Tue, 27 Oct 2020

Why is Italy Seeing Fewer COVID Cases Than Its Neighbors

Voice of America
25 Sep 2020, 17:35 GMT+10

FRANKFURT, GERMANY - Coronavirus cases are surging across most of Europe. France, Spain and Britain are seeing precipitous increases. But some countries, notably Italy and Germany, have yet to see a second wave of the pandemic, although their numbers are also rising, but far less steeply.

In the past two weeks, Italy recorded slightly fewer than 35 new cases per 100,000 inhabitants, compared to nearly 315 in Spain, around 200 in France, and 76.5 in Britain, where the number of people testing positive for the coronavirus is now almost three times as many as at the end of August, according to British government data.

Italy was the first European nation to be struck by the coronavirus pandemic and suffered one of the world's worst death tolls earlier this year. But the rolling average of new cases in Italy the past week has remained at just under 1,500 infections a day. In Britain, it is nearly 4,000 a day, and more than 10,000 in both France and Spain.

For British Prime Minister Boris Johnson, the reason for Britain's big surge in infections is because it is a "freedom-loving country." Britons are less inclined to follow government-dictated rules voluntarily, he noted this week. But he is now urging them to do so, with the added incentive of tough fines if they fail to comply.

Johnson's comments that the British are more liberty-loving than Italians or Germans prompted outrage in Italy.

"Italians also love freedom. But we also care about seriousness," Italian President Sergio Mattarella said.

But many public health officials and infectious disease experts say there is, in fact, little evidence that Italians or Germans have been any better at voluntarily observing mask-wearing rules than the British, French or Spanish, especially when it comes to the young.

Disdain for pandemic rules was evident among young Italians this summer. In Lazio villages and towns surrounding Rome, and further afield in Umbria and Marche, traditional piazza gatherings outside bars for an evening aperitivo were full of young people with masks pulled down, despite their close proximity to each other, VOA found on several trips over the past three months.

"The clock stopped for us for months," Paolo, 25, an unemployed college graduate, told VOA. "No longer," he added, downing a beer in a village square in Sutri, half an hour's drive from Rome.

In northern Lazio in August, frustrated town mayors and the provincial president of Viterbo issued a joint statement urging citizens to obey the rules, warning that police had been instructed to enforce mask-wearing and social-distancing regulations.

"There is no evidence that individual and social behaviors like the use of masks, social distancing or no gatherings have been better in Italy than elsewhere," Dr. Nino Cartabellotta, a leading public health expert, told digital news website The Local this week.

Other experts disagree and maintain voluntary compliance has been higher in Italy than many other European countries, especially in large cities in the north of the country, which were especially hard-hit by the pandemic earlier in the year.

Either way, Italian police are ready to enforce the rules more rigorously than their counterparts in Britain, who have been reluctant to do so on grounds that they do not have the workforce.

On Monday, Italy's Interior Ministry announced that police had carried out more than 50,000 checks nationwide on people to ensure they were observing rules and visited nearly 5,000 businesses to ensure compliance with pandemic protocols.

More than 200 people were fined by police for non-compliance. Three companies were ordered to shut.

Early lockdown, states of emergency

Aside from more rigorous police enforcement, many infectious disease experts suspect Italy is seeing a slower uptick in cases largely because it is reaping the benefits of ordering a nationwide lockdown earlier than other European countries, and because the government has reopened far more gradually and cautiously than its neighbors.

Many restrictions are still in place or are reintroduced quickly when case numbers warrant. Italian authorities closed schools much quicker than other European countries earlier in the year, and they have been much slower in reopening them.

In mid-August as confirmed case numbers climbed, Prime Minister Giuseppe Conte moved quickly to shutter bars and nightclubs.

Italy's central government has been able to move quicker than some other European governments when pandemic circumstances warrant it, largely due to state-of-emergency powers that allow Conte to rule by decree. The government secured parliamentary approval for a six-month state of emergency on January 31, when the first two cases of coronavirus were confirmed in Rome.

In July, the state of emergency was extended to the end of October, and Conte has made it clear he is ready to ask Parliament for another extension of special powers, which make it easier for ministers and regional governors to declare red zones, close businesses and direct more resources to hospitals.

Emergency powers allowed the government to move quickly last month to require Italian vacationers returning from viral hot spots overseas to undergo coronavirus tests on arrival at airports and seaports or within 72 hours after arriving at their homes.

Contact tracing

Experts also credit the slower uptick in case numbers in Italy to better contact tracing and ensuring that self-isolation requirements are observed.

Italy is testing about 100,000 people a day, far fewer than Britain, which is testing around 250 million daily. But Italian authorities have been more effective in tracing the contacts of those infected, said Italy's deputy health minister, Pierpaolo Sileri. He credits Italy's testing and tracing system in helping to avoid the dramatic resurgence of the virus seen elsewhere in Europe.

Italian government officials say more than two-thirds of Italians who tested positive for the coronavirus in the past few weeks took tests not because they had symptoms but because they were identified through contact tracing.

Track and trace in Italy is the responsibility of local and regional health authorities - a far more decentralized approach than that adopted in Britain, whose centralized system has struggled to trace the contacts of those infected.

According to Bing Jones, a doctor in the English town of Sheffield who is involved in test and tracing, few contacts are identified.

"We probably are at less than 10% and falling," he told Britain's Independent newspaper.

Germany's test-and-trace method is also managed at local and regional levels and being credited with helping to keep a viral resurgence at bay. According to a recent study of Britain's Imperial College, an effective testing and tracing system can reduce the reproduction rate of the virus by around a quarter.

Italian and German public health officials warn that their countries are unlikely to escape a second wave of the pandemic. They just hope they can do a good job subduing it more quickly.

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