Europe’s canary: A veteran health journalist reflects on Italy amid COVID-19

Italy and the U.S. have shared striking similarities during the coronavirus pandemic. Italy had until recently the highest number of deaths in Europe; the U.S. has had the highest number in the world. In both countries there have been images of overrun hospitals, patients on ventilators and frantic doctors working without adequate protective gear. There have been serenades from balconies in Italian cities and towns reminding neighbors they are not alone, and New Yorkers banging on pots and pans each night in a show of gratitude for front-line workers.

Since Italy closed down a bit earlier than the U.S., what can we learn from the Italians, who by now are seasoned observers of the virus and the havoc it causes? What can America and the media learn from the Italian experience? I recently asked Italian health journalist Amelia Beltramini for her observations. Beltramini is the former editor of the health and nutrition pages for the science magazine Focus, a best-selling monthly in Europe. She lives in Pavia, a medieval town near Milan and part of the Lombardy region, the hardest struck area in Italy.

Mistakes were made early on, she said. Even though all citizens have the right to free health care, the spread of the virus has been uneven and dependent on the varied responses of health authorities in the country’s 20 health regions. Beltramini contrasted the response of two neighboring regions in the country’s wealthy north — Lombardy and Veneto. Veneto, she said, listened to virologists. The mayor of a town where the first outbreak occurred closed the town, limited the outbreak, tested all relatives and contacts of sick residents twice, eight days apart, and isolated those who were sick. Local health authorities followed isolated patients and tested them as the illness progressed and afterward. “This strategy,” she said, “extinguished the outbreak there and gave hospitals more time to organize and increase ICU beds.” Neighboring Lombardy was not able to organize in the same way against the viral invader.

Beltramini explained that the Lombardy region had made changes to its health system that favor large specialized, for-profit hospitals, which were unprepared for thousands of COVID-19 patients. Doctors and others didn’t have enough PPE, including masks, so testing was reduced. At the same time, workers in Milan, Lombardy’s capital, boarded trains and traveled home to regions in southern Italy, further spreading the disease. The “catastrophe” in Lombardy, she said, was slowed only by the national shutdown, instituted on March 9.

During the peak of the infection, Lombardy was in “real trouble.” A shortage of ICU beds necessitated triaging older patients. Those less likely to benefit from treatment were not placed in ICU beds to make way for younger patients. But for five days in mid-March, in a gesture of European solidarity, the German Air Force flew 63 Italian patients to several German hospitals for free treatment.

Beltramini contrasted the response of two neighboring regions in the country’s wealthy north — Lombardy and Veneto. Veneto, she said, listened to virologists. The mayor of a town where the first outbreak occurred closed the town, limited the outbreak, tested all relatives and contacts of sick residents twice, eight days apart, and isolated those who were sick.

The biggest mistake Italy made, Beltramini told me, was its naïve and slow response to the virus. “We Italians said it will be like SARS and will disappear before arriving in Italy. The first cases were in Iran. We said, ‘Oh well, it’s Iran, no good health care there.’ The United States and Great Britain were thinking ‘Oh well, it’s Italy.’ When the virus arrived, it was much more aggressive than we thought. The only nation that acted quickly was Germany.” She told me Germany was better prepared for the virus with lots of tests, isolation of positive cases, and strong messaging to the population.

Italy’s quarantine has been similar to those in many American cities. The country has been closed for two months and opened May 4. Like New York, only essential services were open during the shutdown — grocery stores, banks, post offices, public offices, newsstands, and pizzerias that deliver. The difference, though, has been Italy’s enforcement and stiff penalties. If anyone left their house, they had to fill out a form downloaded from the internet that specified where they live, where they are going and why, Beltramini explained. Acceptable outings included emergencies and getting health care or food.

These quarantine measures have come with penalties — ranging from about $432 to about $3260, and were tripled if people used their vehicles to travel away from their homes. If a commercial establishment violated the quarantine, another 30 days of closure could be added. And if a person quarantined because of a positive test left the house, penalties included a possible prison sentence. For the most part, people have obeyed, Beltramini said.

Food has been plentiful, she told me, with none of the supply chain shortages and rationing that is beginning to appear in American markets. Neighborhood shops have delivered fruit, fresh vegetables and dried legumes to homes. At Beltramini’s home, supplies of fish, cheese, eggs, frozen foods and cleaning supplies arrive every seven days from a supermarket. As for wine, there’s been no problem either. “The supply of wine in Italian homes is in the cellar with stocks made from autumn trips to the countryside,” she said.

She said while there were some excellent journalists, some with medical degrees, informing the public, many news outlets had closed down their science sections, leaving the virus reporting to those without much or any training in science or health. Some did not know the difference between a virus and bacteria. You could not ask them if it was better to call a virologist or an epidemiologist for a specific question. So-called experts with political connections were “worth very little” when it came to explaining the virus and efforts to mitigate the epidemic to the public. In Italy, she said, the most “impetuous and heated researchers discussed everything, even those (subjects) far away from their areas of expertise.” She added, “Accuracy from sources becomes very important in an emergency.” 

She added that because reporters can’t go into hospitals now to get their stories there have been a lot of “experts” on television that speak hearsay, something that is happening in the U.S. Her advice: rely on the best scientific papers, good reasoning, and connecting the dots. She said that before the virus struck, journalists had not investigated whether the country had enough protective equipment, ICU beds, gowns, and labs to do testing. “When a pandemic starts, every nation wants equipment and then it might be too late to get it. Journalists need more foresight. At the beginning we gave too much voice to those who reassured us this was little more serious than a banal flu and affected only the elderly.”

Nursing homes have been a big a story as in the U.S. “In long-term care facilities the situation is tragic. Visiting relatives and infected but asymptomatic health care workers left without tests and PPE spread the infection among patients, and it was a massacre,” she explained. Last week, data from the Italian government showed that 44% of all virus deaths in the country were in nursing homes. The solution of big nursing homes for the elderly has proven to be fatal during a pandemic, she told me.

Family is important to Italians, a gregarious people accustomed to congregating in the town square. I wanted to know how the quarantine had changed all that. Meetings with friends for coffee or a glass of wine or beer were out. So were family gatherings. During the pandemic, Beltramini’s extended family — including two elders, her 96-year-old mother and 73-year-old ex-husband, and her daughter’s family and children — gave up all contact, despite the fact the families live in adjacent houses. Before, young and old would often meet in a nearby garden restaurant, seeing each other often. In the end there were very few things to do except read and listen to music.

“We were used to getting everything we wanted immediately,” she said. “But we are learning that the pleasure of getting what we want will be even greater when we do get it.”

For me, one of the most uplifting moments of my own quarantine here in New York City was watching online the great Italian tenor sing “Amazing Grace” in an empty square in front of the Cathedral in Milan. I asked Beltramini if she had heard him. Bocelli had chosen the right stage to address the capital city of the region most affected and all Italians, she said, but “Amazing Grace is a prayer addressed to the whole world. It was also a source of great emotion for me, too.”

She told me in their long history Italians have known many dark periods, and it is in those difficulties they know how to give their best. “Today the enemy on the front line is this coronavirus, but if researchers are right, this epidemic will not be the last one.”

On Monday, Beltramini reported that Italy had opened for business. Some construction sites, factories, and offices opened, as long as the businesses can comply with social distancing and disinfecting procedures. As for herself, she said, she took her first walk in public in two months, but there weren’t many people around. Those who were wore masks and kept their distance. “The city is almost deserted and there is no traffic,” she told me. “I would say it works for now.”

Veteran health care journalist Trudy Lieberman is a contributing editor at the Center for Health Journalism Digital and a regular contributor to the Remaking Health Care column.