Italy's healthcare system is in a state of almost total collapse. As of today, 31,506 people in Italy have been infected with the coronavirus; of which 2,503 people have died. The numbers continue to grow. Hospitals are overwhelmed. Doctors have to choose which sick person to save and which sick person not to save. Pictured: Hospital employees tend to a patient at a temporary emergency structure set up outside Brescia Hospital, in Italy on March 13, 2020. (Photo by Miguel Medina/AFP via Getty Images)
Italy's healthcare system is in a state of almost total collapse. As of today, 31,506 people in Italy have been infected with the coronavirus; of which 2,503 people have died. The numbers continue to grow. Hospitals are overwhelmed. Doctors have to choose which sick person to save and which sick person not to save.
The country has almost completely shut down. Many businesses are running in slow motion or have stopped. Prisoners are staging uprisings. Millions of people have been ordered to stay home and are allowed out only briefly to buy food. Most shops are shut. All public gatherings are prohibited, even funerals. Big cities look like ghost towns.
No other Western country has been so severely affected by the pandemic as Italy. Why?
First, Italy has an aging population. The median age of Italians is 47.3 years; one in four Italians is over 65. In addition, the country's birth rate is extremely low: 1.29 children per woman. Even before the coronavirus pandemic, Italy was a dying country. Sadly, the virus has accelerated the process.
Second, the authorities and medical personnel apparently underestimated the danger. Although the Italian government had suspended flights for days from China and Hong Kong from January 31, Italian doctors were saying that the illness was just a "bad flu". On March 9, an epidemiologist, Silvia Stringhini, wrote: "The media are reassuring, the politicians are reassuring, while there's little to be reassured of".
Third, the Italian health system is in appallingly bad condition. There are not enough intensive care units and, as everywhere, the possibility of a major crisis simply was not anticipated. In Italy there are 2.62 acute-care hospital beds per 1,000 residents (by comparison, the number in Germany is 6.06 per 1,000 residents). The Italian health system is entirely run by the government. A public health care service (SSN, Servizio Sanitario Nazionale) pays the doctors directly, limits their number, and sets the maximum number of patients they can treat per year (1,500).
Government-run healthcare always ends up being about the government trying to cut its costs rather than to help its citizens. Private clinics do exist, but represent only a small part of the care offered (the public system represents 77% of total health-care spending. (The only country in Europe where the figure is higher is the United Kingdom, where the figure is 79%.) Public hospitals must manage shortages, and when an exceptional situation occurs, rationing care leads to horrific choices. A recent report by Siaarti (Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva) bureaucratically offers "ethical recommendations for admission and intensive treatment in exceptional conditions of imbalance" and speaks of "consensual criteria of distributive justice" to justify not treating certain patients and leaving them to die.
Fourth, and rarely mentioned, is that Italy today is evidently home to a large Chinese community (more than 300,000), made up of people who arrived in the past two decades and who work in the textile and leather sector. Many of the Chinese living in Italy are from Wuhan and Wenzhou, and some had just been in Wuhan and Wenzhou for the Chinese New Year on January 25, when the Chinese authorities could not hide the epidemic any longer. These Chinese had returned to Italy from China before the Italian government suspended flights from there. The epidemic emerged in Lombardy; Bergamo, one of the capitals of the Italian textile industry, was one of the first cities affected.
Before the pandemic, the Italian economy was already in a state of stagnation; now, as people stay home and shops shut, it will probably plunge into a recession. Italian banks, since mid-February, have lost 40% of their market value. Major financial upheavals seem on the way.
The Italian government was hoping for help from the European Union, but neither the other member states nor the European Union itself has given any at all. Maurizio Massari, Italy's ambassador to the European Union, said at a recent European summit on the pandemic, that Brussels should go beyond "engagement and consultations", and that Italy needed "quick, concrete and effective actions". He got nothing.
Christine Lagarde, president of the European Central Bank, refused to lower interest rates to help Italy; it was a statement Italian leaders took as a demonstration of contempt. Italian President Sergio Mattarella said that Italy expected "solidarity from the EU institutions," not "moves that could hinder Italy's actions". "Italy," said Matteo Salvini, leader of the Lega party, "has been given a slap in the face".
The dismissive attitude of the EU and the other members states seems to have been dictated by the fear of sliding into a situation as calamitous as that of Italy.
All European countries have an aging population, even if less than Italy's (the median age in Germany is 46.8; in France it is 41.2; in Spain it is 42.3). No country in the European Union has taken a clear, hard look at the danger Europe is facing.
"The coronavirus is very contagious," France's minister of health, Agnes Buzyn, said on January 26, "but much less serious than we thought".
The borders between France and Italy were not closed in time (only Austria and Slovenia closed their borders with Italy early), and Italians who wished to go to France were not stopped. The health systems of other European countries are not better prepared than the Italian one was. In Spain, Insalud (Instituto Nacional de Gestion Sanitaria), an organization equivalent to the Italian system, exists, and shortages and rationed care are the rule. The German (Krankenkassen) and the French (Sécurité Sociale) health insurance systems also operate on the same principles as those in Italy and Spain, and produce similar results. The economies of the main countries of the European Union were in a state of stagnation before the pandemic, and, like the Italian economy, are likely to plunge into a recession soon, too.
At the time of publication, 11,826 people were infected in Spain, 7,695 in France, and 9,360 in Germany. In Spain, 533 people have died; in France, 148 people, and in Germany only 26. As in Italy, the numbers escalate fast.
On March 11, German Chancellor Angela Merkel said to journalists who were accusing her of doing nothing, "60 to 70% of Germans will be infected with the coronavirus". Lothar Wieler, President of the Robert Koch Institute, the German government agency in charge of disease prevention and control, added that it was necessary to "avoid overloading hospitals" and to let the epidemic gain ground slowly over time.
An adviser to French President Emmanuel Macron told a journalist at Le Figaro that the strategy of France was the same as in Germany: the decision was made to "let the epidemic run its course and not try brutally to stop it". He suggested that the official will was to create "herd immunity", a term first used in the United Kingdom by Sir Patrick Vallance, the UK government's chief science adviser. He had said that the aim of the British government was to accept that a significant number of the citizens of a country would be infected, recover, and therefore be immunized. The French and German authorities evidently found inspiration in Sir Patrick's remarks.
The British government, faced with criticism from the World Health Organization, replied that "herd immunity" was not a stated policy, but no statement by the German or French governments said that "herd immunity" was not the policy they chose.
Umair Haque, the British Director of the Havas Media Lab, wrote:
"Herd immunity describes how a population is protected from a disease after vaccination by stopping the germ responsible for the infection being transmitted between people. Letting an entire nation be rampaged by a lethal virus for which there's no vaccine? How much death and mayhem would that cause, by the way?"
"Europe has now become the epicentre of the pandemic, with more reported cases and deaths than the rest of the world combined, apart from China," noted Tedros Adhanom Ghebreyesus, director general of the World Health Organization. "More cases are now being reported every day than were reported in China at the height of its epidemic." Sadly, all available data show that he is right.
On March 11, President Donald Trump announced that the US was suspending all flights between the United States and Europe, a decision fully justifiable to save American lives. The next day, nevertheless, the heads of the European Union could not resist trying to maul the president: "The EU disapproves of the fact that the U.S. decision to impose a travel ban was taken unilaterally and without consultation," they said.
It is to be hoped that by now notions of "herd immunity" have been abandoned, and that the EU gets back to salvaging for Europe whatever it can.
Dr. Guy Millière, a professor at the University of Paris, is the author of 27 books on France and Europe.