1/ Why are thousands of people in #Italy still getting infected with #coronavirus every day? And hundreds still dying daily after more than a month of lockdown? I am not an expert. This THREAD contains some of the latest information I've learned from experts in Italy. #COVID19

2/ Because of limited testing, we do not know the total number of people who have been infected with & died of COVID-19 here in Italy. The data we do have seem to indicate a decline of infected & deceased people at a national level.

3/ Italy is entering its 6th week of national lockdown. While numbers seem to be on the decline, there are still 3,000-4,000 new official infections & some 500 new official deaths each day.

4/ A 2-week period with no symptoms is supposed to “clear” people of being contagious or infected, but Italy has gone through roughly 2.5 such periods & is not yet in the clear.

5/ So why are so many people still getting infected & dying? Only detailed research will give the full picture, but talking with experts & looking at available data, here are 3 *possible* explanations in the meantime:

6/ First possible explanation: in 2 separate Milan hospitals a majority of doctors & nurses who contracted COVID-19 still tested positive after 2 weeks. Only 30% tested negative after 2 weeks.

7/ Among that group, one person who tested positive has not yet tested negative after 40 days. That seems to indicate that people might still be contagious over a longer period than currently estimated.

8/ Second possible explanation: even in extremely hard-hit areas such as Lombardy, and even with widespread lockdown measures, there is a sizeable part of the population that still moves about for work or other essential activities.

9/ Google mobility data show that visits to work have dropped by more than 60% in Italy, meaning almost 40% of work-related trips & activities are still taking place, possibly contributing to the ongoing infections & deaths, or at least to their painfully slow decrease.

10/ Google mobility data also suggest that time spent at home is up by 18-24% in Italy. This brings us to the third possible reason why the curve is not going down more rapidly.

11/ Third possible explanation: propelled by the 2 other factors, families may become even stronger drivers of infection, as the lockdown increases time spent at home by people who may be contagious for longer than currently deemed possible and who are still moving around.

12/ So, what can be done?

13/ The city of Milan, among the places in Italy where the infection curve is flattening the least, is now considering doubling the quarantine period to 28 days.

14/ Milan also intends to focus on expanding testing and serological (antibodies) checks to people quarantined at home, as well as their families, to establish who is still contagious before the lockdown lifts.

15/ Physically separating people who have tested positive (infected, recovering or with few/no symptoms) from their family & placing them in specially designated hotels or living quarters, something Asian countries have done, may be the best feasible option. We shall see. END