Dear Italy,  Dear USA

Comparing the Italian vs American Response to a Pandemic: Thoughts of an American in Italy

This weekend marks nearly four weeks that Italy announced its nation-wide lockdown to help stop the spread of Covid-19, halting and transforming my and 60 million other people’s lives. Since then, a lot has happened.

According to the Ministry of Health website, as of March 8th–the first day of lockdown for Lombardia and 14 other provinces in the north–there were:

  • 6,387 people who tested positive
  • 622 recoveries
  • 366 deaths

About a month later, the data from April 3rd dictates that there are:

  • 85,388 people who tested positive
  • 19,758 recoveries
  • 14,681 deaths

So, yeah. The numbers are grim but the good news is that Italy seems to be flattening the curve… albeit slowly. As an [Italian-]American currently living in Italy, I keep myself informed of what’s going on back in the States as well. New York City–my home–has become the epicenter of the virus in the U.S. in a matter of two weeks. The first case was detected on March 1st, and–over a month later–the Big Apple now has roughly 56,289 cases, as shared on the official website of the City of New York. To put into perspective how dire the situation is, NYC accounts for a roughly a quarter of all reported cases in the United States–239,279 according to the CDC.

The U.S. has not [yet] issued a federally-mandated national or regional lockdown similar to what China, Italy, Spain and France have done, and–as the days go on–I can’t help but compare how different countries are handling this global health crisis as the virus has spread west… specifically my two countries.

Of course, I’m aware that the U.S. is 33 times the size of Italy and know that it’s unreasonable to compare the numbers. Instead, I want to discuss the response–the words spoken and action/inaction taken by both governments throughout this pandemic.

Let’s go back to the beginning.

On February 21st, news broke of Italy’s first reported Coronavirus case–the patient was a 38-year old man from a small town in the Lombardia region, about 60km/37mi from Milano. The town, along with nine others, was immediately placed on lockdown–quarantining nearly 50,000 people. The same day, Prime minister Giuseppe Conte stated, “We were prepared for this possibility … The people shouldn’t be worried, we had a plan and we are carrying it out. We’ll proceed with maximum caution”.

The first confirmed case on U.S. soil was back on January 20th, in the state of Washington. Similarly, the patient was a man in his mid thirties. The first action taken by the U.S. Centers for Disease Control (CDC) was to redirect all flights from Wuhan–the Chinese city where the outbreak started–to five major U.S. airports for screening. However, it appears that not much was done on the local level to stop the virus from spreading. President Donald Trump, two days later, responded to a CNBC reporter’s question regarding whether he was worried about a looming pandemic, “No, not at all. We have it totally under control. It’s one person coming in from China … It’s going to be just fine”.

Both unsatisfactory answers coming from both Conte and Trump, in my opinion. It’s reassuring that they did not appear worried and wanted to prevent people from panicking, but–at the same time–full transparency was needed from the beginning. Given that both leaders have access to a wealth of data and resources, it’s hard to believe that neither of them knew that things would soon take a turn for the worst.

Each governments’ actions in the weeks following the first cases.

An eerily semi-empty Piazza Duomo on February 25th. Credit: Matteo Bazzi/EPA.

The virus continued to spread ferociously in the north of Italy, prompting many in big cities to adopt new protocols and practices almost immediately. Streets were emptier. Bars were no longer allowed to offer self-service for aperitivo. Many companies (including mine) recommended their employees to work from home–way before the government forced us to. Conte was adamant in his unwillingness to suspend the Schengen Agreement, still allowing free travel among some European nations. On the first of March, Conte officially declared the affected towns in the north a “red zone”, and–while many Italians in the affected regions stayed home–for the rest across the boot, life resumed as usual.

Three days later, he issued a decree stating that all schools and universities in Italy would be closed until March 15th–a shock to the rest of the country. On the night of March 7th, a leaked memo revealed that the government intended on essentially closing off the entire region of Lombardia and 14 other provinces until April. This was a colossal misstep as it sparked chaos and a massive exodus from the north, further spreading the virus all over Italy. On the evening of March 8th, Conte took the restrictions a step further and extended the lockdown to the entire country. Citizens were to keep one meter apart. We were to stay at home unless for dire needs. All restaurants and bars were to close at 6pm. That didn’t last long, though, because it was announced on March 11th that all non-essential businesses would have to close until April as well, further crippling Italy’s fragile economy.

As more and more people became infected, different regions took different courses of action. The Veneto region, the other focal point in the north, immediately began testing residents–even those without symptoms–after the first virus-related death in a town called Vo Euganeo in February. Widespread testing and “proactive tracing” appeared to have helped discover new cases and isolate the infected, a plan that seems to have slowed the spread drastically. In Lombardia, however, action was slow and the region was reluctant to implement aggressive testing–a deadly decision as cases skyrocketed and hospitals soon became overloaded with direly sick patients. Conte publicly blamed the hospital that handled the first Covid-19 patient in Italy, expressing its failure in observing the proper protocols and declaring that regions should consult the federal government before acting.

President Trump and members of the task force at the first press conference addressing Coronavirus on February 26th. Credit: Evan Vucci/AP.

As for the U.S., the swift creation of the White House Coronavirus Task Force was announced on January 29th, and–two days later–a public health emergency was declared. On the same day, January 31st, Trump issued an executive order severely restricting or prohibiting travel for passengers flying into the U.S. from China. However, there was no immediate lockdown, or “shelter-in-place”, policy introduced in Washington state (or any other, for that matter) to control the spread internally.

Immense inaction followed for the next few weeks as the administration continued to downplay the crisis and Trump even claimed that the virus may disappear with the arrival of warmer weather in April. By the end of January, there were a total of six confirmed cases in the U.S., but the CDC lab in Atlanta was the only institution that was able to test for the virus. In early February, they had developed their own test kits and sent them out to state and local labs to try out, but–days later–the tests proved to be faulty and were sent back. As the CDC worked to improve the flawed tests, some bureaucratic obstacles prevented the Food and Drug Administration (FDA) from approving laboratory-developed tests quickly, and the virus spread largely unnoticed.

On February 25th, a CDC official warned that it wasn’t a matter of if, but when…and that Americans should “begin preparing for the possible spread“. At a campaign rally in South Carolina on February 28th, Trump contradicted the CDC warning and accused Democrats of politicizing the Coronavirus, telling the roaring crowd that it was their new “hoax”. A day later, the FDA finally announced that it would still need to approve the kits, but independent labs could begin testing as they wait for the federal OK. On March 6th, Trump falsely claimed that whomever wanted to get tested for Covid-19, would be able to. Ten days later, the FDA revised its February 29th statement, and set forth a new policy “for states to take responsibility for tests developed and used by laboratories in their states”.

It’s evident that Italy, although not perfectly, reacted much more swiftly and urgently than the U.S. did–even though the first case in Lombardia was reported one month after that in Washington. While the Italian PM played the blame game early on, he made difficult yet necessary decisions for his country based on facts in the weeks following the first case. Trump chose to minimize the science and mislead the public as his administration grossly mishandled the crisis from the beginning.

Further steps to slow the spread.

The Italian government has not loosened the restrictions put in place one month ago as cases continue to rise, but–instead–extended the quarantine until April 13th (for now). There have been several misunderstandings on what is and isn’t allowed, but–aside from confusing messaging and mischievous citizens–the national lockdown seems to be working to flatten the curve. The campaign #IoRestoaCasa, or I’ll Stay at Home, that the federal government created in early March has continued to gain traction going into April. As of yesterday, all residents in the Lombardia region must wear masks or protective cloth over their nose and mouth when going outside. No other region has announced similar measures yet.

Across the Atlantic, the Coronavirus Task Force issued guidelines–a campaign called 15 Days to stop the Spread–on March 16th. On the same day, the first major U.S. city issued a “shelter-in-place” policy. About 6 million residents in the San Francisco Bay Area were ordered to stay home unless to “provide or receive certain essential services or engage in certain essential activities”. The number of cases in California was growing exponentially, so the governor issued a state-wide lockdown three days later. Sure enough, the states of New York, New Jersey, Connecticut, Illinois and Ohio followed suit shortly after. Earlier this week, the Task Force updated its previous guidelines, encouraging social distancing and increasing the window to 30 days. Currently, governors are expressing great concern to the federal government, lamenting that states are competing with each other for resources and supplies. As a result, the CDC is now recommending that all Americans without medical masks make and wear cloth masks in public, although Trump has admitted he won’t be wearing one.

While Italy proceeded with a national lockdown 17 days after the first reported case, there has been no fixed policy put in place by the White House as cases across the nation proceed to soar. Individual states, like the Italian regions, are acting accordingly based on their needs; but greater assistance is needed from the federal government.

The message to the people.

Conte continues to inform the public with every new decree and update, constantly reiterating that–although it’s difficult right now–these measures must be respected so we can be able to resume normal life soon. He discusses the number of deaths, offering condolences to the victims and families. He thanks all the doctors, nurses, reseachers and medical staff working at the frontlines. The PM’s messages are hopeful, yet practical–supplemented with empathy and supported by science. He’s usually alone when addressing the nation, but–if presenting with other ministers at a briefing–they sit far from each other. Journalists pose their questions via video conferencing.

The Coronavirus Task Force held its first press briefing on February 26th, nearly a month after its creation, and the president has been pretty consistent in addressing the country daily. At a March 13th outdoor briefing, when asked whether he took any responsibility for the testing delay in the country, the president responded that he did not. Trump’s press briefings usually begin with praises for his own administration and various CEO’s, whom he often invites to speak. He focuses mostly on the economic losses–alluding to the stock market, unemployment numbers and presidential approval ratings. Trump’s briefings are sometimes hostile as he accuses the media of fake news, argues with reporters and casts blame on others. However, he does allow the medical experts to share critical information and data daily. For a long time, Task Force members huddled together on the podium, but–as of recently–they are respecting their own guidelines and keeping at arm’s length. Journalists are still present in the room, but now the seating plan allows only two people per row.

Conte and Trump are two very different men with very different views of the world, but they should at least share something in common during this time. As leaders of their respective countries, they should be able to appease the public and offer some solace when addressing them. Conte does a good job of trying to unify his country, while Trump continues to sow division and deflect responsibility–often blaming the past administration and individual states.

The way forward.

The entirety of Italy is and will continue to be on lockdown until the foreseeable future. With Easter around the corner and arrival of warmer temperatures, Italians are getting restless. Aside from the economic toll the crisis is exerting on the country, the social impact is also tremendous. This past weekend saw more people out in the street, from north to south. Consequently, there was also a spike in public fines given to people for violating the quarantine–an action the government should have taken much earlier. Hopefully this will deter others from stepping out with invalid reasons these next few weeks–a critical phase in the fight against the disease.

As of April 3rd, about 300 million Americans–40 states plus D.C. and Puerto Rico–are in the midst of a “shelter-in-place” order. I imagine this number will slowly increase as the virus spreads. Unfortunately, cases are still being confirmed at rapid rates in states that have already issued the order, such as New York and Louisiana. Americans are witnessing top officials refuse to follow basic guidelines, but the example must be set from the top. It’s crucial that the administration agrees on a collaborative and cohesive plan immediately to help the states most in need and save American lives.

4 Comments

  • Sara

    On the first point: “…full transparency was needed from the beginning. Given that both leaders have access to a wealth of data and resources, it’s hard to believe that neither of them knew that things would soon take a turn for the worst.”

    I don’t care about defending Italy or Conte, but, truth to be told, Italy was the first to be severely infected in the Western world and I don’t think that, at that point, they had reliable data on what was going to happen. The virus was “brand new” and China was presumably not sharing the true data. There was always this question in our minds: “Is China giving us the correct numbers? Are they reliable? Is this virus more letal that what it seems?” I don’t honestly think they knew exactly how dangerous it was at the beginning.

    What appalled me was seeing other Western countries, even neighbours like France (so not THAT far away), belittling the situation or even daring to make fun of the “Italian approach”, when we were sharing with the world our data in a transparent way and we kept telling them to pay attention. What I truly don’t understand is how could European countries be so arrogant and superficial, when there was a country WITHIN the continent that was sharing with them what was happening with daily reports and trustworthy figures. I don’t know if it’s our bad reputation or the belief that bad things always happen to the others, but I would have honestly expected other countries to be humble enough to listen and learn from our experience.

    This is not to say that Italy didn’t make mistakes, far from that, but yeah, in that specific phase there was a lot of confusion and little information from China. Sorry for the rant, I hope you don’t mind!

    Sara

    • Rosa P.

      Thanks for your comment, Sara! Even without clear reporting and numbers from China, the World Health Organization was urging countries to prepare and act from January–the same month that Italy hosted a Chinese delegation in Roma. About nine days later, PM Conte even suspended all China flights, but allowed connecting flights and all others to touch down in Italy. This shows that he was fully aware of the health crisis in China, but didn’t act in Italy. For sure other European countries failed in their initial responses, but I believe the government needed to be honest with the Italian people from the beginning. Even the quarantine roll-out (lockdown first in Codogno, then the northern areas) was incredibly confusing and government officials didn’t succeed in relaying the severity of the situation to the people, so Italians didn’t take any of it seriously until the entire nation was locked down on March 8/9th. We were simply ‘advised’ to stay and work from home. Walter Ricciardi, a WHO board member & top adviser to the health ministry, also admitted that he struggled to convince his colleagues to act swiftly. So, there were voices close to Conte advocating for urgency; it just came too late. This, of course, is all easier said than done; none of us know how we would act if we were in the situation. I just believe that both the U.S. and Italian governments knew more than they led on.

      • Sara

        Absolutely, they surely knew more than us. As for WHO, I have to say that I was under the impression they were contributing to the confusion at the beginning (not for their fault obviously), because, even if they asked for them, they weren’t given samples of the virus to study. At January 14th they declared that there was no proof of human-human transmission and, if I remember correctly, they were telling us there was no sense in testing people with symptoms, that had had no contacts with people coming from China. That’s not to blame them, they just told us what they knew. That’s why I believe the confusion had the upper hand at the beginning. I was sincerely confused by the info there were out there.

        Then, surely, we were all too slow to act. Not contesting the rest of what you said, I just had another impression of “the very beginning”. But that’s just my pov. Then, really, I have 0 interest in defending the Italian Government because, considering the kind of job that I have, I risked A LOT because strict measures weren’t taken earlier.

        I hope you and your dear ones are ok! Stay safe, Sara.

        • Rosa P.

          The rollout of information in January was a bit all over the place, true.. but I think that by mid-February, all governments were aware of the gravity of the situation and–unfortunately–acted too little and too late. But, then again, I’m always a little cynical of politicians and governments (:

          Thanks, you as well!

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