COVID-19: What went wrong in Italy and Spain?

OVIEDO, Spain / ROME, Italy

Although the pressure on Italian and Spanish hospitals is slowly beginning to ease, Spain and Italy remain the world’s two worst-hit countries by the COVID-19 pandemic so far.

Together, the two Mediterranean countries account for around 40% of the total global COVID-19 deaths, with the disease having claimed some 31,000 lives in the two countries in less than two months.

Around 200,000 cases, many of them severe, remain active in both states.

There is no doubt that the two countries share several characteristics – highly social citizens, fair weather, densely populated cities, physically affectionate social interactions, and large elderly populations.

Yet, as both witness the overwhelming influx of COVID-19 patients begin to subside, it is now clear that timely government action could have potentially saved thousands of lives.

Unfortunately, overconfidence was another trait shared by the governments of Spain and Italy in the critical weeks leading up to COVID-19’s explosion. Authorities in both countries underestimated just how fast the virus could spread and how quickly it could push their healthcare systems to the verge of collapse.

It took about three weeks from the time Italy discovered its first coronavirus case on Feb. 21 to the closure of all non-essential businesses and a national ban of unnecessary movements by the public.

Italy’s failures – partially justified by the unprecedented nature of the event – happened despite the successful policies to contain the pandemic already used in countries such as China, South Korea, and Singapore.

Denial

According to many observers, one of the first stumbles in the Italian response to the outbreak was its failure to recognize the magnitude of the pandemic, and make decisions in real time, as the crisis was unfolding.

In late February, some Italian politicians, including the leader of the center-left Democratic Party Nicola Zingaretti – who was later infected by COVID-19 – showed themselves having drinks in Milan, promoting the idea that Italy’s financial hub should continue business as usual amid the virus.

“The initial state-of-emergency declarations were met by skepticism by both the public and many in policy circles — even though several scientists had been warning of the potential for a catastrophe for weeks,” researchers wrote for the Harvard Business Review in late March.

To further complicate what was admittedly an unprecedented crisis, Italy failed to adopt a coordinated approach to the emergency.

When the first decree announcing the closing of northern Italy was issued on March 8, it sparked a massive, frightened exodus to southern Italy, ironically and inadvertently spreading the virus to other regions.

In addition, the government often clashed with regional governors who were calling for a quicker and more extensive response.

Mass gatherings as clouds gathered

Spain, despite the added advantage of seeing what was happening in Italy, also failed to recognize the exponential spread in the critical early weeks of the virus’s introduction into the country. In Spain, the first COVID-19 case was reported on Jan. 31. The first death occurred on Feb. 13, but it was not diagnosed post-mortem until early March.

On March 8, the same day a quarantine zone was declared across much of Northern Italy, the Spanish government was encouraging people across the country to take to the streets for International Women’s Day protests.

At the time, 10 people had already died of COVID-19 in Spain and 520 cases had been confirmed. On the day of the massive protests, Spain’s health minister held a press conference telling people to stay home if they were feeling ill.

In Madrid, Spain’s hardest-hit region, 120,000 people packed into the city center to support gender equality. The same day, supporters gathered in crowds as large as 60,000 in dozens of other Spanish cities, as other large events like football games and political rallies continued in full force.

Among those who joined the women’s march, three Cabinet ministers from the country’s left-wing coalition and the first lady were later diagnosed with COVID-19. Irene Montero, the minister of equality, tested positive just four days later.

Even though the mayor of the Italian city of Bergamo described a February Champions’ League football match between Italy's Atalanta and Spain's Valencia as “a biological bomb,” Spain’s government has not criticized its decision to promote the massive protests.

In an interview with El Correo daily on Sunday, Fernando Grande-Marlaska, Spain’s interior minister, said “this government has no reason to regret anything.”

‘Virus isn’t in Spain’

In late February and early March, there was no strong voice in the government warning of the seriousness of the pandemic. Fernando Simón, the epidemiologist leading the Spanish government’s response, said in late January that Spain probably “wouldn’t have more than a few cases.” In late February, a critical moment in the virus’ spread across the country, he told a press conference that “the virus isn’t in Spain.”

As a result, Spain failed to stockpile medical equipment, tests and protective gear until it was too late – issues compounded by budget cuts to the healthcare system in the years of austerity following the 2008 financial crisis. So far, around 20,000 Spanish healthcare workers have been diagnosed with COVID-19.

It wasn’t until the day after the women’s protests that authorities claim to have noticed a massive uptick in the spread of coronavirus. On March 10, all gatherings of more than 1,000 people were banned in cities, including Madrid. Just six days after International Women’s Day, the country was under total lockdown.

Like in Italy, in the week of limbo between normality and full lockdown, thousands of people living in cities like Madrid fled to their second residences or hometowns to avoid being quarantined or cooped up in the city. On March 9, Spanish Prime Minister Pedro Sanchez was filmed greeting people with the customary two kisses on the cheek, a gesture now viewed as recklessness.

Hardly a week later and Spain was engaged in a full-fledged war against the disease. The spread had gotten so out of control that the country imposed one of the world’s strictest lockdowns on March 14, one which will last until at least April 25.

Everyone was told to stay at home, the national government centralized the sanitary response, and the country eventually released its biggest ever financial stimulus hoping to cushion the economic shock of the pandemic.

A tale of 2 regions

Unlike in Spain, different regions in Italy ended up putting in place different policies, which had a clear impact on the virus’ spread. The most striking example was the contrast between the crisis management of Lombardy and Veneto, two neighboring regions that were hit first by the outbreak.

Lombardy – Italy’s wealthiest region – still has the grim record of more than 28,300 current cases and 9,400 deaths, in a population of 10 million. Veneto fared significantly better, with about 9,900 current cases and 695 deaths in a population of about 5 million.

Veneto’s outcome was due to a much more extensive approach than Lombardy, based on broad testing of both symptomatic and asymptomatic cases, together with active tracing of possible positives and a strong emphasis on home diagnosis and care, which reduced the hospitals’ burden.

Experts said the so-called “Veneto model” could have been used early on to shape both regional and central policies. That, however, happened only more than a month from the start of the outbreak.

Like Lombardy, Spain quickly fell behind in testing and only had enough resources to diagnose the most severe cases or those in essential workers by the time the state of emergency began. The country now aims to follow the lead of Veneto and is devising a strategy to test the population more broadly.

Unfortunately, the story is a continuing one. As Italy failed to learn from Asian examples and Spain in turn failed to learn from Italy, other countries like the United States are continuing to prove how deadly an overly optimistic attitude can be in a time of global pandemic.