Ever since Italy was struck by the worst outbreak of novel coronavirus outside China, experts and pundits, both local and international, have been pondering how the disease could spread so quickly in a prosperous western democracy with an advanced public health system.
The short answer is that we don’t have enough information about the arrival and spread of the virus in Italy to understand what happened and draw lessons for other countries. However, there a few social, economic and political factors, along with a good dose of bad luck, that may have combined to make Italy the perfect target for this aggressive virus.
As of March 11, there were more than 10,000 confirmed cases in the country, and 631 deaths – a mortality rate of more than 6 percent, much higher than the World Health Organization’s global average estimate of 3.4 percent.
One factor at work could be demographics. The Covid-19 epidemic is especially dangerous for elderly people and those who have pre-existing medical conditions, and Italy happens to have Europe’s oldest population, with 23 percent of the population over the age of 65 and a median age of 47.3. That is much higher than the median age in the United States of 38.3, and 30.5 in Israel.
But demographics are only part of the story. After all, there are other countries with ageing populations, like Japan, which have so far been more successful in containing the virus and have - for now - a far lower mortality rate than Italy.
It now seems clear that already in January the disease somehow reached Italy, and was allowed to spread undetected for weeks in the north of the country, because of a lack of testing and the attribution of some serious cases to "regular" seasonal flu.
"We realized our house was on fire only once most of the first floor had burned down," Prof. Massimo Galli, an expert on infectious diseases at Milan University told Italian daily Corriere della Sera. "But this was a random situation that could have happened in other parts of the world as well."
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Chance may indeed have played a role, but luck has nothing to do with Italy’s socioeconomic malaise, which has most probably contributed to the country’s sluggish reaction to the crisis.
Italy’s economy has mostly stalled for the last two decades, and the country is saddled with enormous debt, nearly 135 percent of GDP, second in Europe only to that of Greece. With an economy that can be thrown into recession by any minor disruption, and a government with little breathing space to spend more money, it is not surprising that Italy’s leaders hesitated to quickly impose the draconian, but necessary, measures required to contain the virus.
The rest of the damage was done by Italy’s notoriously slow bureaucracy and litigious interest groups. It took days of public and acrimonious debate just to decide to close soccer stadiums to the public, and for the last weeks the country has been playing catch-up with the virus, unable to get ahead of the epidemic.
Although Italy’s public health system is ranked as one of the best in the world, years of spending cuts have rendered it fragile and incapable of facing a major crisis. As a result, testing capabilities have been expanded but still remain inadequate, hospitals are running out of intensive care beds, ventilators and other lifesaving equipment, while desperate and overworked doctors and nurses are forced to triage patients to decide who lives and who dies.
All this would be bad enough but there’s another disastrous factor to add to the toxic brew, which should also function as a flashing warning light to other countries about to experience an exponential rise in coronavirus cases: Italy’s ruling political class does not seem up to the task.
The government of Prime Minister Giuseppe Conte is held up by a fractious coalition led by the 5 Star Movement, a populist anti-establishment grassroots party that in the past has espoused anti-vaxxer ideas and a host of conspiracy theories about chemtrails and pharmaceutical companies purposely spreading diseases (alongside persistent anti-Semitic tropes as well). And the main opposition group, the anti-immigration League party led by Matteo Salvini, is not far behind in terms of unscientific, anti-intellectual beliefs.
Finally, both at home and abroad, much outrage has been vented over Italians’ supposed disregard for the rules, with the media full of stories of people leaving quarantine zones to go on vacation, or traveling to areas with lower infection rates. But it is unclear how widespread such behavior really is, and how much it has contributed to the spread of the disease.
It is too easy to appeal to stereotypes about disorganization and disrespect for rules – or even Italians’ penchant for hugging and kissing – in order to dismiss Italy’s situation as an exceptional case. The line that "Italy is different/dysfunctional/too demonstrably affectionate, it could never happen to us" may be comforting, but it is dangerous.
Around the globe, we would do better to consider how many of the factors that must have played a role in Italy’s crisis also plague other countries, including our own. Think of the state of the healthcare system in the United States and the chronic shortage of hospital beds in Israel, or of the apparent ineptitude and denialism of U.S. leaders and the stalemate in Israel’s political system.
Italy may well have been a perfect petri dish for coronavirus, but there are many other – and more populous and wealthy – countries offering ample conditions for a contagious catastrophe.
Ariel David is an editor at Haaretz, and a Tel Aviv-based foreign correspondent for Italian and English-language publications. He was previously AP's correspondent in Rome, covering Italy and the Vatican. Twitter: @arieldavid1980