At the moment of this writing (Sunday March 15th 2020), Italy is the epicenter of the COVID-19 pandemic. The numbers coming out of Italy are simply staggering: 175 deaths and 3500 new confirmed infections just yesterday. These statistics are more shocking when considering that this situation came to be in just a month.
In early February the only known coronavirus cases in Italy were travellers like a Chinese couple and a family of Taiwanese tourists and a few Italian nationals from the, now infamous, Diamond Princess cruise ship. At that time, the Italian authorities were implementing common epidemiological best practices and mapping all the people who came in contact with those known cases.
The situation drastically changed on Feb 21st when an otherwise healthy 38 year old male named Mattia with no recent history of travel outside Italy was hospitalized in Codogno with respiratory distress and tested positive for COVID-19. A day later, on Feb 22nd, the first coronavirus death inside Italy was reported in a small town 120 miles away. It was later discovered that the two cases were connected and that Mattia was “patient one”. Unfortunately, “patient zero” was never found. Based on the incubation period (about 5 days) and the typical progression (about two weeks) of the disease it is likely that the first infection happened sometime in late January or early February.
Therefore, by the time the first death was reported, the virus had about three weeks to spread undetected among the population. The lack of early detection was due, at least partially, to the coincidence of the flu season peak and is certain to have made the outbreak substantially worse. In this early phase, the number of infections doubled every 2 to 3 days. Therefore, already at the time of the first reported death, the virus had a strong foothold.
The Italian authorities enacted what at the time seemed very stringent countermeasures. On Feb 22 they declared a “red zone” around the town of Codogno and limited all movements of the 50 thousand people living in the area. On March 8 the entire region of Lombardy, the economic engine of Italy, and its 16 million inhabitants were ordered to lock down. The following day, on March 9, the lockdown was extended to the entire country. It is now widely acknowledged that all these measures were belated and therefore ultimately ineffective to change the trajectory of the outbreak. However it is unclear whether either politicians or the general public would have accepted such costly measures earlier.
I spoke this morning to my brother-in-law who is a pediatrician at the San Raffaele’ hospital in Milan, and he confirmed that the situation is now dire. While it is true that about 80% of the cases are mild and have symptoms similar to a seasonal flu, it is also true that about 20% of the cases require hospitalization and 10% of these require intensive care. Since there is no effective treatment yet, each hospitalization lasts a long time (between 2 and 3 weeks). This, together with the sheer volume of cases, is leading to shortage of hospital beds, particularly in Intensive Care Units (ICU). China faced and solved the same problem by building two emergency hospitals. That impressive feat was successful b/c of the tight control that Chinese government has on the entire economy and it is unlikely to be repeated by any other country. Italy is trying to address the shortage of hospital capacity by converting gyms and part of the Padiglione Fiera of Milan (the equivalent of Boston convention center) to host extra beds. Italian authorities are also considering retrofitting a cruise ship to be used as a makeshift hospital. Small factories in Brianza, a region which prides itself for its pragmatism, are converting their production toward protective masks which are now in short supply.
So why is the outbreak in Italy so much worse than the rest of Europe? What did the Italians do wrong? Nothing, the outbreak simply started earlier there. The outbreak in Germany, Spain and France seems to have been delayed by 8-9 days, while the outbreak in the US was delayed by 11 days with respect to the Italian one. The Italian health system is a universal single payer system which, while not perfect, is good and modern by any standard. The fact that the outbreak happened there should make all of us extremely aware of the severity of the situation we face.
However, the US will not necessarily face Italy’s destiny. The severity of the outbreak can be substantially reduced by implementing good public health countermeasures such as the closing of schools, universities and workplaces. All of these measures will disproportionately affect low-income families. Many students rely on schools and universities for food and housing. Many workers don’t have the option to work from home and will lose out on income with the closure of events and facilities. For some workers this health crisis is likely to become also an economic crisis. Also, the outbreak will not be contained unless we, as a society, take care of the homeless population.
We therefore demand that:
- All people have access to free testing, treatment and healthcare
- All people have access to housing for the duration of the public health emergency, in particular we call for a moratorium on evictions and the opening of all unoccupied homes to anyone who needs one
- All people receive a basic income for the duration of the public health emergency
If we are serious about providing for the well-being of our country and bringing an end to this crisis, we need to ensure that people receive the support they need.
These are unprecedented times requiring unprecedented solidarity.