Italy had 62 coronavirus cases on February 22, and two-and-half weeks later it has more than 10,000 cases, with more than 600 people dead and the country on lockdown. What happened?
While the virus initially seemed under control, it had been quietly spreading, as the Guardian reports:
In reality, as would become clear in February, the virus had been circulating unnoticed in northern Italy via other local chains of infection, in all probability since mid-January.
Another critical misunderstanding also appears to have emerged, this time between central government and hospitals in the north.
It concerns what the proper protocols were for testing unexplained fevers and respiratory complaints, and whether people with no apparent connection to China should be tested.
On 18 February, a fit 38-year old with no apparent links to China fell ill in Codogno. He saw his GP and visited his local hospital several times, but his symptoms were not picked up as resulting from the coronavirus.
Known as Patient One by the Italian media, when he was finally admitted to hospital he was tested after a 36-hour delay, which he spent outside isolation. By that time he had infected a number of medical personnel and other contacts over a period of days.
The government quickly locked down towns affected by the initial outbreak, but it still didn’t want to disrupt the economy and everyday life in a swath of the country:
. . . mixed political messaging may have been more at fault than any weaknesses in Italy’s health system. We know now too that the geographical scope of those initial quarantines was far too limited.
As anxiety spread to bigger cities, including the industrial hub of Milan and the tourist centre of Venice, the political messaging was confusing.
Among those pushing a “business as usual” message was Nicola Zingaretti, the head of the centre-left Democratic Party, who travelled to Milan for a meet and greet with young people to reinforce his pitch. Zingaretti announced at the weekend that he had tested positive for the virus.
Meanwhile, the disease has hit particularly hard, perhaps because, as Time notes, of the relatively old population in Italy:
Italy, however, is also reporting an above average mortality rate at 4%. The average age of coronavirus patients who have died because of the virus in Italy is 81, according to the National Health Institute. Italy, which has one the world’s oldest populations, could be facing a higher mortality rate as a result of its above-average elderly population. “Italy is the oldest country in the oldest continent in the world,” Casani says. “We have a lot of people over 65.”
And the illness is reportedly over-topping the medical system, accounting for the extreme urgency with which the government is trying to get it under control. According to Bloomberg:
Newspapers and WhatsApp groups are rife with personal accounts from doctors on the front lines of the epidemic. When new patients come in with pneumonia, a symptom of advanced coronavirus infections, doctors have little time to decide whether to assign them intensive-care beds, ventilation machines or respirators that could make the difference between life and death.
Some doctors have said that they sometimes make the call on who gets treatment based on the age of the patient. In some areas, hospitals are suspending other treatments to focus personnel on the contagion.
A doctor who asked not to be named because of potential repercussions painted a dire picture of the situation in a hospital in Milan. While the coronavirus is best known for causing severe disease in elderly patients, even some young people are affected, the doctor said, and without sufficient beds and ventilators, some can’t be treated.
The hundreds of patients needing treatment for pneumonia have swamped the supply of available specialists, the Milan doctor said. Physicians such as gastroenterologists, who normally focus on the digestive system, have been conscripted to help out with lung patients, and they’re still not enough, the doctor said.
Gallera said about 150 more acute care places will open up in the next week. Whether this will be enough to keep up with the spread of the contagion depends on how effective the government’s containment measures prove to be.
On this point, here is an alarming interview with a doctor about the stresses on the system.
Italy is a case study in why the “just the flu” argument doesn’t work, at least not if the virus runs out of control.