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On the afternoon of February 27, I finally got a call through to the local service in Milan conducting swab tests for coronavirus.

I’d been provided their details by Italy’s COVID-19 national response team, after initially calling emergency on 112.

When someone who spoke English was found, I explained the situation, as I had done already on three occasions: we had been working near the red zones, had come down with colds and were calling to arrange a swab.

“No, no, no,” the woman said.

“We don’t make this test.”

She told me I had the wrong number, and insisted I call the emergency number.

When I explained that it was in fact 112 which had directed me to her, she was silent for a moment.

Then: “But that’s the only number we have to give you.”

It was an early glimpse into a confused bureaucracy racing to come to grips with an unfolding crisis. At the time, there were only several hundred infections and 12 dead.

Now, the death toll has spiked to more than 2,500, with almost 28,000 people diagnosed with the disease.

 

On Sunday alone, 368 people died from coronavirus in Italy. On Monday that figure was 349. On Tuesday it was 345.

 

At the centre of the pandemic is Bergamo — Italy’s most infected city — which is now home to apocalyptic scenes.

Coffins waiting to be interred fill the Tempio di Ognissanti, a local cemetery church, which has been converted into an emergency morgue.

 

The city’s crematorium is running on a new 24-hour schedule. Newspaper L’Eco di Bergamo is running 10 pages of obituaries; it normally prints just one.

 

Bergamo anaesthetist Christian Salaroli told daily newspaper Corriere della Sera that the hospitals were so overwhelmed, and the supply of respirators so inadequate, doctors were having to choose who receives treatment.

“We decide depending on their age and the condition of their health,” he said.

Watching in horror, many around the world are now wondering how Italy got it so spectacularly wrong?

Italy thought it was under control until Patient One showed up

The country’s first known cases were two visitors from Wuhan, in China.

Detected on January 29, they were placed in isolation in a hospital in Rome and the wheels of a national response began to grind forward.

The next day, Italy was the first European state to block all flights to and from China and Prime Minister Giuseppe Conte declared his country’s emergency response “the most rigorous in Europe”.

 

But a local outbreak was already taking hold. Two weeks after Conte’s bold words, a 38-year-old man known only as Mattia — who in the days prior had socialised with friends and competed in a fun run — saw his GP in Codogno complaining of a flu.

On February 16 and then again on February 18, he visited the 24-hour casualty department of the local hospital and was turned away both times with instructions for bed rest.

On neither occasion was he tested for the virus.

It was only after he returned at 3:00am the following day, now experiencing difficulty breathing, that alarm bells began to ring.

He was tested 24 hours later and on February 21 a positive diagnosis was returned. Italy now had its first known local transmission. In the press, the man was dubbed Patient One.

So-called red zones were draped over Codogno and 10 other villages in the north of the country and curfews were introduced for bars and restaurants in Lombardy.

When he learned of the sequence of events, Conte fumed. In a television interview, the Prime Minister said: “We know that the way one hospital facility was managed was not entirely appropriate … [and] that certainly contributed to the spread.”

People were first urged to go out until things got worse

Conte’s remarks prompted a war of words with Lombardy’s Governor Attilio Fontan and Codogno’s head of medicine, Giorgio Scanzi.

“We have done our duty,” he hit back.

“We have a clear conscience.”

The squabbling reflected a general sense of confusion about the seriousness of the threat.

Fontana told the regional parliament the disease was “just a little more than a normal flu,” and the next day, the province even reversed the curfews on restaurants.

The leader of the Democratic Party, Nicola Zingaretti, made a point of showing up at a bar for a very public Aperitivo, the traditional Milanese evening drink, and light supper.

 

He urged the country to avoid “destroying life or spreading panic”.

But within nine days, Fontana went into quarantine after an adviser tested positive, and Zingaretti himself contracted the virus.

The following day, on March 8, Rome extended the lockdown from the northern provinces to the nation’s frontiers and unveiled a 10 billion euros emergency fund.

In Lombardy alone, confirmed cases of the pathogen had climbed over 4,000, and the death toll was climbing past 267.

Conte delivered a televised address: “Non c’e’ piu’ tempo,” he said, which translated to: “We have run out of time.”

Coronavirus surfaced during flu season

The scale of the catastrophe in Italy remains difficult to digest.

Just 19 days after Patient One was diagnosed, Italy had 12,462 coronavirus patients, more than 1,000 people in intensive care, and 827 people had already died.

The epicentre of the global crisis had swung from China to Europe.

Many have condemned those initial missteps in Italy as critical errors, including prominent Italian intellectual Beppe Severgnini.

He wrote in the New York Times that “mistakes were made” by Italy in the early days of the pandemic.

Severgnini claimed, for example, that the China flights ban may have prompted travellers to enter the country via neighbouring European states, masking the spread of the virus and preventing an effective quarantine.

A scientist from the Italian National Institute of Health told TIME the virus “had probably been circulating for quite some time” before it was detected, as the disease surfaced during the normal flu season.

Nino Cartabellotta, a leading Italian public health expert, has raised questions about whether an unusually high number of suspected pneumonia cases a month prior to the outbreak should have been tested.

“It could [also] be that there weren’t any severe cases,” he said.

“[And] they only emerged in a clinically mild way.”

Italy might be a victim of being the first hit

It appears clear now that the only means by which Italy might have headed off the catastrophe was the implementation of its unprecedented national lockdown far earlier, before there was evidence of its prudence — an almost impossible proposition.

“Waiting strategies have always favoured the spread of the virus,” Cartabellotta said.

 

 

 

Exponential infection curves are now showing up not just in neighbouring European states, such as Spain and France, but also in the United States and in Australia.

 

It may be simply that Italy was first by dint of sheer misfortune.

“You can argue they noticed it late,” infectious diseases modeller from the University of Bern Christian Althaus told the Guardian.

“But that could have happened elsewhere, too. Once they realised what was happening, I think they took it seriously.

“The first lockdown was the right choice, and expanding it nationwide probably too. They realise they need to curb the epidemic.”

There’s a separate question, however, as to how the disease has been fought.

Italy is recording a mortality rate which rocketed on Sunday (local time) to 7 per cent — double the global average.

Of the G7, Rome’s expenditure on public health has hovered at levels behind France, Germany and the UK.

The Servizio Sanitario Nazionale – Italy’s answer to the UK’s National Health Service – has been grossly underfunded for years.

Lorenzo Casani, who runs a medical clinic for the elderly of Lombardy, told TIME there had been “continuous cuts to care and to research”.

“We were not prepared,” he said.

“We do not have enough doctors for the people. We do not have an organised plan for pandemics.”

Casani too described a frightening new reality in which doctors “have to make this horrible choice and decide who is going to survive and who is not going to survive”.

Part of the picture in Italy is demographic. Almost a quarter of Italians are aged 65 or older, the highest such number in the EU.

Many of these people will be carrying pre-existing conditions and other vulnerabilities to such a virulent new strain of flu.

In an attempt to get the outbreak back under control, Italy is now policing public squares and limiting movement of its 60 million inhabitants.

In Milan, a trade fair pavilion is being converted into an emergency field hospital.

Will other countries learn from Italy’s outbreak?

It’s not clear however that other European states have been paying sufficient attention to the travails of their neighbour.

Only in recent days have Spain and France enacted similar lockdowns. On Monday, the EU proposed a temporary ban on all non-essential travel to anywhere on the continent.

The UK will be exempt from such a ban, but it appears that London is, in any case, forging a different path through this global disaster.

When my colleague and I were finally allowed to fly out of Italy, we had expected to be screened at Heathrow. We were not.

We placed ourselves in quarantine and tried to arrange a test for the virus; the NHS’s COVID-19 hotline was almost as difficult to negotiate as Italy’s.

England has yet to introduce any of the more draconian restrictions: schools remain open, as do its borders.

 

Until Monday, it appeared Prime Minister Boris Johnson’s administration had made a decision to tolerate the spread of the virus through a greater proportion of the UK than many other countries, in pursuit of herd immunity.

But new modelling has revealed this approach risked a potential death toll of 250,000 people.

Johnson has since ramped up the UK’s response, asking those who display symptoms to quarantine themselves. He also flagged a three-month isolation for everyone over the age of 70, from this weekend.

It’s an attempt, however belated, to head off the horror that has descended on Italy, and prevent the printing of page after page of obituary notices.