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About Those Other Immunocompromised People?
While much is being made of the course of COVID-19 in Italy, it is worth remembering a couple of things as we focus our efforts in the United States. It appears that the same disease which we are now encountering found a very different population and medical readiness in Italy.
1. Italy has been committing demographic suicide for decades. Italy is down to 1.3 live births per woman. A major author wrote a decade ago that the big Italian family was a myth today, that an Italian child is most likely to grow up with no siblings and only one first cousin. So, it should be no surprise that Italy’s median age is already over 47. That is, Italy was already vulnerable to a disease that especially threatens the elderly because that is where their population has been shifting. The same holds for much of Europe.
2. Before this latest pandemic, Italy was ranked behind Mexico on the Global Health Security Index, rating nations’ readiness to prevent, contain, and treat infectious disease outbreaks. So let’s not hear too much about 1st world medical systems in Italy.
In comparison, the U.S. median age is 38. We rank 1 on the GHS index, to Mexico’s 28 and Italy’s 31. So, yes, we should expect to see the disease run a somewhat less lethal course here. However, words matter. The real experts warned repeatedly that it is not just the elderly with underlying conditions, rather it is people with compromised immune or respiratory systems who face serious, life-threatening danger from COVID-19.
That brings us right back to Dr. Drew’s warnings for the past year, and it validates his call for a significant portion of the COVID-19 Congressional slush fund to get put directly to use in attacking the public health crisis of the homeless in Los Angeles, San Francisco, and Seattle. Dr. Drew’s comment was that he would completely change his assessment of the disease if it got loose in the Los Angeles homeless population: immunocompromised, already lacking basic immunizations, malnourished, living in close, crowded quarters, with no sanitation.
But, would that only mean more deaths of street people, who are already vulnerable to other sources of early death? No. If an infectious respiratory ailment gets into the homeless populations of major cities, then all the other people living and working in the area suddenly face much greater exposure. If it is time to deploy a public health army of sorts, this is where it needs to go.
Published in Domestic Policy
On the other hand, the United States is in the lead among major Western developed countries for one of the risk factors for COVID-19: Obesity. The U.S. is 33% obese and Italy 21%. Obesity is concentrated in our lower classes clustered in the major cities, who also tend to smoke and have poorer health in general, while naturally living right next to each other (being in the city). Not going to be pretty.
I believe the same people who castigate the President for his assertive actions to protect citizens – regardless of what the actions are are – will demand that there be no actions which would infringe any of the so-called rights of the homeless and illegal to be ill and infect others with their illness(es.) And no vaccines shall be required.
As to the demographics of Europe, it seems to me that no one is reporting nor considering the massive impact the intrusion of millions of non-citizens to otherwise stressed EU States like Italy and Greece. I can’t imagine that any of the invaders are fundamentally healthy and with current medical records. They seem to have comprised young adult males which one would presume to be stronger than others, but even if ill are they likely to seek care or continue to spread disease among their peers?
Italians have a significantly longer life span than US, overall actually healthier.
Northern Italy has one of the best health systems in the world, comparable to our own, and it is overwhelmed.
I suspect the big cities in the US are in for a wild ride.
Doesn’t Italy also nationalize their healthcare?
According to Wikipedia, health care spending in Italy is about 77% public.
For comparison, Canada’s health care spending is about 70% public. Health care spending in the USA is about 64% public.
They have multiple tiers. Their first tier (private) is very good.
My sister was in Italy last fall and said the tour guide, whose mother was a doctor, paid cash to go to a private clinic because the wait was too long. Her mother insisted. I have no idea how to compare health systems, as you noted lifestyle is a major factor in longevity. All I know is what I read and hear.
Italy’s demographic suicide isn’t the lesson to be taken from this. It’s that Italy is imposing a near China-level quarantine on its citizens in an effort to slow the spread of the illness.
But as long as R0 is high enough, as long as on average each person with the virus infects enough people to keep it going. At R0=2.6, which has been reported in the West (China’s was >3 at the worst) the number of cases will double in a bit over 6 days. This matters.
As Aesop notes,
This is what it looks like right now in northern Italy. Unless we get R0 down, this is coming before the election to a hospital near you.
While we have people – and a political party – in this country whose political careers would benefit from the epidemic spreading, we can be confident that their patriotism will outweigh their self-interest as it so often has in the past.
What about the push pack program started under Clinton to mobilize treatment in case of a national emergency? Anybody know how that figures in here, or if it does? This would be a good time to dust it off.
There is a book called Germs: Biological weapons and America’s Secret war that could be a good read right now.
Pray God patriotism does outweigh, now, the self-interest. Some apparently failed to get the “patriotism” memo.
I was thinking of Loral, and Skolkovo, and Feinstein, and Biden, and Uranium One… and was trying to be high minded enough not to conclude with /sarc. Maybe the horse will learn to sing.