The rest of the world must learn from our mistakes, says repentant Italy
As a stunned nation watches its dead being removed by the army truckload, it has words of advice for the countries not far behind
REMINISCENT of a nation at war, it was an image that shocked Italy – a convoy of army trucks taking dozens of coffins away from a city so overwhelmed by coronavirus it could not cremate them fast enough.
The lorries rumbled through the empty streets of Bergamo, a city at the heart of Italy’s devastating contagion.
“I would never have imagined we would see a convoy of army trucks carrying coffins. These are terrible days, without precedent,” Giuseppe Conte, the prime minister, said this week.
From a handful of cases just one month ago, Italy has the grim distinction of being the country with the deadliest coronavirus outbreak, as the authorities yesterday extended its month-long lockdown.
These have been heartbreaking, morale-sapping days, with the number of deaths in the country reaching a world record 10,779.
Yesterday, the country reported another 756 fatalities as officially registered cases increased by 5,217 to 97,689.
As the Italians pray for light at the end of a very long tunnel, a reckoning has already started – what did Italy do right, what did it do wrong and what can other countries learn?
One factor that put Italy at a disadvantage was that the virus was probably infecting the country well before it was officially detected in late February. Experts believe it may have been in northern Italy as early as December, with doctors assuming it was regular influenza.
The seat of the outbreak was identified as being in 10 towns near Milan, and on Feb 22 this “red zone” was placed under quarantine. Even then, the government veered between alarm and complacency, giving mixed messages as people began dying.
Beppe Sala, the mayor of Milan, launched a campaign – Milan Non Si Ferma (Milan Doesn’t Stop), reassuring people and saying that life should continue as normal.
He issued a mea culpa this week: “At the time, it seemed to capture the spirit of Milan. Even the scientists could not give us an unequivocal interpretation of the gravity of the situation. But if I made a mistake – well I’m here now, doing my bit every day.”
On Feb 19, despite growing alarm, the authorities allowed 46,000 football fans to pour into the San Siro stadium in Milan to watch a Champion’s League match between Bergamo’s team, Atalanta, and Valencia.
Angelo Borrelli, head of the Civil Protection Agency, said: “It was potentially a detonator, but we are only able to say that now because we have the benefit of hindsight.”
Giorgio Gori, the mayor of Bergamo, said the game was “among the sad explanations” for the high infection rate.
On Feb 27, Luigi di Maio, Italy’s foreign minister, told the international press in Rome that they were unfairly exaggerating the crisis. Holding up a map of Italy, he showed that the area under lockdown represented just 0.05 per cent of the country and the number of people affected was 0.089 per cent of the population.
He criticised “alarmism and false information” and appealed to tourists and investors to keep coming to Italy.
The authorities were walking a tightrope of wanting to protect public health while desperate not to harm tourism, investment, business and industry, at a time when economic growth was already woeful.
Attilio Fontana, the governor of Lombardy, seemed to be a lone voice, repeatedly urging the national government to impose stricter measures, but he was overruled. Ministers in Rome did not want to shut down the country’s economic engine in the north.
Infections continued to spread and the death toll rose, the “red zone” was extended on March 8 from the 10 towns to a vast area of northern Italy, encompassing Lombardy, Veneto and Emilia-romagna.
News of this was leaked the day before, resulting in 20,000 people in the north fleeing south, back to ancestral towns and villages their elders left decades ago for jobs in the north. Many used trains – described by one expert as “biological bombs”.
One day later, the prime minister announced that the whole of Italy was being locked down: all 60million people subject to strict quarantine.
Still the infection spread, to Bergamo and Brescia, where there were insufficient intensive care beds. Doctors and nurses wept with exhaustion.
Today some officials believe those cities should have been placed under an immediate, more draconian, lockdown. “Not imposing a red zone around Bergamo, as the mayor of the city was calling for, was an error,” said Beppe Sala.
He pointed to another factor – that years of budget cuts in the health system had reduced the number of doctors and local clinics – people with coronavirus were instead being treated in large hospitals.
“The hospitals have become centres of diffusion for the virus. When you have lost the capacity to make home visits, you expose yourself to these risks,” he said.
The virus has taken a heavy toll on Italian doctors and nurses – nearly 50 doctors have died and more than 6,000 medical staff have been infected.
“Paradoxically, at a time when most of Italy is shut up at home, hospitals are the only places where thousands of people find themselves in close contact,” Pierluigi Lopalco, a professor of hygiene at Pisa university, told La Repubblica newspaper.
A dozen Italian doctors recently wrote a joint letter, saying that health systems worldwide had to be switched from hospital-based care to homebased care in the battle against Covid-19.
In a letter to the New England Journal of Medicine on March 22, they said: “Western healthcare systems have been built around the concept of patient-centred care,” but the Covid-19 pandemic requires home-based care.
Keeping patients at home rather than sending them to hospital would help contain the pandemic, they said.
As the number of deaths and cases soared, the government brought in even more stringent measures. But it was too little, too late.
When a delegation of experts from
‘If you don’t have the right data, you can’t make the right decisions. There should have been more testing’
‘When most of Italy is shut at home, hospitals are the only places where thousands of people find themselves in close contact’
the Chinese Red Cross came to Milan last week, they said Italy should have done more to stop the spread of the virus.
“Here in Milan, there isn’t a very strict lockdown policy. Public transport is still working and people are still moving around,” said Sun Shuopeng, the vice-president of the Chinese Red Cross.
“It is time to close economic activities and prohibit the movement of people. Everyone must stay at home, in quarantine.”
His stark warning was underlined hours later, when Italy surpassed China as the country with the most people killed by the virus.
Since then, the Italian death toll has continued to climb, with experts saying it has not yet reached its peak.
There is a dispute, however, over the true scale of the Italian tragedy. Many, including Mr Borrelli, now believe the real number of infections may be up to 10 times the official figure.
With 600,000 infections or more, that would bring the fatality rate down to between 1 and 2 per cent – commensurate with countries like
China. But no one knows for sure. The only way to find out would be to conduct random testing, to get a clearer idea of what percentage of the population is infected. Italy only tests people who display symptoms. Guido Cozzi, a professor of macroeconomics at the University of St Gallen in Switzerland, said: “If you don’t have the right data, you can’t make the right decisions. There should have been more testing at the earliest stages.”
Widespread testing, enforced lockdown of badly hit locations and active surveillance of positive cases have emerged as the only way of halting the spread of the virus.
Italy’s mistakes should not be made by countries like the UK, which are a couple of weeks behind the trajectory.
“I would urge any government to conduct random sampling so they can understand what is going on in the population,” said Prof Cozzi. “In the UK, they have the resources to do that.”
As Italy’s north continues to grapple with the outbreak, there are fears those “biological bombs” could explode in the south, posing an enormous challenge to regions known for poor public health services. Vincenzo De Luca, the governor of Campania, the southern region that includes Naples, said: “There is a real chance of adding a tragedy of the south to the tragedy of the north.”
The Italian authorities argue they were the first in Europe to confront the pandemic and that it posed agonising decisions for a Western democracy. “No one in Italy or Europe was prepared for all this,” said Giulio Gallera, the regional official in charge of health for Lombardy.
Alberto Mantovani, a prominent immunologist in Milan, added: “In the last month we were hit by a tsunami.” However, Italy knows it made mistakes and is beginning to acknowledge them.
Other countries, including Britain, do not have the excuse of navigating uncharted waters. They have a duty not to repeat Italy’s errors.
“We acted with determination and we were the first in Europe to do so,” the prime minister, told parliament in Rome this week.
“History will judge us, but now is the time for action.”