When Italy was the epicenter of the COVID-19 pandemic last month, the virus killed 919 victims in the country on Mar. 27 alone.
For reference, the severe acute respiratory syndrome outbreak that sparked a global panic in 2003 killed a total of 774 people in 29 countries worldwide, according to the Centers for Disease Contol and Prevention.
It’s undeniable that the entire world is facing the reverberations of the pandemic, with cases reported in at least 185 countries and territories. Italy, however, was pushed to the front of the global stage as it was one of the first countries outside of China to suffer disproportionately at the hands of the virus. What led to Italy’s epicenter status and how did this influence the response of other nations throughout the world?
First things first, understanding what coronavirus is and how it can develop, spread and lead to a pandemic can provide insight into Italy’s crisis.
As many of us know by now, COVID-19, the disease caused by the novel coronavirus, originated in Wuhan, China, and began proliferating at unprecedented rates across the globe. Typical methods for curing respiratory problems were no match for the newfound disease, puzzling health care workers worldwide. The long incubation period undermined the new virus’ severity, and to top it off, the emerging symptoms coincided with flu season – making it difficult to correctly identify the seasonal sickness’ symptoms versus a novel strain of the coronavirus.
Interestingly, the term “coronavirus” is actually not exclusive to the recently coined pandemic – a coronavirus is a type of virus that tends to originate in animals such as pigs, birds and bats and is only rarely transmitted from animals to humans. COVID-19, SARS and the 2012 outbreak of the Middle East respiratory syndrome all fall under the “coronavirus” umbrella, as the latter two originated in animals and it is likely that the novel coronavirus did as well. In the case of these deadly coronaviruses, bats are the probable origin.
Coronavirus cases like SARS, MERS and now COVID-19 are life-threatening for a reason: As the virus jumps from animals to humans, it creates a unique hybrid called a “zoonotic virus” that adapts to our immune system’s responses in the process. Not all zoonotic viruses become deadly threats, though – in fact, zoonotic diseases are quite common. Some other well-known zoonotic viruses include salmonella infections, rabies and Lyme disease.
COVID-19 also presents an example of a threatening illness often referred to as “Disease X.” According to the World Health Organization, this phenomenon has to do with the idea that “a serious international epidemic could be caused by a pathogen currently unknown to cause human disease.”
Pandemics like COVID-19 can spread silently, and combined with the mystery shrouding a novel disease, the real severity can be downplayed and dismissed as it was in Italy.
Caterina Caserta, a high school student from Rovigo in Veneto, Italy, one of the regions in Northern Italy most impacted by the virus, explained her view of the sentiment toward the disease when it first originated.
“There was this idea that coronavirus was not as dangerous as people depicted it,” Caserta said. “They were saying, ‘Well, it’s only a flu you know, don’t worry about it, we can’t stop the whole country.’”
Federico Trudu, a third-year political science student at UCLA from Cagliari, Italy, seconded the relaxed mentality of many Italians at the beginning of the crisis.
“Unfortunately, many people in other regions managed not to follow the orders to stay home, and that’s how the virus spread,” Trudu said in an emailed statement. “Still to this day I see pictures from big cities like Milan, Naples and Rome with packed farmers markets.”
At first, political leaders also promoted a sense of calm amid the brewing storm. In February, leader of the Democratic Party in Italy Nicola Zingaretti posted a photo of himself maintaining the social tradition of having an aperitivo as well as advocating for #MilanoNonSiFerma, or #MilanDoesn’tStop, according to The Atlantic.
Caserta said that it is extreme for Western governments to take measures such as a national lockdown. This is perhaps why Western governments were slow to respond – they may not have wanted to impose restrictions on personal freedoms right away.
The implications of taking certain political measures also may have halted Italy’s immediate response. In an interview with CNN, Giorgio Palù, professor of virology and microbiology at the University of Padova and former president of the European Society for Virology said that lockdown procedures were slow to start because of the debate surrounding who should be allowed within Italy’s borders.
“There was a proposal to isolate people coming from the epicenter, coming from China,” Palù said in the article. “Then it became seen as racist, but they were people coming from the outbreak.”
Politics aside, what other factors contributed to Italy’s crisis?
For one, Italians are no strangers to dense, urban living – and when combined with a high infectivity rate of a disease, the environment becomes a breeding ground for transmission.
Scientists determine the infectivity of a disease using a term called “R0,” which represents the number of new cases an infected person will cause during the time they are infected. If the R0 is less than one, the disease will eventually cease to exist in a population, because the infected person will infect fewer than one person on average. Imperial College London predicted the R0 for coronavirus to be around 2.6 on average, but the value could range anywhere from 1.5 to 3.5. To compare, the R0 for the flu ranges between 2 to 3.
Likewise, the population density in Italy is relatively high. Italy’s population density averages 533 people per square mile, while the United States has only 94 people per square mile. Similarly, more than two-thirds of the population lives in urban areas like Milan, which contains more than 19,000 people per square mile.
Population density is not solely to blame, though – social gatherings also played a part. For example, one-third of Bergamo, Italy’s population attended a soccer game between Bergamo’s home team Atalanta BC and Spanish club Valencia CF, and more than 40,000 fans were in attendance. Scientists are citing the game as the reason why Bergamo became an epicenter of the pandemic. The game took place just days before the first locally transmitted case of coronavirus was reported in Italy.
It didn’t take long for these factors to combine and contribute to Italy’s status as the epicenter of the pandemic.
Unfortunately, the high number of cases has put immense strain on Italy’s medical force – Caserta and Trudu both said that there isn’t enough personal protective equipment for doctors. Caution is key – Trudu said in an emailed statement that there are only about 250 intensive care unit beds in the entire island of Sardinia, so Italians have been careful to contain the spread.
However, Trudu said that leaders acted quickly to curb the transmission of the virus.
“The major difference that I noticed about Italy – in contrast to the US – is that the Italian government acted quite promptly to shut down the country and protect its citizens,” Trudu said in an emailed statement.
To curb the outbreak, Italy enforced the national lockdown further by prohibiting activities such as walking far from home and closing parks. On Feb. 23, 11 towns were enclosed with police and military checkpoints. In addition, on Mar. 21, Italy made the momentous economic decision to shut down all production they deemed nonessential to save lives.
Thankfully, Italy’s situation seems to be improving. Italy recently recorded its lowest number of deaths in three weeks, and ICUs reported a decreased number of admitted patients for the ninth day in a row.
It’s important to remember Italy’s situation could happen anywhere – and because the U.S. is the new epicenter of the pandemic, it’s more critical than ever that we look to other countries to see what worked and what didn’t. Where we go from here is up to us and our governments, who have to consider what – or who’s – at stake: the people close to us.
Caserta and Trudu emphasized an important takeaway after witnessing their home country at the forefront of the pandemic.
“If the government tells us to stay home, we have to stay home,” Caserta said. “And we (can’t) break the rules this time, because it’s for our health but also for the people around us and for the people that we love.”
Contributing reports from Olivia Fitzmorris, assistant Blogging editor.
