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| Isolating the Sick at Home, Italy Stores Up Family Tragedies | Isolating the Sick at Home, Italy Stores Up Family Tragedies |
| (about 4 hours later) | |
| ROME — When her middle-aged son got sick, Ruffina Pompei did what she had done for decades, bringing vegetable soup and freshly squeezed orange juice to his room. She slept in an armchair outside his room and changed his clothes. She told her husband, 89, to steer clear. | ROME — When her middle-aged son got sick, Ruffina Pompei did what she had done for decades, bringing vegetable soup and freshly squeezed orange juice to his room. She slept in an armchair outside his room and changed his clothes. She told her husband, 89, to steer clear. |
| But the coronavirus tore through the apartment. | But the coronavirus tore through the apartment. |
| Her son died in a hospital in the region of Abruzzo on March 29. Her husband died the next day in the same hospital. Ms. Pompei, 82, was also diagnosed with the virus. | Her son died in a hospital in the region of Abruzzo on March 29. Her husband died the next day in the same hospital. Ms. Pompei, 82, was also diagnosed with the virus. |
| “I could not leave him alone,” she said of her son. | “I could not leave him alone,” she said of her son. |
| Before everyone else in the West, Italians received and largely obeyed an order to stay at home. “I’m staying home” became a hashtag, then the name of a national ordinance and then a motto hung from balconies and windows. But while staying home has worked, reducing the rate of infections, bringing down the daily toll of the dead and creating breathing room for hospitals, home has become a dangerous place for many Italians. | Before everyone else in the West, Italians received and largely obeyed an order to stay at home. “I’m staying home” became a hashtag, then the name of a national ordinance and then a motto hung from balconies and windows. But while staying home has worked, reducing the rate of infections, bringing down the daily toll of the dead and creating breathing room for hospitals, home has become a dangerous place for many Italians. |
| Italian households represent “the biggest reservoir of infections,” said Massimo Galli, the director of the infectious diseases department at Luigi Sacco University Hospital in Milan. He called the cases “the possible restarting point of the epidemic in case of a reopening.” | Italian households represent “the biggest reservoir of infections,” said Massimo Galli, the director of the infectious diseases department at Luigi Sacco University Hospital in Milan. He called the cases “the possible restarting point of the epidemic in case of a reopening.” |
| The family acts as a multiplier, said Andrea Crisanti, the top scientific consultant on the virus in the Veneto region. “This is a ticking time bomb,” he said. | The family acts as a multiplier, said Andrea Crisanti, the top scientific consultant on the virus in the Veneto region. “This is a ticking time bomb,” he said. |
| The predicament of home infections is emerging not just in Italy but in hot spots across the globe, in Queens and the Paris suburbs, as well as the working-class neighborhoods of Rome and Milan. It is also a problem that local officials and epidemiologists say is getting too little attention, particularly as the government has announced tentative steps toward reopening in early May. | The predicament of home infections is emerging not just in Italy but in hot spots across the globe, in Queens and the Paris suburbs, as well as the working-class neighborhoods of Rome and Milan. It is also a problem that local officials and epidemiologists say is getting too little attention, particularly as the government has announced tentative steps toward reopening in early May. |
| Italy’s leading virologists now consider home infections, alongside clusters in retirement homes, to be a stubborn source of the country’s contagion. Living together in close quarters and the failure to move the infected into dedicated quarantine facilities have, they say, paradoxically propped up the curve of infections that “stay home” measures were designed to suppress. | Italy’s leading virologists now consider home infections, alongside clusters in retirement homes, to be a stubborn source of the country’s contagion. Living together in close quarters and the failure to move the infected into dedicated quarantine facilities have, they say, paradoxically propped up the curve of infections that “stay home” measures were designed to suppress. |
| The problem is one the Chinese government bludgeoned quickly. It ordered the roundup of all residents in Wuhan infected with the coronavirus, warehousing them in quarantine camps, sometimes with little care. While that approach may have helped contain the virus, ripping people apart from their homes is anathema to Western democracies, especially Italy, where tight-knit families are the rule. | The problem is one the Chinese government bludgeoned quickly. It ordered the roundup of all residents in Wuhan infected with the coronavirus, warehousing them in quarantine camps, sometimes with little care. While that approach may have helped contain the virus, ripping people apart from their homes is anathema to Western democracies, especially Italy, where tight-knit families are the rule. |
| Italy, like other Western democracies, has wrestled with the difficulty of balancing the containment of the virus with the economic, social and political costs of removing people without symptoms from their own homes. The government has not made isolating patients outside their homes a priority. | Italy, like other Western democracies, has wrestled with the difficulty of balancing the containment of the virus with the economic, social and political costs of removing people without symptoms from their own homes. The government has not made isolating patients outside their homes a priority. |
| “As a doctor I would say let’s put tanks in the streets and let’s do a police state,” said Guido Marinoni, the president of the Bergamo doctors’ association. “But the Western world has different realities.” | “As a doctor I would say let’s put tanks in the streets and let’s do a police state,” said Guido Marinoni, the president of the Bergamo doctors’ association. “But the Western world has different realities.” |
| Italy has not enacted, or articulated, a clear national effort to prevent contagious people from infecting their households. The country has essentially accepted a controlled tragedy at home as it focuses on preventing a contagion from running like wildfire through the society at large. | Italy has not enacted, or articulated, a clear national effort to prevent contagious people from infecting their households. The country has essentially accepted a controlled tragedy at home as it focuses on preventing a contagion from running like wildfire through the society at large. |
| “Domestic contagion is the lesser evil,” said Giorgio Palù, a former professor of virology and microbiology of the University of Padova and the former head of the European and Italian Society for Virology. Compared to unleashing the contagion on the streets, it was better to keep the virus in the family. “At home,” he said, “I block it.” | “Domestic contagion is the lesser evil,” said Giorgio Palù, a former professor of virology and microbiology of the University of Padova and the former head of the European and Italian Society for Virology. Compared to unleashing the contagion on the streets, it was better to keep the virus in the family. “At home,” he said, “I block it.” |
| Silvio Brusaferro, the president of Italy’s national health institute, and one of the leading advisers to the Italian government in the crisis, acknowledged that homes were “higher-risk places,” and on Friday, demonstrated that family infections accounted for up to 25 percent of new cases. But he said that what was essential was that home infections “do not spread further.” | Silvio Brusaferro, the president of Italy’s national health institute, and one of the leading advisers to the Italian government in the crisis, acknowledged that homes were “higher-risk places,” and on Friday, demonstrated that family infections accounted for up to 25 percent of new cases. But he said that what was essential was that home infections “do not spread further.” |
| But that offers little solace to the close-knit, multigenerational families decimated by the virus in their own homes — to the infected sisters who lost their father and then saw their grandfather hospitalized in hard-hit Bergamo; to the Campanian hairdresser who lost both her parents; to the metalworker in Voghera who died days after losing his two sons. | But that offers little solace to the close-knit, multigenerational families decimated by the virus in their own homes — to the infected sisters who lost their father and then saw their grandfather hospitalized in hard-hit Bergamo; to the Campanian hairdresser who lost both her parents; to the metalworker in Voghera who died days after losing his two sons. |
| Experts have estimated that more than a million people in Italy could be infected with the virus at home. The persistence of cases is telling. Despite a nationwide drop in the number of new infections and deaths, Lombardy, which remains the Italian epicenter, announced more than 5,000 new cases this week alone, with nearly 900 deaths. | Experts have estimated that more than a million people in Italy could be infected with the virus at home. The persistence of cases is telling. Despite a nationwide drop in the number of new infections and deaths, Lombardy, which remains the Italian epicenter, announced more than 5,000 new cases this week alone, with nearly 900 deaths. |
| Many public health officials say that the actual number of infections could be as many as 10 times that. | Many public health officials say that the actual number of infections could be as many as 10 times that. |
| Federico Ricci-Tersenghi, a scientist at the University of Rome La Sapienza who specializes in theoretical modeling, said that stemming the contagion required facilities like in China dedicated to isolating positive cases. | Federico Ricci-Tersenghi, a scientist at the University of Rome La Sapienza who specializes in theoretical modeling, said that stemming the contagion required facilities like in China dedicated to isolating positive cases. |
| “Staying home is not the solution, not for the economy or for the epidemic,” he said. “To reopen without having this in place is very risky. It’s probable that the epidemic will start up again.” | “Staying home is not the solution, not for the economy or for the epidemic,” he said. “To reopen without having this in place is very risky. It’s probable that the epidemic will start up again.” |
| When a delegation of Chinese doctors came to Italy in March, they emphasized the importance of prefabricated structures with a high number of beds to isolate all the positive cases. | When a delegation of Chinese doctors came to Italy in March, they emphasized the importance of prefabricated structures with a high number of beds to isolate all the positive cases. |
| “They explained that it was essential to separate positive cases from the family,” recalled Giampietro Rupolo, the president of the Red Cross in Padua, who was among those who greeted them. “Otherwise it was harder to contain.” | “They explained that it was essential to separate positive cases from the family,” recalled Giampietro Rupolo, the president of the Red Cross in Padua, who was among those who greeted them. “Otherwise it was harder to contain.” |
| But Italian officials have clearly determined that housing the infected in dedicated facilities is not feasible. | But Italian officials have clearly determined that housing the infected in dedicated facilities is not feasible. |
| Giovanni Rezza, director of infectious diseases at the national health institute, said that the government did not think that a centralized effort was “feasible, possible, appreciated.” | Giovanni Rezza, director of infectious diseases at the national health institute, said that the government did not think that a centralized effort was “feasible, possible, appreciated.” |
| Italian media have reported that the government is considering making the lifting of lockdowns in Italy’s regions contingent on local authorities providing quarantine facilities for the infected. Experts have also emphasized the importance of contact tracing and early diagnoses, since contagion can also happen before a patient starts showing symptoms. | Italian media have reported that the government is considering making the lifting of lockdowns in Italy’s regions contingent on local authorities providing quarantine facilities for the infected. Experts have also emphasized the importance of contact tracing and early diagnoses, since contagion can also happen before a patient starts showing symptoms. |
| For now, however, Prime Minister Giuseppe Conte has largely steered clear of the issue of home infection. A government decree in March allowed local authorities to seize hotels to host patients who cannot safely self-isolate at home. But, as is the case with many of the government decrees, it is being interpreted and implemented differently around the country. | For now, however, Prime Minister Giuseppe Conte has largely steered clear of the issue of home infection. A government decree in March allowed local authorities to seize hotels to host patients who cannot safely self-isolate at home. But, as is the case with many of the government decrees, it is being interpreted and implemented differently around the country. |
| Updated June 24, 2020 | |
| Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles. | |
| A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico. | A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico. |
| The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. | The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. |
| The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. | The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. |
| So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. | So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. |
| Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. | Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. |
| A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. | A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. |
| The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. | The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. |
| Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. | Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. |
| If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) | If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) |
| If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. | If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. |
| In most cases, only people with confirmed cases can go to dedicated hotel rooms. But the hotel rooms are not available everywhere, and neither are tests for the virus, which in the hardest-hit places are given only to people who have been hospitalized. | In most cases, only people with confirmed cases can go to dedicated hotel rooms. But the hotel rooms are not available everywhere, and neither are tests for the virus, which in the hardest-hit places are given only to people who have been hospitalized. |
| Officials in Tuscany have urged people who left the hospital with mild symptoms to isolate in converted hotels. But urge is all they could do, and by mid-April only 200 had chosen the facilities. Others preferred to sign a document declaring they would self-isolate at home. In Milan, the Michelangelo Hotel, set aside for residents with positive coronavirus test results, was far from full. | Officials in Tuscany have urged people who left the hospital with mild symptoms to isolate in converted hotels. But urge is all they could do, and by mid-April only 200 had chosen the facilities. Others preferred to sign a document declaring they would self-isolate at home. In Milan, the Michelangelo Hotel, set aside for residents with positive coronavirus test results, was far from full. |
| In Bergamo, the hardest-hit part of Italy, there are only 400 spots set aside in local hotels for an infected population at home estimated to be around 65,000, according to the local doctors’ association. | In Bergamo, the hardest-hit part of Italy, there are only 400 spots set aside in local hotels for an infected population at home estimated to be around 65,000, according to the local doctors’ association. |
| Working-class Italians often face the hardest choices. | Working-class Italians often face the hardest choices. |
| In the southern region of Calabria, Paolina Mazza, 63, who has the coronavirus, self-isolated at home after her husband was hospitalized with the virus. She expressed frustration that authorities gave her no alternative but to go home, where she tried to keep some distance from her son, 39. | In the southern region of Calabria, Paolina Mazza, 63, who has the coronavirus, self-isolated at home after her husband was hospitalized with the virus. She expressed frustration that authorities gave her no alternative but to go home, where she tried to keep some distance from her son, 39. |
| “We don’t have a second house to isolate and they live in a tiny apartment,” her daughter Daniela said. “We are constantly scared.” | “We don’t have a second house to isolate and they live in a tiny apartment,” her daughter Daniela said. “We are constantly scared.” |
| Even some doctors considered the infection of their own families as inevitable. | Even some doctors considered the infection of their own families as inevitable. |
| Federica Brena, a 35-year-old doctor in the coronavirus ward of Bergamo’s Humanitas Gavazzeni hospital, came down with symptoms and immediately diagnosed herself and self-isolated at home, with her husband and 1-year-old son. | Federica Brena, a 35-year-old doctor in the coronavirus ward of Bergamo’s Humanitas Gavazzeni hospital, came down with symptoms and immediately diagnosed herself and self-isolated at home, with her husband and 1-year-old son. |
| “The ideal option would have been to never go back home,” she said. “It was obvious that I would infect the two of them.” | “The ideal option would have been to never go back home,” she said. “It was obvious that I would infect the two of them.” |
| Her son came down with a fever and a cough. Her husband also got sick a few days later, and his fever did not go down for 12 days. “Living in a home with other people, for as much as one tries to isolate, it’s hard,” she said, adding everyone was improving. “Especially if you don’t live in a palace.” | Her son came down with a fever and a cough. Her husband also got sick a few days later, and his fever did not go down for 12 days. “Living in a home with other people, for as much as one tries to isolate, it’s hard,” she said, adding everyone was improving. “Especially if you don’t live in a palace.” |
| Self-isolating was also especially difficult for older people, who often need special care and attention. | Self-isolating was also especially difficult for older people, who often need special care and attention. |
| In late February, Emanuele Visigalli and his brother looked after their mother, 79, who had come down with a cough and temperature in the Lombardy town of Fombio, near the country’s initial outbreak. | In late February, Emanuele Visigalli and his brother looked after their mother, 79, who had come down with a cough and temperature in the Lombardy town of Fombio, near the country’s initial outbreak. |
| He tried to get her hospitalized, but dispatchers from the coronavirus hotline suggested she self-isolate at home. The idea of abandoning them, he said, was impossible. | He tried to get her hospitalized, but dispatchers from the coronavirus hotline suggested she self-isolate at home. The idea of abandoning them, he said, was impossible. |
| An ambulance first came for his mother. Then for his father, 81. Then, a week later, another came for him. Both his parents died in the hospital, but he improved and doctors sent him home. | An ambulance first came for his mother. Then for his father, 81. Then, a week later, another came for him. Both his parents died in the hospital, but he improved and doctors sent him home. |
| He said he did not hug his children or kiss his wife when he got back, and started sleeping in a separate room that his wife disinfected every day. | He said he did not hug his children or kiss his wife when he got back, and started sleeping in a separate room that his wife disinfected every day. |
| “At the dinner table, I sit on one side of the table and they all sit on the other side,” he said. Looking out his window, he said he grew upset by the people walking the streets. “What is their problem with staying at home?” | “At the dinner table, I sit on one side of the table and they all sit on the other side,” he said. Looking out his window, he said he grew upset by the people walking the streets. “What is their problem with staying at home?” |