Sapporo Snow Festival, which saw artists carve giant ice sculptures between Jan. 31 and Feb. 11, drew millions of visitors from around the world. 

Any event involving large crowds increases the transmission rate and illustrates the limits of preventing spread.

Dr. Theodore Karasik

To be clear, any event involving large crowds increases the transmission rate and illustrates the limits of preventing spread. Festivals and gatherings find people in close proximity, with funneling through entrances and exits putting people close to one another. 

Italy’s red zone announcement and subsequent handling of the results — prison riots and people moving rapidly from Lombardy — are likely to set a standard example of how not being ready for a global pandemic such as COVID-19 impacts almost everyone, simply due to our interconnected world. Milan’s launch point illustrates the spread radius and its implications are overwhelming just about everyone. Local administrators from China to Italy are being found to be unprepared for such outbreaks.

In Lombardy, the fleeing helped to spread the pathogen. Containment strategies work when social distancing, in the form of self-isolation, prevents COVID-19 from scattering further. Home education helps to finish studies during the period of disinfection, and the encouragement of working from home and “staying put” during this period is important. The risk to Europe is extremely high as new clusters appear. Applying key isolation rules and adjusting behavior to stem the distribution of the disease through understanding crowd dynamics is increasingly important. 

• Dr. Theodore Karasik is a senior adviser to Gulf State Analytics in Washington, DC. Twitter: @tkarasik