Showing posts with label COVID-19. Show all posts
Showing posts with label COVID-19. Show all posts

Tuesday, July 20, 2021

Katherine Eban on COVID-19 Origin

Peter Attia interviewed Katherine Eban about the origin of the COVID-19 disease (link to podcast), an investigative reporter who's done some amazing work on generic drugs in the past.


While I have a few issues with her argument about the COVID-19 disease's origins (hence this short post) let me say that I think this is in general an excellent interview, and a very good introduction to the issue if you are not familiar with it already. Eban and Attia go through the key points, and a number of rather uncomfortable points are included. So I recommend it, but with the caveats addressed below (which is not comprehensive).

Attia sells the transcript to these podcasts to subscribers, and I do not subscribe, so I did these brief snippets myself. Timestamps are mine, as are any errors.

00:05:47: "One might say [the origin] was settled a while ago, or seemingly settled..."

So, a little bit of my background on looking into this:
So over a year before Vanity Fair published Eban's article, it was pretty obvious that the Wuhan Institute of Virology lab (WIV) was a possible, if not likely source of the disease.
"“The idea that it was just a totally natural occurrence is circumstantial. The evidence it leaked from the lab is circumstantial. Right now, the ledger on the side of it leaking from the lab is packed with bullet points and there’s almost nothing on the other side,” the [Trump administration] official said."

That quote was from an OpEd in the Washington Post published on April 14, 2020. This podcast contains nothing that adds to or subtracts from that conclusion.

So, disagreements.

The Moratorium

The Asian Times article from April 22, 2020 makes a mistake that Eban repeats in her own analysis:

"Back in October 2014, the US government had placed a federal moratorium on gain-of-function (GOF) research – altering natural pathogens to make them more deadly and infectious – as a result of rising fears about a possible pandemic caused by an accidental or deliberate release of these genetically engineered monster germs."

Lin, the author, links to an article that says: 

"[The White House] is halting all federal funding for so-called gain-of-function (GOF) studies that alter a pathogen to make it more transmissible or deadly so that experts can work out a U.S. government-wide policy for weighing the risks. Federal officials are also asking the handful of researchers doing ongoing work in this area to agree to a voluntary moratorium."

Eban's Vanity Fair article states:

"In October 2014, the Obama administration imposed a moratorium on new funding for gain-of-function research projects that could make influenza, MERS, or SARS viruses more virulent or transmissible. But a footnote to the statement announcing the moratorium carved out an exception for cases deemed “urgently necessary to protect the public health or national security.”
Eban sent me an article similar to Lin's source via twitter: 

Which stated (correctly) that:

"...the US government is temporarily halting funding for new studies aiming to give novel functions to influenza, SARS, and MERS viruses."

Despite it's erroneous title: "Moratorium on Gain-of-Function Research".

NIAID funding of EcoHealth, including WIV.
The relevant definition of "moratorium" here is "a suspension of activity". As the 2014 White House order makes clear, this was not a moratorium, as all existing research projects were grandfathered, only "new" projects were prohibited. Further, there's no evidence whatsoever that anyone asked or that Ecohealth refused to "voluntarily" halt its gain-of-function (GoF) research project. (As I discussed in this twitter thread, based on NIAID and HHS documents, the WIV research was clearly GoF.)

It's clear from the language of the White House order that someone from NIAID should have asked EcoHealth to pause its research!

And indeed, as HHS documents make clear, the research project, which was not "new", continued to receive funding.

Even NIAID Director Fauci states that funding continued:

""About $600,000 was spent over a five-year period," Fauci said during a congressional budget hearing. "That comes to anywhere between $125 (thousand) and $150,000 per year that went to collaboration with Wuhan."
So there was never a moratorium that applied to or was followed by the NIAID and the WIV.

Further evidence that there was no moratorium for WIV is that the "pause" was lifted on December 13, 2017, while on November 30, 2017, Zheng-Li Shi (the 'bat woman') published a paper that listed the NIAID grant as a funding source:
"Funding: This work was jointly funded... the National Institutes of Health (NIAID R01AI110964)..."
And it was GoF, using the "reverse genetic" technique:
"Recombinant viruses with the S gene of the novel bat SARSr-CoVs and the backbone of the infectious clone of SARSr-CoV WIV1 were constructed using the reverse genetic system..."
As Eban had noted, in the VF article: "The grant was not halted under the moratorium or the P3CO framework." Which is quite obvious, as it was never subject to the "pause", however none of this nuance is discussed in the podcast.
00:31:53: "...led the US Government to impose a moratorium on funding of any kind of gain of function research of SARS and MERS pathogens."
This is clearly not accurate.
00:32:10: "Interestingly, in the very beginning of the Trump Administration, in January of 2017, that moratorium was lifted. But it was replaced by this [P3CO] framework..."
Obviously since the pause never applied to WIV, and was never followed by WIV, it is incorrect to imply, as she does here, that it was lifted by the Trump Admin. There was nothing to lift.

Her discussion of the P3CO framework is well worth reading, as NIAID Director Anthony Fauci had apparently decided to ignore it, just as he had ignored the Obama-administration request to voluntarily halt the SARS research conducted by WIV. However she never makes this connection, despite (inaccurately) quoting part of the footnote noting who at NIAID had the authority to waive the pause for WIV funding: 
"An exception from the research pause may be obtained if the head of the USG funding agency determines that the research is urgently necessary to protect the public health or national security."

Did NIAID Fund Gain-of-Function Research? 

Attia then asks her (00:32:47) about NIH Director Collins and NIAID Director Fauci denying they funded GoF work (in at least one case for Fauci, under oath). "Can you evaluate the veracity of those statements?"

00:33:44, Eban: "So here is where we enter this true semantic marshland, because the feeling of, and I'm not talking about wingnuts who want to fire Fauci, credible people who have evaluated this say that there is some sort of rhetorical grey area here. First of all... well the Government hasn't funded research at the [WIV] directly, they have funded, basically, an intermediary non-profit called EcoHealth Alliance, which in turn has given sub-grants to the [WIV]. So, yeah, no direct funding, but yeah, indirect funding. 
"Now, part of the obligation of EcoHealth Alliance was to report back to the NIH [actually, the NIAID] and say, here's our progress reports, here is what the [WIV] was doing with some of your grant money, and we ensure that they have been doing this safely. We don't know what's in those progress reports, because NIH [again, NIAID] has not released them. 
Attia: "That sounds like a FOIA waiting to happen..."

Well, we really don't need a FOIA to come to a conclusion about this, and it's not a semantic marshland, because sufficient information to draw a conclusion is already available.

For starters as I detailed here, NIAID defines GoF research as: 

"...any selection process involving an alteration of genotypes and their resulting phenotypes is considered a type of Gain-of-Function (GoF) research, even if the U.S. policy is intended to apply to only a small subset of such work.

"...To answer these questions, virologists use gain- and loss-of-function experiments to understand the genetic makeup of viruses and the specifics of virus-host interaction. For instance, researchers now have advanced molecular technologies, such as reverse genetics, which allow them to produce de novo recombinant viruses from cloned cDNA, and deep sequencing that are critical for studying how viruses escape the host immune system and antiviral controls. Researchers also use targeted host or viral genome modification using small interfering RNA or the bacterial CRISPR-associated protein-9 nuclease as an editing tool."

WIV was clearly doing reverse genetics research, a type of GoF, per the NIAID definition, as detailed above and reported in a publicly-available, peer reviewed paper, or, as the State Department put it recently:

"The WIV has a published record of conducting “gain-of-function” research to engineer chimeric viruses."

Second, NIAID monitors what award grantees and sub-award grantees are doing:

"The work was a collaboration among scientists from EcoHealth Alliance, Duke-NUS Medical School, Wuhan Institute of Virology and other organizations, and was funded by the National Institute of Allergy and Infectious Diseases [NIAID], part of the National Institutes of Health. The research is published in the journal Nature."

Third, NIAID requires that sub-award grantees be approved:

"While principal investigators (PIs) can perform a range of grant actions under the NIH standard terms of award, they must get prior approval from NIAID for the following things: ...Addition of a new foreign site or foreign subaward."

Fourth, the Government was notified that the WIV was not meeting standards:

"Two years before the novel coronavirus pandemic upended the world, U.S. Embassy officials visited a Chinese research facility in the city of Wuhan several times and sent two official warnings back to Washington about inadequate safety at the lab, which was conducting risky studies on coronaviruses from bats."

Eban seems to be paltering here: the distinction that she attempts to present as a justification for Fauci's and Collins' statements falls apart simply when looking at the NIAID documents about their supervisory role in sub-award grants.

"“I can’t guarantee everything that’s going on in the Wuhan lab, we can’t do that,” Dr. Fauci said..."
It's the NIAID's self-declared responsibility to ensure basic protocols are followed, and he is the Director. If he has doubts (as he should have) about the WIV, he should have pulled the grant. He could also have implemented the pause and the protocols outlined above, which he failed (or declined) to do. Collins is similarly culpable.

In light of the evidence, it's simply impossible to answer Attia's question in any other way than to acknowledge they were likely being dishonest.

Bias

00:06:11 Eban: "...with Trump out of office... it was a good time to begin to look into..."

Why is the fact that Trump is out of office relevant to where a disease that has killed millions come from? It shouldn't be, unless you are putting politics ahead of people's health.

Identifying the cause of this disease, if it was human-caused, as seemed likely even a year ago (and as Eban notes, even the Chinese came to the conclusion that the labs in Wuhan were likely the cause of it), is rather crucial if we're going to avoid another apparently iatrogenic pandemic.

From Vanity Fair:

"As the pandemic raged, the collaboration between EcoHealth Alliance and the WIV wound up in the crosshairs of the Trump administration. At a White House COVID-19 press briefing on April 17, 2020, a reporter from the conspiratorial right-wing media outlet Newsmax asked Trump a factually inaccurate question about a $3.7 million NIH grant to a level-four lab in China. “Why would the U.S. give a grant like that to China?” the reporter asked.

Eban in the podcast:

00:35:45: "In my investigation there are credible questions about that funding. Why were we allowing taxpayer dollars to a high-level Chinese laboratory, where we now believe there were was actually military scientists working in there. They're obviously an adversary..."

The Newsmax question was not "factually inaccurate", the grant did indeed go to China and the NIAID oversight process makes it clear that they would have known where it was going. It's actually a damn good question, and had it come from "the mainstream media" which had "studiously avoided" the topic, as she noted, Eban would doubtless have approved of it. 

Eban did excellent work, as far as she went, but it appears her political bias prevented her from drawing the obvious conclusions above—comments about conspiracy theories are used repeatedly, even as her reporting demonstrates that the 'conspiracy theorists' were working off the known facts most effectively in this particular case.

Conclusion

From the Vanity Fair article:

""Inside the NIH, which funded such research, the P3CO framework was largely met with shrugs and eye rolls, said a longtime agency official: “If you ban gain-of-function research, you ban all of virology.” He added, “Ever since the moratorium, everyone’s gone wink-wink and just done gain-of-function research anyway.”"

From Fauci's FOIA'ed emails:

"Auchincloss replied to Fauci, saying, “The paper you sent me says the experiments were performed before the gain of function pause but have since been reviewed and approved by NIH. Not sure what that means since Emily is sure that no Coronavirus work has gone through the P3 framework ... She will try to determine if we have any distant ties to this work abroad.”"

Concluding that a manager who presides over what seems likely to be a gross violation of safety protocols, ignores policies designed to enhance safety, and then attempts to hide his culpability should be fired isn't a "wing nut" response, it's management 101. 

00:35:07 Eban: "The NIH now is being buried up to their eyeballs in FOIAs, absolutely. People want to know, what did they know about this research."

This is what happens when you're not forthrightly trying to find out what went wrong. It's a red flag.

The conclusion I have gotten to, which she provides a good bit of evidence to support, is that the fellow who has been leading our response to COVID-19 likely financed its creation, and the fellow who was tasked with finding out where it came from likely created it. Both are doing their very best to distract us from those conclusions. And there's little chance either will pay a price.

That's a pretty grim conclusion to come to.

Hopefully Eban will continue this line of research, but put the bias to the side.

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Thursday, May 13, 2021

Interview: The Seed Oil/COVID-19 Connection—Discussing Leukotoxin on A Neighbor's Choice with David Gornoski

From last Friday, May 7th: discussing some follow-up data to this post from last year: 

Does Consumption of Omega-6 Seed Oils Worsen ARDS and COVID-19?
"David Gornoski is joined by nutritional researcher Tucker Goodrich. The two talk about camping as a break from modern excessiveness; the connection between linoleic acid and COVID; and more. Are people who are high in Omega-6 fatty acids more susceptible to COVID? What is ARDS? Should chicken consumption be decreased? Is butter bad for us as certain “studies” claim? Are peanut and palm oils good for us? Listen to the full episode to find out."

Here's the direct link, and here's the embedded player: 

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Sunday, November 22, 2020

Follow-up to "Does Consumption of Omega-6 Seed Oils Worsen ARDS and COVID-19?"

Two gentlemen were kind enough to send along the full text of a study I only referenced by abstract in that original post.

I've updated the post accordingly, and for those who'd rather not dig through it, here's the update:

PS: Thanks to Drs. Toshi Clark and Joseph Mercola for sending the full text of 1.02 to me.
Here's the summary of that paper:

"...This latter finding suggests that peroxidation of linoleic acid seen in the plasma of patients with ARDS probably occurs in the lung, since the lung is undergoing oxidative stress from sequestered neutrophils, and from ventilatory support with high FIO2.  
"The data further suggest that providing lipid substrates in the form of enteral or parenteral nutrition to patients experiencing severe oxidative stress may greatly exacerbate the underlying disease process. Specific and sensitive measurements of changes in the plasma polyunsaturated fatty acid linoleic acid, and one of its oxidation products, 4-hydroxy-2-nonenal, support the proposal that patients with established ARDS are under severe oxidative stress from their disease and from treatment with high FIO2 concentrations."

Emphasis mine.  The lipid substrate used was Intralipid, discussed above.

Here's the paper: 

1.02.
Quinlan GJ, Lamb NJ, Evans TW, Gutteridge JMC. Plasma fatty acid changes and increased lipid peroxidation in patients with adult respiratory distress syndrome. Read Online: Critical Care Medicine | Society of Critical Care Medicine. 1996;24(2):241–246. doi:10.1097/00003246-199602000-00010

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Thursday, October 15, 2020

Can You Get Reinfected With COVID-19?

 Derek Lowe has an interesting post on the three documented cases of reinfection so far:

"Immunity and Re-Infection"

He concludes, in part:

"So the situation, for now, seems to be that yes, re-infection is possible. But it’s also quite rare. There are surely cases that we’ve missed, but it’s clearly not something that is happening much." 

I posted the following as a (currently unapproved) comment on that post:

So three people have been reinfected, as covered above. 

However, Covid-19 is similar enough to other CoV that up to 81% of people have been found to have some level of immunity against the "new" version. 
"Cross-reactive SARS-CoV-2 peptides revealed pre-existing T cell responses in 81% of unexposed individuals and validated similarity with common cold coronaviruses, providing a functional basis for heterologous immunity in SARS-CoV-2 infection." 

So what about reinfection? It would be reasonable to expect that this virus would also be similar to the other versions, as it's similar in almost every other way. 

Unfortunately, reinfection is common in the other CoV. See here: 
"In OC43 infection, a serum hemagglutination inhibition anti-body titer of >=40 was associated with protection... against reinfection. Nevertheless, 43 per cent of men who became infected with OC43 virus had initial serum antibody titers of >= 20 and < 80."

43% is pretty high. And here: 
"Researchers have studied four species of these seasonal coronaviruses across the past 35 years, and found reinfection occurred frequently, around a year after the first bout."

And here: 
"Neutralizing antibody to 229E was commonly present in the sera of the students. The level... did not appear to influence the occurrence of, or likelihood of illness with, reinfection... underscores the natural occurrence of reinfection with this virus." 

So yes, we've only seen three people get reinfected with the new virus. 

But there's no reason to think this will be rare. It should be quite common, especially as this virus becomes endemic, as I expect it will. 

It will be interesting to see if a vaccine is possible...
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Tuesday, June 2, 2020

Does Consumption of Omega-6 Seed Oils Worsen ARDS and COVID-19?

1. Sometimes you just get lucky.

Several years ago [1.01] I came across the following paper [1.02]:

While I have only been able to access the abstract [got it, see PS at end], it's pretty telling of something I've seen implied in a number of different disease processes:
"Conclusions: During intensive care treatment, patients with ARDS decrease their percentage plasma concentrations of total plasma linoleic acid, but increase their percentage concentrations of oleic and palmitoleic acids. As plasma linoleic acid concentrations decreased, there was usually an increase in plasma 4-hydroxy-2-nonenal [HNE] values, one of its specific peroxidation products, suggestive of severe oxidative stress leading to molecular damage to lipids."
HNE is a highly toxic breakdown product of omega-6  fatty acids (n-6), such as the linoleic acid mentioned above, that has been implicated in a number of different disease processes. [1.3] It's also a commonly-used marker of oxidative stress (OxStr), a process in which primarily n-6 fats in different cell structures are broken down into various toxins, including HNE. Linoleic acid is the n-6 fatty acid which is most commonly consumed in an industrial diet.

This was the first time I'd seen an example of this breakdown happening during the course of a disease, so I made note of it.

2. ARDS is the process by which SARS kills you.

The post moved to Substack.
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Sunday, April 5, 2020

COVID-19: Is Italy — and Mass Quarantine — "Flattening the Curve" or Riding the Trend?

March 16:
To take the COVID-19 pandemic "seriously", must we institute a mandatory shut down, AKA a mass quarantine?

This question prompted me, as always, to ask: has this been tested?

March 16:
Without going through the entire history of epidemics and measures designed to stop them, it can be said that clearly quarantine is one tool to stop the spread of disease.

Nevertheless, as observed in the Journal of School Health in 1951 [1]:
"Anderson and Arnstein in "Communicable Disease Control," 1948, in discussing poliomyelitis, say: "School closure, as well as closure of moving picture theaters, Sunday schools, and other similar groups, is frequently attempted in response to popular demand that 'something be done.' Although tried repeatedly, it is of no proved value, never altering the usual curve of the epidemic: nor has the disease been more prevalent or persistent in those communities with the courage to resist those demands.""
Mass Quarantine and Polio [1]
Now no one would suggest that polio is not a serious disease. While many forget the annual polio epidemics that once terrified Americans, there are few diseases in history that were more serious.

Additionally, since polio was an annual disease, much like influenza, they had a pretty good data set of interventions that worked.

Quarantining the sick to prevent them from spreading the disease was the practice. Quarantining everyone to prevent disease spread through the population was not.

In the case of COVID-19, this is the difference between the intervention pursued in South Korea [2], where the infected and their contacts were tracked:
"“South Korea is a democratic republic, we feel a lockdown is not a reasonable choice,” says Kim Woo-Joo, an infectious disease specialist at Korea University."
And Italy, where the whole country was locked down on March 9. (The Italian lockdown started in the region of Lombardy where the worst infection emerged, on February 21 [3] and spread to all of Lombardy on March 7 [4] then the entire country on the 9th.)

So as Italy developed into the one of the worst COVID-19 outbreaks in the world, I was curious to see if there was any evidence that the severe measures they took had a discernible effect.

For starters, I was curious about the claims of exponential growth. The influential Imperial College (IC) report (whence the phrase "flatten the curve") stated:
"Infection was assumed to be seeded in each country at an exponentially growing rate (with a doubling time of 5 days)..." [5]
This allowed IC to predict that 81% of Americans (220 million) would be infected 90 days out. There are some other problems with these assumptions, but first let's look at that one.

Exponential Growth

Is the spread of this virus exponential?

Exponential means a given initial value, and a constant rate of increase. In order to get to their projected infection prevalence of 220 million Americans, the IC people must have used a "seed", an assumed value of infected people, and then a rate of increase each day of around 15%.

In looking at the Italian data [6], it quickly becomes apparent that the initial spread of COVID-19 in Italy was remarkably fast, far faster than that predicted by the IC in their worst-case analysis. I created two exponential curves, one to match the actual cases on March 9, when the lockdown occurred, and one to match cases on March 27, when I started looking into this.

In this chart, March 9 is indicated in the X axis labels, and you can see there's an inflection in the cases recorded on the date the lockdown was implemented (red arrow). The exponential growth rate for the March 9 curve was 39.72%, and 28.24% for the March 27 curve. (I didn't bother graphing the IC grown projection, as it was almost a flat line at the bottom of the graph.  But what's also immediately apparent is that the curve of the actual cases is not exponential, as the rate of increase appears to be steadily declining (the line crosses both of the exponential curves). Growth is higher early on, but steadily declines.


To drill down on what was actually happening, I next graphed the percentage increase in actual cases.

The orange line again represents the actual number of cases, showing the actual percentage change for each date. The green line again marks the 39.72% exponential growth curve, and the blue line the 28.24% curve. (Since exponential growth is a constant percentage rate of growth, those lines are flat.)


This chart makes it very apparent that the initial increase was explosive, with a 425% increase on one day—from 4 cases to 21. But that sort of increase isn't sustainable. The next day was 276%, then 99%, then 46%.  These early increases are likely artifacts of discovering new cases, so don't represent an actual growth rate, however the spread of the virus was certainly real.

The fascinating thing about looking at the actual data is the things you learn. We already see how fast the initial rate of growth is, but we also see that it's clearly not exponential, it's a steadily declining growth rate.

We also see that the initial rate of increase was worse than the worst-case scenario in the IC paper, in the short term.

Yet, despite implementing draconian lockdown measures, there's no evidence of an inflection point in the curve of the epidemic in Italy. In the initial chart there was what looked like an inflection point on March 9, the day of the full lockdown, but in this view of the data it's clear that was just a tick down in the declining growth rate, which increased back to trend line the following day.

So the next thing to look at is the trends in the data.

"Flattening the Curve"

This chart shows the same as the above, with the increase to 425% truncated out. I think it's an outlier, and not worth considering in looking at the data. When I first did this analysis, I truncated all the data prior to 2/24, but got similar results (with much higher R2), so here I leave it in.

The green line is a logarithmic trend line, the red a 10-day moving average. I picked the 10-day moving average because the median incubation period for COVID-19 is 5 days, with 5 days expected for serious symptoms to occur.


So we see that after an initial explosive growth in cases, the growth rate rapidly declines, and the trends for growth also rapidly decline. The increase on 3/29 is 6%, the increase on 3/31 (not shown) is 4%. The IC expectation for the worst-case was 15% at this point. There's no apparent change in the trend after the nation-wide lockdown of March 9.

So what's clear is that the predictions of exponential growth of 15% per day absent draconian measures was grossly wrong. Actual growth in cases was far higher. There is no clear effect of the implementation of draconian lockdown measures in the curve of growth, as predicted in 1948 [1]:

Riding the Trend
"Although tried repeatedly, it is of no proved value, never altering the usual curve of the epidemic..." [1]
When I started this analysis, I expected to see that the lockdown would have had some effect, what I was surprised to see was the high growth rate initially and the lack of any apparent effect at all.

Unfortunately, given the nature of this epidemic and the lack of testing for it (which is typical of epidemics), cases might be the wrong measure to look at. Cases are dependent on testing, and it's possible that cases are being missed, due to mild effects, in fact it's pretty much guaranteed that mild cases are under-counted.

So I also looked at deaths.



But the curves are almost the same same. Which implies that we may be missing the mild cases, but the cases being tracked do have a close relationship to the death rate. What we do see now though, is that it appears that the deaths track pretty closely to the exponential line (40.6% p/d) up until the lockdown was implemented. This is of course likely why the lockdown was implemented.

If we zoom in to see the details of the growth rate:


Again, an explosive early increase, delayed behind the increase in cases. The date rate increase tracked with the two exponential lines until around the time of the lockdown.

So I also ran the trendlines:


Here the inflection point is closer to the lockdown date, but it still seems to precede it by a few days.

If the nationwide lockdown had caused the downturn in the increases in the deaths, we would expect that we would see an inflection point after the lockdown, not before it.

The concordance between these death and cases lines suggest that the rate of infection shown by the actual cases data is a pretty good indication of some level of serious infection, although we are probably missing a lot of mild and asymptomatic cases. There's also an indication that deaths in Italy may be over-counted, but if so it at least seems to be a consistent over-counting. [7] Unfortunately, due to lack of data from widespread testing and inconsistencies between how statistics are counted in different countries, it's hard to estimate a non-serious infection rate.

I have read that the failure of the lockdown in Italy to prevent Italy from becoming a worst-case scenario is due to the nature of the Italians, who have a reputation for enjoying life without the highest regard for regulation. Whatever the truth of that view may be, I don't think it explains this phenomenon.

A few quotes:
"Residents of Lombardy describe deserted streets and panic after seven virus deaths.... “It’s a surreal situation,” Enrico Bianchi, who owns a veterinary pharmacist, told the Guardian. “People are locked in their houses for fear of going out. It is really strange to go around the town, the few people around are wearing masks.” [1]
From February 24. From March 20 [8]:
"Italian authorities have pressed charges against more than 40,000 people for violating the lockdown, according to figures from the interior ministry."
And the gem:
"Giuseppe Conte, the prime minister, had said the beneficial effects of the lockdown would be felt two weeks from its start as the coronavirus is thought to carry an incubation period of two to 14 days."
That would be March 23rd:



There doesn't seem to be much of a change in the data at that point. His prediction doesn't seem to have born fruit.

But perhaps the most interesting evidence for the compliance of the Italians with the lockdown is this new service from Google [9] which tracks compliance of their users with the lockdown orders, using data they collect from their Android cell-phone operating system.

Italian compliance is far higher than what is happening in the U.S. right now, where workplace reduction numbers are in the order of 38% (in the area where I live).

Italians are clearly obeying the lockdown, and in large numbers, and non-compliance is being dealt with. I'm not aware of a single person that has been arrested in the U.S. for non-compliance.

Life has ground to a halt in Italy, apparently.

Conclusion
"However, the work at hand does provide some cause for limited optimism, suggesting that, even at today’s rapid pace, if a city acts quickly it can buy time even when the pandemic appears at its gates."
That is from a review [10] of two papers analyzing the Influenza Pandemic of 1918. [11, 12] What those papers make clear is that while lockdowns can be effective in containing a quarantine, they are most effective when implemented before a community is infected. This should surprise no one, as even people living in medieval times knew that the best barrier to plague was to live within a walled city. [13] But as a Japanese study looking at influenza in schools noted, looking at the results of their model:
"[Reactive] School closure has a remarkable impact on decreasing the number of infected students at the peak, but it does not substantially decrease the total number of infected students."
Even the peak closure decrease of 24% was in the model, the actual observed data was higher. Reactive closure means closure after the school has been exposed to the pathogen, it's in the community, and while communication from one student to another in school may be blocked, there are other routes of transmission. So whatever benefit reactive closures offered, it was small, and short-lived, as once closures were ended, influenza came right back, infecting most of those students in missed in the first (or second) pass.

So mass quarantine seems to be effective if you are living in a walled city in Spain or in a simulation. As we can see from the Italian case, it seems to be quite ineffective in real life, even in a situation where serious police enforcement is in place to ensure compliance.

It appears to be clear from the Italian data that the claimed success of the lockdowns is simply a matter of the natural course of the epidemic. Comparing Italy to the rest of the world, as the Financial Times does [14] reveals that the gradually-decreasing curve of growth of infections in Italy is typical of the epidemic in other countries:

From Financial Times' COVID-19 Tracking Site
With the notable exception of South Korea, where lockdowns have not been used.

It seems apparent that if you are actually looking to "flatten the curve", then lockdowns are not the most effective means of doing it.

It also seems apparently that the apocalyptic growth estimates used by the Imperial College and others were both too hysterical as to later growth trajectories and also not severe enough to recapitulate the actual course of the epidemic and the ability of authorities to proactively implement mitigation strategies, based on the Italian experience.



1.
Should polio close schools? Journal of School Health. 1951;21(7):249-252. doi:10.1111/j.1746-1561.1951.tb01445.x

2.
How Italy, South Korea differ in tackling coronavirus outbreak | News | Al Jazeera. https://www.aljazeera.com/news/2020/03/italy-south-korea-differ-tackling-coronavirus-outbreak-200313062505781.html. Accessed March 16, 2020.

3.
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