The country of Italy has been put under a dramatic total lockdown as the number of cases of COVID-19 soars. There are more than 10,000 cases and counting, with more than 600 deaths reported so far.
The most severe restrictions since World War II have been instituted with schools and universities closed, while shops, restaurants and normally packed tourist sites left completely deserted. Milan, the country’s financial and fashion capital is like a ghost town. Local police have resorted to arresting and fining citizens who are found to violate the quarantine.
Italy now has the second-highest number of confirmed infected cases, as well as the second-highest, reported death toll, behind only China. The main question that is troubling many is why has Italy been hit so hard by this coronavirus?
The case fatality rate from COVID-19 in Italy is thought to be five per cent, much higher than the global average of 3.4 per cent, according to the World Health Organisation (WHO). So, what has put Italy and its citizens so much more at risk of severe disease?
There are several potential reasons for this.
One main factor seems to be the age distribution of its population. Italy has an ageing population, actually the oldest population in Europe, with almost a quarter of its residents age 65 and older. Indeed, Italy is known to have one of the highest life expectancies in the world.
Elderly people are known to be more susceptible to the worst complications of COVID-19 as reported by the Centres for Disease Control (CDC), and most of the deaths in Italy have been among people in their 80s and 90s.
Emerging data from China have shown that 80 per cent of adults that died were over the age of 60. Also known is that underlying medical conditions play a role in the severity of the illness.
Smoking particularly increases the risk of pneumonia and respiratory failure as it can impair lung function and weaken the immune system, therefore contributing to more severe illness. A recent study showed that 21 per cent of Italians are smokers when compared to less than 14 per cent in the US.
Another risk factor could be related to local customs. Italians are very sociable with large family networks and the common greeting being kissing and hugging. They are not used to being physically separated and enjoy each other’s company.
Coronavirus is transmitted through droplets from person to person and through contaminated surfaces. As a result, social isolation and distancing were advocated fairly early on in an attempt to curb the spread.
Unfortunately, Italians are known to have a somewhat rebellious nature and often view authority with some degree of mistrust. Many people initially shrugged off the COVID-19 risk, continuing to mingle, with several instances of citizens defying the recommendations put in place for their well-being.
For example, in the early stages of the outbreak, when the government aimed to limit movement, a couple left one of the affected zones to go skiing in another region. When caught, they were both found to be positive for COVID-19.
Just mere hours before the full lockdown, many Italians then rushed to the grocery stores in the middle of the night despite advice weeks earlier to equip themselves with certain essentials.
Italy has now found themselves hardest hit in Europe, with the number of deaths outnumbering France, Iran and South Korea combined.
Importantly, one of the other main factors to remember is the variable nature of the symptoms of COVID-19 which may be very mild. The danger with this is that many people do not know that they have the virus.
In Italy, the first known patient that tested positive for the virus was on February 20 in Lombardy. However, just 18 days later, there were over 6,000 people in the country infected.
The main reason proposed for this was that the virus was able to spread undetected for weeks. People essentially were infected without any significant symptoms. As testing then expands within a community, more cases, including the mild cases are subsequently picked up.
It is crucial for all of us now to follow the recommended public health measures and learn the lessons from other affected countries. A tremendous joint effort is needed to reduce its spread and the possible eventual consequences.