ITALY: THE EPIDEMIC THAT SHOOK THE WORLD
Imagine a plague that infected millions in just a year,
killing as many as 5,000 people per day. Passport Health 2016, Plague of Justinian
Italy has had possibly the most severe and intense
coronavirus epidemic of all. It is the country that has so far been the most devastated
by the COVID-19 disease, in a plague of almost Biblical intensity. Until Italy,
few in the Western world had taken the COVID-19 epidemic very seriously. It was
‘something happening’ in China and the far East and maybe on cruise ships.
Then a spectacle appeared of thousands of people in Italy perishing,
medical facilities being overwhelmed and bodies piling up, a scene of horror
reminiscent of the Black Death. The experience was more like an alternate
reality from science fiction than something really happening in comfortable
modern times where hospitals are sterile well-organised sanctuaries and few can
expect to die before their allotted time is reached.
Italy and ancient plagues
Italy is one of the world’s favoured tourist destinations: a
landscape of Classical and Renaissance buildings and museums containing the
iconic works of the great masters. The canals of Venice; the galleries,
cathedrals and bridges of Florence and Rome; and the fashion of Milan are high
on the itinerary of travellers and daydreamers alike. For those who know Italy well, however, it is
also the home of bureaucratic delay, democratic disarray and corruption.
Italy and pandemics are far from strangers. Because it has
been a densely populated trading nation, it has been subject over the millennia
to outbreaks of many infectious diseases including smallpox, malaria, typhoid
and cholera, and some of the largest outbreaks of bubonic plague.
Around the time of Christ, Rome was the world’s richest and
most populous city and the centre of the civilised world - but it was
vulnerable to plague (probably smallpox) brought by returning troops. The
Antonine plague at its peak affected a quarter of the population of Rome and
killed 2000 people per day. The plague also affected Han China at the same
time.
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| Plague, Florence 1348. Sabatelli, Wellcome Collection |
In the mediaeval period, cities again reached a size and
density sufficient for diseases to flourish. The Black Death struck China,
India and the Near East, then arrived in Europe in October 1347, when 12 ships
from the Black Sea docked at the Sicilian port of Messina with most of the
sailors dead. Soon afterwards, epidemics began in the major ports of Genoa and
Venice. Boccacio’s masterpiece the Decameron is a hundred tales told by
travellers sheltering from the Black Death outside of Florence. The term
‘quarantine’ was coined in 1348, when
Venice became the first city to close its ports to incoming vessels, forcing
ships to wait in the middle of the Venetian lagoon for 40 days before they were
permitted to disembark.
Agnola di Tura, who “buried his five children with his own
hands”, described in Siena:
great pits were dug and piled deep with the multitude of dead [...] And there were also those who were so sparsely covered with earth that the dogs dragged them forth and devoured many bodies throughout the city.
The COVID-19 plague in Italy
~20 Jan
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COVID Variant C spreads from Munich to Lombardy
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31 Jan
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3 cases Variant B in Rome. Recovered 22-26
Feb.
Flights from China stopped, emergency declared
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14 Feb
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Patient #1 goes to hospital, identified 21 Feb, recovers 7 Mar
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19 Feb
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Game Zero Milan
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21 Feb
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Epidemic starts, 14 cases Lombardy. Lockdown of
Red Zone.
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23 Feb
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Cases in 3 neighbouring regions. First two
deaths. 9000 people leave for south
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27 Feb
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322 cases as far as Sicily, 11 deaths. Zingaretti
gaffe.
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26 Feb-6 March
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Travellers from Lombardy infect 8 other countries,
back-infect China
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8-9 March
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Quarantine in the north, then all Italy.
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11 March
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Commercial activity prohibited. 43,000 violate
quarantine
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20 March
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Italy passes China in deaths. Chinese team criticises
laxity of lockdown
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21-22 March
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Non-essential production stopped. Outdoor
physical activity banned in Lombardy. 53,000 cases, 5,000 dead. Inflection
reached with 6,600 daily cases on 21 Mar
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May 4
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Opening to Level 3 Lockdown
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Because
a single political party in Italy can rarely muster the support to govern, a
system has arisen where an independent Prime Minister manages a coalition of
different parties. The current PM, Giuseppe Conte, was a lawyer who had not previously
held political office, but since 2018 he has led several very different
coalitions. He has had the key role to play in dealing with the outbreak.
Before 21 February - the silent epidemic
While the 2020 COVID-19 pandemic soon created
scenes in Italy to rival those of ancient times, the initial response in Italy was
the same as in all Western countries - low key beyond the point of negligence.
Unlike China's neighbours, Western countries did nothing after the Chinese
announcement and the WHO warning on 31 December - nothing to close
borders, improve readiness or develop kits.
2020 was to be the Year of Italy-China
Culture and Tourism, but contact was not supposed to proceed
in this way. A few cases of the standard Wuhan B variant were picked up quite
early in Italy. Some
officials on the right
had already been picketing their former ally Mr Conte to quarantine
schoolchildren from Chinese immigrant families who were returning from holidays
in China. Liberals criticised the proposal as populist fear-mongering.
On 31 January, the day of the upgraded
WHO announcement, two Chinese
tourists in Rome tested positive for the virus. That day, the Italian
government suspended all flights to and from China and declared a state of
emergency. The Italian Council of Ministers appointed a
Special Commissioner for the COVID-19 Emergency. China had closed the Wuhan border five days
earlier.
But this was not where
the virus was coming from. From the phylogeny, around 20 January a
unique basal strain found its way to Europe and began to spread widely and
quietly. This C variant is the one associated with the Munich cluster. For the next month the virus was passed by people
without symptoms, or it was mistaken for a flu. By chance this European variant rapidly found its way to
densely populated northern Italy. There it spread rapidly through the community
in the wealthy Lombardy region, and from there throughout most
of Europe.
The Lombardy region is the Italian business powerhouse having
by far the most commercial trade and international connections. Its principal
urban area with 8.2 million people is Greater Milan, surrounding the country’s most culturally vibrant and business-centred
city.
Bergamo, a city with a population of 1.1 million about 50 km north of
Milan, has suffered the most during the epidemic. A football match held in
Milan on 19 February between Bergamo club Atalanta B.C. and
Spanish club Valencia, was
later dubbed Game Zero by the press. About a third of Bergamo's population
attended the match. A month later almost 7,000 people in Bergamo had tested positive and more than 1,000 people had died from the
virus. This match was also probably responsible for bringing the epidemic to
Spain.
The superspreader – or was he?
The
visible epidemic started on 21 February when 16 confirmed cases were detected
in Lombardy, and 60 additional cases and the first deaths were notified next
day. It usually takes up to four weeks for a death, so this cluster had probably
been in Italy from January.
The
first patient identified has become known as Patient #1, 'Mattea' a 38-year-old manager at Unilever. Mattea had had a
busy month. He attended at least three dinners, played soccer and ran with a
team, all apparently while contagious and without heavy symptoms.
Mattea’s symptoms began
on 10 February. He went to hospital on 18 Feb complaining of flu-like symptoms.
He was sent home but returned the following day. He was allowed to wander round
the Condogno hospital where he infected several doctors, nurses and patients. He was only tested for coronavirus on 20 February after he
was placed in ICU and doctors learned that in early February he had met with a
man who had been to China. This was a red herring as this contact was negative
for the virus and China was not where his infection was coming from, but Mattea
was finally tested.
At
first it was thought that Mattea had infected hundreds of people. However –
this is unlikely. “Who we call Patient One was probably Patient 200,” said
Fabrizio Pregliasco, an epidemiologist.
21 February - Red lockdown
News of the outbreak reached Rome immediately, but Italy was flying blind, as the first country in Europe to suffer a real epidemic in a century. The Italian Council of Ministers realised a genuine epidemic was under way, and they introduced quarantine measures in a “red zone” of eleven municipalities around Codogno in Lodi province to the south-east of Milan, closing schools, bars, nightclubs and quarantining 50,000 people. Entry and exit were not allowed, all work and sports activities were suspended, and a curfew was imposed. |
| Red zone, eleven municipalities |
This was certainly a forceful decision – but the
quarantine was a failure. It covered far too small an area, while the
government tried to play down the seriousness of the situation and confused the
public. It also caused panic buying and set the population moving away from the
quarantine zone, spreading the pandemic further. Compared with
successful interventions later in countries such as Australia, it was token,
arbitrary and did not try to gain the support of local leaders or of the
general population.
The national leaders did not put forward a clear, united
plan that everyone could get behind, and they did not have the stomach for more
extensive restrictions within the heavily populated areas where the epidemic
was strongest. The most
infected municipality, Bergamo, was not included in the lockdown – and neither
were all the other provinces and regions where the virus was running loose,
especially the cities of Milan and Venice.
Seven
thousand people headed away from the red zone to avoid the epidemic and the
possibility of a lockdown, a good number probably carrying the infection. Austria
closed its borders, which turned out to be a very wise move, but most other
European countries did not.
The State Department in USA issued a travel warning against
Italy. The UK issued an advisory against all but essential travel to the red
zone – necessarily ineffective. Over the next week, a number of countries in Europe and even Nigeria
reported that travellers from Italy were bringing the disease. On 3 March China
announced that Italy had sent it eight infected patients from a restaurant in
virus-ravaged Bergamo – China’s first “backflow cases”.
Panic
buying started in Milan, with bottled water and pasta “flying off the shelves”.
Shares in European
airlines plunged in value. in the expectation that bookings into and out of the affected area would
be cancelled. More seriously, global share markets began a downwave that in
three weeks would knock 30 per cent off markets.
“Panic control” on 27 February
By 27 February the epidemic was
out of control with 212 confirmed infections in Lombardy, 7 deaths and 112
other cases in neighbouring provinces. Now however, at just the wrong time the
Italian authorities got cold feet when the saw that the doors of the whole
region were slamming shut and business was seriously threatened.
What now seems to us like a tiny part of what should have
been closed was in fact economically significant. The plains surrounding
the locked-down towns are home to 3,000 companies, and it was estimated that every
day of quarantine resulted in a loss of 50 million euros for the local economy.
International
buyers of textiles were pulling their orders on irrational fears that clothing
might be infected. “We can consider 2020 is lost”, said an industrialist lobbyist.
National officials sought to downplay the threat, blaming
the press and arguing that the virus hit only a tiny fraction of the
population. Still unaware of what was to come, the government responded to
criticisms that the publishing of so many cases only “created hysteria and
tarnished the country’s image abroad”.
A consultant to the government and WHO Executive Committee
member Walter Ricciardi did not help by suggesting the numbers in Italy might
be exaggerated. He complained that Veneto, the second most affected region, had
decided to test hundreds of people, and some who were not ill were
”unnecessarily testing positive”.
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| "We can't stop Milan and Italy". Nicola Zingaretti |
So the order was given to stop reporting asymptomatic cases
and if found, to isolate them at home. The same day the leader of the governing Democratic Party, Nicola
Zingaretti, posted a picture of himself clinking glasses for “an aperitivo in
Milan,” urging people “not to change our habits”.
This merely spooked the population further. People caught living and working on opposite sides
of the boundary were already complaining bitterly. Those without symptoms
in the red zones said the suspension of testing added insult to injury. The measures in
the region also divided families, damaged businesses and created the sense that
Italy was sacrificing the few to protect the many. One woman in isolation said,
“they are leaving us here to die while the infection is just as bad outside.”
Outside the red zone, the quarantine had in fact little effect on daily life or the spread of
the virus. People carried on going to
bars and discos, eating meals at crowded restaurants, and hugging and kissing
each other despite government advice telling them to limit social contact.
Despite the police presence, the red zone was not an easy area to isolate, and
the quarantine border was described as ‘porous’.
By March, the extreme
situation in Bergamo was very obvious, and Italy’s Superior Institute of Health
recommended including it
in the quarantine on March 2 – but no action was taken.
The
virus rampaged unchecked, and by the beginning of March, it had spread to all
regions of Italy. On 4 March, when the death toll hit 100, the PM announced the
closure of all schools. The Italian public were still not taking it seriously. In
a broadcast on March 4, a young
woman reporter announced in a video. “I will continue kissing and touching.
Even if I become contaminated it’s only like the flu”.
On 7
March, as the toll hit 5,883 infections and 233 dead, glass-clinking party
boss Zingoretti was diagnosed as infected. He posted a new video, this time informing
Italy that he, too, had the virus. As he was based in Rome, this gave the most
obvious of warnings to the country that the epidemic was not “something in the
north”.
In a small symbolic victory, Patient #1 Mattea began breathing on his own on 7
March, with just a small amount of oxygen assistance, He was the first seriously
ill patient to recover in Europe.
8-9 March - total lockdown
In the night
between 7 and 8 March, the government approved a decree to lock down Lombardy
and 14 other provinces in Veneto, Emilia-Romagna, Piedmont and Marche,
involving more than 16 million people. At last the heavily infected
centres of Milan, Venice and Bergamo were quarantined.
The decree
"absolutely avoided any movement into and out of these areas" and,
like the previous one, it provided sanctions of up to three months in prison
for those who violated the lockdown. It was possible to move into and out of
the areas only for emergencies or "proven working needs", which must
be authorised by the prefect. The closure of all gyms, swimming
pools, spas and wellness centres was decreed. Shopping centres were closed on
weekends, while other commercial activities could remain open if a distance of
one metre between customers could be guaranteed.
The decree imposed
the closure of museums, cultural centres and ski resorts within the lockdown
area, and the closure of cinemas, theatres, pubs, dance schools, game rooms,
betting rooms and bingo halls, discos and similar places across the entire country. Civil and religious ceremonies,
including funeral ceremonies, were suspended. All organised events were also
suspended, as well as events in public or private places, including those of a
cultural, recreational, sporting and religious nature, even if held in closed
places. This measure was described as the largest lockdown in the history
of Europe, as well as the most aggressive response taken in any region
beyond China.
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| Milan lockdown |
Even this major move
was pre-empted and led to panic. It was leaked to a newspaper, and as a result panic
buying commenced, and the stock market fell another 11% on open. Many people attempted
to escape the lockdown by train and had to be intercepted and quarantined. Only
about 1000 were involved, considerably less than the escapees from the first
lockdown, but they had travelled further, all over Italy.
As soon as the article became public, shocked regional and
municipal leaders in the north argued that they were caught off-guard and that
implementing the rules so suddenly would be impossible. The leak late
Saturday night infuriated Mr. Conte, and prompted not only panic in Milan but
also resistance and anger from mayors and regional presidents across the
political spectrum in the northern areas.
Attilio Fontana, the president of the Lombardy region and a
prominent figure in the opposition right-wing League party, said the plan
included decisive steps toward containing the virus but was also a “mess”
because it created confusion about what citizens could and could not do. Fontana soon
became an advocate of lockdown when he was himself quarantined.
Luca Zaia, the President of Veneto, which includes Venice and other cities
marked for lockdown, said that the government had notified him about the potential
ban only “at the last minute.” Since the region was kept out of discussions to
draft the order, he said, “it’s literally impossible” for the region to enact
it so quickly.
The government
order also locked down provinces in the Emilia Romagna region south of
Lombardy. Stefano Bonaccini, the region’s liberal president, called the decree
confusing, and implored Mr. Conte and the country’s health minister, both
nominal allies, for more time to come up with a more “coherent and shared”
solution.
Mayors in some of
the cities marked for quarantine expressed deep ire over first hearing about
the proposed order on television. “It’s incredible,” said Rasero Maurizio, the Mayor of Asti in the northern region of Piedmont, who posted a video from his
home saying that he had just heard about the potential closing of his town on
television. “No one told me.”
It had become obvious that a
partial lockdown would be no more successful than the limited red lockdown had
been, and the infection of Zingaretti in Rome clinched it. The following day,
as escapees from the north were intercepted in railway station in the south,
the epidemic had become so grim that the lockdown was at last extended to all
of Italy. From 11 March all
commercial and retail businesses except those providing essential services,
like grocery shops and pharmacies, closed down.
Even once the Italian government considered a universal lockdown
necessary to defeat the virus, it failed to
communicate the threat powerfully enough to persuade Italians to abide by the
rules, which seemed riddled with loopholes. Nevertheless, a serious of grim
episodes soon persuaded the people of its wisdom.
At
the height of the epidemic on 19 March, the Army was deployed to the city
of Bergamo,
the worst hit Italian city by the coronavirus, as the local authorities can no
longer process the number of dead residents. The city's mayor Giorgio
Gori said the true number of dead could be much higher than
reported. The local crematorium could only handle 25 bodies per day, and army
trucks transported bodies to crematoriums in several other cities, as mortuaries in the city overflowed.
The pictures of convoys of army trucks
removing bodies were what really startled the rest of the world into action.
On 20
March, Italy exceeded China in total coronavirus deaths. On 21 March,
Conte announced further restrictions within the nationwide lockdown, by halting
all non-essential production, industries and businesses in Italy. This measure
had also been strongly asked for by multiple institutions, including trade
unions, mayors, and regional presidents, as well as medical professionals, but
was initially opposed by the industrialists. On that day, the inflection point
of the epidemic was reached, when daily numbers began to decline.
Doctors were making comparisons to war-time
triage medics as facilities became greatly over-extended, having to decide
who lives, who dies and who gets access to the limited number of ICU beds. Stories
emerged of old people being left alone to die as the tiny number of available
ventilators were given to young people – increasing the death rate.
In scenes that would soon become familiar in other heavily
affected countries, not just the capacity of hospitals but also crematoria and
funeral parlours was exceeded. Bodies were piled
up in churches.
Health workers were more than proportionally infected, as
they tended to accumulate a heavy virus load. In Italy, 13500 healthcare
workers were infected, and over one hundred doctors died. This further
weakened the ability of the system to respond.
Different
response in Lombardy and Veneto
Lombardy
has 10 million people, and it has endured 80,000 Covid-19 cases and 14785
deaths; Veneto is home to 5 million people, but it has seen just 18,500 cases
and 1589 deaths. Its outbreak is a fraction the size. The difference can be
attributed to different approaches.
Veneto’s strategy was from the beginning
pro-active and multi-pronged, following a general strategy that had worked in
Korea and elsewhere:
- Extensive testing of symptomatic and asymptomatic cases early on.
- Proactive tracing of potential positives. If someone tested positive, everyone in that patient’s home as well as their neighbors were tested. If testing kits were unavailable, they were self-quarantined.
- A strong emphasis on home diagnosis and care. Whenever possible, samples were collected directly from a patient’s home and then processed in regional and local university labs.
- Specific efforts to monitor and protect health care and other essential workers. They included medical professionals and those in contact with at-risk populations and the public.
In Lombardy however, the
relatively low number of ICU beds were filled within days, and primary
care physicians were forced to become the front line filter of virus patients.
They tried to treat and monitor a large number of those patients at home. Many
people died at home or soon after hospitalisation, having waited too long to
call an ambulance.
Meanwhile, only those with strong symptoms were actually
being tested for the virus, because Lombardy’s labs could not process more
tests. With little clinical information available, doctors had no guidelines on
when to admit patients or refer them to specialists. Being outside the hospital
system, they did not have the same access to protective masks and equipment. The
region was extremely behind in providing personal protective equipment and it
was inadequate.
While the regional government scrambled to build a field
hospital and find more ICU beds, Lombardy’s nursing homes were mostly left to
fend for themselves. On March 8, the government decided to allow recovering
coronavirus patients to be put in nursing homes in an attempt to free up
hospital beds. That, too proved disastrous. There were huge outbreaks at the
aged care homes, and thousands of elderly patients died.
Easing restrictions
As the
first country in Europe to have an epidemic, Italy was also the first country
to relax restrictions. On 31
March, the president of the Italian National Institute of Health, Silvio
Brusaferro, announced that the pandemic had reached its peak in the country. The news was confirmed also by the head of
the Civil Protection, Angelo Borrelli. Confirmed cases did reach inflection on 22
March, when cases were still rising at 25% per day, and deaths have been
falling since 1 April (Figure 2).
On 4 May, Italy moved to Level 3 lockdown status. The manufacturing sector, including textiles, construction and wholesale
commerce restarted. People were free to travel beyond their municipality for
limited reasons and with a self-certification document, but not their region
unless visiting a second home. Parks and gardens reopened. Bars and restaurants were permitted to sell
takeaways, if ordered online. The wearing of masks was compulsory inside public
places, on public transport or wherever social distancing cannot be
guaranteed.
During
the re-opening, temperatures were taken on sold-out south-bound trains. Italians now behaved in a ‘very
diligent way’, with protective masks everywhere and social distancing being
firmly observed. The ‘touching’ Mediterranean culture of Italy may never be the
same.
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| Figure 1. Daily confirmed COVID-19 cases, Italy |
Further relaxation will occur on 18 May, when retail shopping, museums, libraries and cultural centres to reopen; and on 1 June bars, restaurants, hairdressers and wellness centres, as long as they all meet stringent requirements regarding regular disinfecting and social distancing. extensive testing and contact tracing of the virus. Restrictions will be quickly reimposed on a zonal basis if necessary.
Economy
and environment
Economy
The
economic impact of the continued lockdown is on a scale that has no precedents
outside wartime. Projected figures of the Ministry of the Economy
are in line with those of the IMF and EU, forecasting a contraction of GDP by
8% in 2020.
Italy
was already in a fairly difficult economic state. Living standards had been
frozen for twenty years. A series of corruption scandals from 1992 led to the rise of populists. Italian
banks are burdened with bad debts.
On 11 March billions of euros were promised in to prevent economic collapse.
Public debt to GDP will now rise
to an astronomical 155.7%. Italy’s
debts were already 20 times those of Greece at the time of its financial
crisis. It has been widely considered that Italy might eventually trigger a
watershed event in the Eurozone – but Italy is Europe’s fourth largest economy
and ninth in the world with a GDP of $2 trillion, so it was always presumed it would
trade its way out of any problems. That is no longer so certain.
The epidemic
has exposed the impact of drastic cuts to Italy's public health system over the
past few years to improve public finances, and it has prompted calls for the
government to authorise hiring of thousands of doctors and nurses. In Lombardy,
nursing students were allowed to graduate a month early so they could be put to
work immediately. Italy entered the crisis with 8.6 ICU beds per
100,000, well below the OECD average of 15.9 and around a quarter of Germany’s
33.9 - and this balance has had to be restored.
Although
Conti's popularity is at an unprecedented 85% approval level, this confidence is
not shared politically and he may have to step down if his coalition
breaks.
Italy’s
economic and political situation will bear careful watching in the months
ahead.
Environment
The
environmental improvement resulting from the cessation of human activity has
been remarkable. Venice’s lagoon is showing clear water from the first time in
memory, and cormorants have returned to dive for fish they can now see. “We
Venetians have the feeling that nature has returned and is taking back possession
of the city”.
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| Pollution 2019 Europe |
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| Pollution 2020 Europe |
The Copernicus satellite that tracks atmospheric air pollution has shown a huge drop in nitrogen oxide emissions in Lombardy, where they are often the highest in Europe.
Milan has announced an ambitious
plan to reduce automobile usage after the epidemic is
over. There will be a large expansion of cycling and walking space. The
area is one of Europe's most polluted.
Mortality
The case mortality rate has
been very high in Italy from the beginning, running at about 13.7% of detected
cases. This may be due to only the most severe cases being tested because of
the late start, or it might represent some sort of local susceptibility. Even
in better-performing regions like Veneto, the death rate is 8.5%. whereas
Lombardy has an 18.4% case mortality rate, the worst in the world.
Italy does have the
oldest population in Europe with a lot of comorbidities, and always has more
deaths than anyone else from seasonal influenza or other outbreaks. About
90% of the dead are over 70 in Italy, and 56% are over 80, and many had serious
underlying conditions. The case mortality rate has been about 25% for those
over70.
Abandoning high-risk cases, very poor air quality, and even
impurities in biofuel, have been advanced as possible reasons for the death
rate discrepancy with other countries.
As in the USA, a discrepancy in the death rate has revealed that the number of deaths were understated by over 15,000, with most of the excess deaths occurring in March.
As in the USA, a discrepancy in the death rate has revealed that the number of deaths were understated by over 15,000, with most of the excess deaths occurring in March.
 |
Figure 2 Daily deaths, Italy, 7 day moving average |
At the current rate of decline, one can expect about another
30,000 deaths, bringing Italy’s official
total to near 60,000.
Exactly why the case death rate is so much lower at 4.1% in
neighbouring Germany is yet to be revealed, though the swamping of ICUs and
Italy’s low testing rate must take much of the blame.
Discussion
Italy's performance has
been regarded more as an example of how not to do it than as something to emulate. The
late discovery of a massive cluster, the lack of a uniform response, chasing
after the virus rather than anticipating it. the poorly defined zones with
infection already extending well outside the quarantined area, the leaking of news
of quarantine so that infected people moved away ahead of lockdown, the mixed
message of political leaders so that the population never really embraced
social distancing until it was too late - none of this seems necessarily so bad
but taken together the approach was particularly ineffective against
coronavirus and led to an epidemic of major proportions.
Italian authorities have defended their response,
emphasising that the crisis is unprecedented in modern times. They assert that
the government responded with speed and competence, immediately acting on
the advice of its scientists and moving more swiftly on
drastic, economically devastating measures than their European counterparts. Indeed they did, but was what they did and how they did
it that turned out to be in error. Their response might have worked on another
disease, but with coronavirus it actually made matters worse.
Like other Western
countries, Italy looked at the example of China not as a practical warning, but as a “science fiction movie that had nothing to do with us.” They
did not seek advice from China until the epidemic was near the top. In any case
they probably would have ignored it as “too damaging and intrusive”.
The abiding feature of
the Italian catastrophe was that it acted as kind of Hiroshima moment for most
of the Western world. It became very hard for anyone to maintain that coronavirus
was ‘just flu’, to pooh-pooh strong action as alarmist, or to say that
quarantine was unnecessary. Italy was the canary in the coalmine. The lessons are
now all there and well-documented.
However, even with the
grim example of Italy in front of them, the responses of the other liberal
democracies were also mostly unsuccessful in restraining COVID-19. One is
tempted to conclude that without a prior plan or strategy in place, which none
of them had, liberal democratic systems were ill-fitted to respond to an
epidemic crisis with the promptness, decisiveness and accuracy required by the
coronavirus epidemic. Disaster was the natural result.
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