healthcare / News

Report from Italy: On the Brink

By Nancy Spannaus

March 18, 2020—American journalist Andrew Spannaus updated his report on the fight against the coronavirus in Italy yesterday. His conclusion: The country is “on the brink” of seeing its hospital system overwhelmed. (His full report can be found on Consortium News)

Testing for the coronavirus in Italy.

Given that Italy is a G-7 country with a historically strong commitment to a social safety net, its experience, both positive and negative, should serve as a strong object lesson to us in the United States.

Dangerous Similarities

There are some ways in which Italy’s situation is quite similar to that of the United States. Most dramatic is the lack of domestic supply of crucial medical supplies, and sufficient hospital beds for a surge in serious illness.

For example: There is only one company in the country that produces ventilators, now in critically short supply. Ditto for protective masks. This is globalization run amok, destroying the basis for countries to provide the most basic protections for their populations, and it is equally true in the United States.

As to hospital beds, the situation is equally dramatic.  To quote Andrew:

The other issue that people seem afraid to acknowledge is the effect of budget cuts. In order to comply with the European Union budget criteria, Italy has undergone several waves of austerity over the past 30 years. The result has been a drop in the number of intensive care beds per capita by 60% since 1990. There are plenty of other details, but that number really stands out, as it’s the key metric for dealing with the crisis today.

While Italy’s take-down of the system can be attributed to the budget strictures imposed on it by the European Union bureaucracy (in the name of “democracy”!), the United States has no such excuse.  We have done it to ourselves, to the point where our hospital beds per capita are less than those in Italy, and tens of other poorer countries. Both are dwarfed by Japan and South Korea, but Italy had only 3.2 beds per thousand as of 2017-8. The United States had 2.9!

Report from Italy: On the Brink

Hospital beds per capita. Italy, not listed, is slightly above the United States.

While some of the usual sources are calling for triage plans[1] – guidelines for who to let die, and who to save – in the state of Lombardy there is an emergency effort underway to build a new several-hundred bed facility within a week. Money has been raised, and the plan is waiting for equipment to be obtained. It is not yet clear whether such efforts will be undertaken in the United States, although New York Governor Cuomo has floated proposals in that direction.

Another similarity between Italy and the United States seems to be “general resistance to wide-scale testing, usually citing the lack of available resources.” Andrew points out that some companies, such as the one where his wife works, have refused to test their workers, even after two cases of coronavirus were found at their facilities.

As might be expected, he adds, attitudes in the Italian population are becoming less cavalier. As people find their neighbors and people in their family being diagnosed with the virus, they are taking the pandemic more seriously.  After all, Italy’s population is the second oldest in the world,[2] and respect for one’s elders is not yet dead there. The average age of coronavirus fatalities in Italy is 80.1.

Here in the United States, the problem has been more systemic, given both the delay and the lack of reliable test kits in anywhere near the number required. Rationing tests to a very limited cohort of the population prevented action to stop the surge in cases we are seeing now, and in fact continues to be the case, including in the generally wealthy northern Virginia area where I live.

Instructive Differences

While Italy’s national government was slow to react with mitigation and containment measures, the strong action taken in the state of Lombardy is worth noting.  As Andrew described in my interview with him 13 days ago, very strict cordons sanitaire were set up around 10 small towns in the province in the immediate aftermath of the virus outbreak.  Police were deployed, no one was allowed in or out without necessary precautions or reasons, etc.

In those towns, the virus outbreak has now begun to subside, showing the success of strong measures at the beginning. But because of the slowness of action nationally, the virus had already spread around the country, although not necessarily from that locality. Of course, now the horse is out of the barn, so to speak, and the same experiment cannot be repeated.  We are in the world of “mitigation,” as U.S. Infectious Disease expert Dr. Anthony Fauci so regularly repeats, out to slow the spread but faced with the reality that it has already invaded every state of the union to an unknown degree over the last months.

Report from Italy: On the Brink

An Italian singing out her window, to raise spirits during the crisis.

The other instructive difference that I would note, although it is not included in Andrew’s article, is the spirit of the Italian population in the face of increasingly tight restrictions on their movements. It is in times like these that deeply embedded cultural characteristics matter, and if their positive qualities can be tapped, can make all the difference.

In Italy, that culture includes a glorious Classical music tradition that, while not unprecedented elsewhere, still holds a strong grip on the population. Thus, Andrew confirms that at 6 o’clock every evening, Italians around the country, especially in the cities, are going out on their balconies and singing. They sing in praise of their doctors and medical personnel, and in praise of the human spirit overcoming adversity. One of the most stirring, I believe, is an aria from Puccini’s opera Norma, which concludes with the ringing phrase “Vinceró” (I will win)! But there are not that many opera singers, so the usual songs range from the national anthem to classical songs, folk songs, and contemporary rock and pop music.

We Americans last found such a spirit of national unity in the period of Franklin Roosevelt[3], a leader who was able to mobilize both our spirits and our physical resources in the midst of the existential threats of the Great Depression and global fascism. I would contend that his American System economic measures and the indomitable optimism he conveyed to the American population, were of one and the same piece. We desperately need updated such measures today in the midst of this national emergency.

Franklin Roosevelt Addresses the Nation on Banking Crisis in March, 1933

Franklin Roosevelt addresses the nation on the banking crisis in March, 1933

Can we not revive them now?

[1] I’m aware of two such calls. One came from London Daily Telegraph writer Jeremy Warner in his March 3 column, when he wrote: “not to put too fine a point on it, from an entirely disinterested economic perspective, the COVID-19 might even provide mildly beneficial in the long term by disproportionately culling elderly dependents.” The other came from U.S. doctor Ezekiel Emanuel, a key spokesman for Obamacare, who took the occasion of an oped in the New York Times to trot out triage plans rather than call for building the necessary resources for treatment.

[2] The Italian population over 65 is 22.8%.  In the United States, it’s 14.9%.

[3] For a full discussion of the lessons we can learn from FDR’s economic mobilization for World War II, see the series that begins with this article.

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