Analysis, Latest on coronavirus outbreak

ANALYSIS - Italy: Coronavirus trauma

After China, South Korea – how did the largest number of cases occur in Italy, thousands of miles away?

Michelangelo Guida   | 18.03.2020
ANALYSIS - Italy: Coronavirus trauma


Italy recorded its very first death of the coronavirus on Feb. 22.

Before that, the first virus case was seen in two tourists who came from Hubei province in China on Jan. 23 and entered through the Milan airport, shortly after falling ill in Rome, and an Italian on Feb. 6, who returned from Wuhan, where the disease originated.

Following the first cases, Italian officials suspended all flights to China, where the disease first occurred on Dec. 31.

Italy, the first country to take this step as a precaution among all European Union countries, filled the international airports with thermal cameras as an addition to the first step. Italian Prime Minister Giuseppe Conte claimed with self-confidence that “the preventing system that Italy applies is the most solid one in the European continent.”

The first patients were released after getting better. On the other hand, in Codogno, Italy, 60 kilometers (37 miles) from Milan, a new case was diagnosed with a simple illness by a family doctor and sent home after suggesting treatment on Feb. 14.

When the patient was re-admitted to the hospital just two days later with acute respiratory infection complaints, necessary precautions were not taken and the virus was transmitted to other patients and staff.

The virus has now spread in that area, although tests have begun to be carried out as cases have increased. The aforementioned "patient zero" had met a friend returning from China. But the test was negative for the friend, and DNA analysis showed the source of the virus could be Munich or Finland.

What is interesting is how the virus arrived in Codogno, which has only 16,000 inhabitants, has not been understood until now.

However, it should not be seen as surprising that Codogno, which has an agriculture-based economy, is the center of the epidemic despite being a quiet town.

Northern Italians live in low-population and green-rich settlements and use transportation facilities to commute to surrounding major cities every day for study and education.

On Feb. 22, the government declared eleven municipalities where the epidemic spread a “red zone” and vacated schools; even imposed a ban on staying home and quarantined the area.

At the beginning of March, the number of cases in Italy showed the fastest increase among EU countries. The increase was seen to be the second-highest increase in the world except for China, where the virus first appeared, and March 4, it was decided to decertify education in primary, secondary and higher education institutions throughout the country.

On March 8, when it was seen that the spread of the virus could not be prevented, Conte decided to quarantine all provinces of the region of Lombardy, where cases are most intense in the northwest of the country, as well as 14 provinces in the north. The next day, the entire country was quarantined, restricting the freedom of movement of more than 60 million people.

So how did the largest number of cases emerge in Italy, thousands of miles away, after China, the center of the pandemic, and its neighbor, South Korea?

Why is the number of cases in Italy even more so than in Japan, which has far more intense relations with China?

For this issue to be understood, of course, some of the characteristics unique to Italy need to be remembered.

The death rate of COVID-19 in the country rose to more than 4 percent, a figure even higher than in China. It is not easy to gather this painful information, of course. However, although coronavirus has been detected in all death cases in the said regions, it is not possible to determine whether the virus is the only and genuine cause of death in the current crisis.

According to the Civil Defense which is responsible for crisis management and experts who spoke to the media, one of the reasons is the prevalence of older people in Italy.

Unfortunately, the COVID-19 virus naturally affects people who have weaker immune systems and old people who also suffer from other illnesses.

In 2015, the country's population aged 65 and over was close to 22%, while its population under 14 was just 14%.

To understand the data better, a comparison can be made with Turkey. Although it has increased since 2015, the proportion of Turkey's citizens over the age of 65 to the population was only 8% in the same year, while the proportion of the population under age 14 was recorded as 26%.

Another reason for having this many cases is the officials were a bit late to take proper measures. For example, even though all flights with Italy were suspended Feb. 29 in Turkey, Italy stopped its flights with China the next day. Notwithstanding, this precaution, which was not taken in any other member of the EU, caused polemics. According to some experts, in the weeks before flights were suspended, it was a necessity to take everyone, who came from China or any other country with the epidemic, in quarantine in their own homes and they had to be observed by medical staff.

However, this never happened. Additionally, it should not be forgotten that China is the country that spends money on international tourism more than any other country in the world. In just 2019, the number of tourists who came to visit Italy from China reached 3.1 million.

On direct flights, at least those arriving from China could be registered. But after the flight ban was put in place, the chances of being able to control passengers from areas where the virus had been seen were greatly reduced. Indeed, thermal cameras installed at airports can detect a COVID-19 carrier without symptoms, although it can detect diseases that lead to high fever.

At this point, the biggest problem was the Schengen Agreement, which is one of the foundations of the EU and provides free passage of people, goods and services. Although flights were canceled, contacts with China could not be completely cut off because of people transferring via other countries or flying to another Schengen country and entering the country by different means. At this point, the timid attitudes of Germany, the EU's largest country, are remarkable. At the time these lines were written, flights with other European countries continued, except for connections to Paris or London, although the bulk of flights to other parts of Italy from Milan liner airport were canceled. Only Austria suspended the Schengen Agreement and reinstated police and health checks on its former customs. Vienna has taken a similar stance on the refugee crisis before, but there are serious doubts about how effective customs can be in dealing with the virus.

Cultural, social and economic integration among European countries is so high that it is impossible to sever all connections at once, leaving thousands either stranded or breaking the supply chain. There is also no immediate action plan. However, as with the refugee crisis, it was clear that EU institutions had difficulty coming up with a quick and clear solution to the issues or setting up an urgent action plan. This problem poses danger not only to Italy but also to all EU member states.

Another problem which might count as one of the reasons why the balloon had gone up this high is the medical sector in Italy. The hospitals with the lowest number of beds among European countries are Italian. Although this number is higher than in Turkey, it is insufficient compared to the average age of the population. Although family physicians in every neighborhood seemed to be successful, the system was inadequate in the process of managing such a crisis. Currently, the government has sent engineer officers to a quarantined factory to produce breathing apparatus to increase the capacity of intensive care units.

Not taking clear enough steps also result in panic from time to time. As soon as the curfew was introduced, it was first to run to the grocery stores, even though there was no problem with the food stocks. As red zones began to increase, citizens wishing to return to their homeland filled train stations and airports. In the country, where there is serious internal migration, the possibility of the virus spreading has increased due to the impact of thousands of people who want to return to their families immediately.

Panic has even spread to prisons. To protect prisoners, face-to-face talks with families have been suspended. As a result, 12 people were killed in riots in at least 22 correctional facilities, possibly involving prisoners hoping for a general amnesty instead of suspending face-to-face talks.

Despite all these, measures taken by Italy after the first cases are considered too timid. While initial quarantine decisions were important, its geographic scope was expected to be wider. The reason geographic coverage was narrower than expected was the desire of the authorities to prevent the spread of an unnecessary air of panic among citizens and to minimize economic impacts.

Let us not forget that Codogno is located right next door to Milan, the industrial hub, and Venice, which hosted 12.1 million tourists in 2018.

Of course, the fact that most of the rulers in these regions are members of the main opposition Northern League may have given rise to political reservations about limiting the quarantine.

Milan Mayor Giuseppe Sala continued his persistently #Milanononsiferma (Milan does not stop) campaign, relying on Italians' notorious underestimation attitude and positive approach. National leader Nicola Zingaretti, who belongs to the same party (Democratic Party), continued his regular life in front of the cameras by holding meetings and rallies in Milan. But a few days later he posted a video on social media explaining that he had contracted the virus and would remain in quarantine at home.

On the other hand, according to some experts, Italy was able to spot the iceberg only after its summit had surfaced. So, COVID-19 tests began to be administered after the first severe case appeared that did not respond to the usual treatments.

Also, the outbreak of a seasonal flu period did not raise doubts about the case increases, only a special protocol was applied to patients from China. The first cases, which probably appeared in hospitals as of mid-January, had no connection to China. In these cases, H1N1 and N3N2 virus treatment and protocol were applied.

If this latest interpretation is correct, if the measures implemented by Italy are not implemented in time in other European countries, unfortunately, the COVID-19 virus will spread similarly in other regions.

In the words of former Prime Minister Matteo Renzi, “Italy has been the Trial Chamber of Europe,” and this was only the first case, if not a special case for Italy.

Today, life has stopped in the land of "Bella Vita" (beautiful life). The lively and dynamic streets are replaced by silence and anxiety. Despite this, hope is not lost, and one can think of The Decameron of Boccaccio: 10 young people flee Florence to take refuge in a village to escape the plague of 1348. There, to relieve loneliness, distress, and fear, each young man, in turn, tells a happy ending story, and thus an unforgettable work emerges.

[Michelangelo Guida is a political scientist at Istanbul's May 29 University]

* Opinions expressed in this article are the author’s own and do not necessarily reflect the editorial policy of Anadolu Agency.

* Translated by Merve Dastan in Ankara

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