San Marino is a small city-state of around 33K people completely surrounded by Italy. It is located at 43 degrees N. Latitude. Its climate is described as humid subtropical. Because of its small size, San Marino flew under the COVID-19 radar for a long time, largely due to the disaster that was making the news in Italy. Once San Marino’s deaths and cases were normalized by their small population, however, it became obvious that this country had been the hardest hit per capita in the world. See the values on the Y axis for San Marino and compare to Washington, which I have shown below. San Marino has had to date over 10x the number of cases per 1000 people and over 20x the deaths that Washington (one of the hardest hit in the USA has experienced!
The Good News for San Marino: The charts above show that both the case curve and the death curve have entered a region of deceleration. There are still cases being reported, but they are less each day. Per the San Marino Coordination Group for Health Emergencies, they had a total of 193 cases confirmed as of 4/3 and only 47 of these were hospitalized. Of the 47, only 13 had severe symptoms. That breaks down to 25% hospitalization and 7% in ICU (not sure how many needing ventilators). Is this a picture of what a slowing outbreak looks like? San Marino only had 2 deaths reported on 4/3. These numbers are all down from 3/30 when they had just 192 total cases and 59 in hospital with 16 in ICU. I wish I could find hospitalization numbers like the above for each day of the outbreak, but so far I can’t locate them. I am finding scattered reports from countries and states on this, but in general there’s not much. Iceland has a good portal where they’ve advertised 45 hospitalizations (12 ICU) on 1417 confirmed cases. The denominator is very high for Iceland compared to any other country largely because they’re doing randomized testing. They have indicated that 50% of their confirmed cases have no symptoms. So, of the symptomatic cases, Iceland is seeing 6.3% hospitalization and 1.7% ICU. Much lower than San Marino still, but there’s a good chance that San Marino has a large untested population that isn’t being counted.