Ever since Italy was struck by the worst outbreak of novel coronavirus outside China, experts and pundits, both local and international, have been pondering how the disease could spread so quickly in a prosperous western democracy with an advanced public health system.
The short answer is that we don’t have enough information about the arrival and spread of the virus in Italy to understand what happened and draw lessons for other countries. However, there a few social, economic and political factors, along with a good dose of bad luck, that may have combined to make Italy the perfect target for this aggressive virus.
As of March 11, there were more than 10,000 confirmed cases in the country, and 631 deaths – a mortality rate of more than 6 percent, much higher than the World Health Organization’s global average estimate of 3.4 percent.
One factor at work could be demographics. The Covid-19 epidemic is especially dangerous for elderly people and those who have pre-existing medical conditions, and Italy happens to have Europe’s oldest population, with 23 percent of the population over the age of 65 and a median age of 47.3. That is much higher than the median age in the United States of 38.3, and 30.5 in Israel.
But demographics are only part of the story. After all, there are other countries with ageing populations, like Japan, which have so far been more successful in containing the virus and have – for now – a far lower mortality rate than Italy.
It now seems clear that already in January the disease somehow reached Italy, and was allowed to spread undetected for weeks in the north of the country, because of a lack of testing and the attribution of some serious cases to "regular" seasonal flu.
"We realized our house was on fire only once most of the first floor had burned down," Prof. Massimo Galli, an expert on infectious diseases at Milan University told Italian daily Corriere della Sera. "But this was a random situation that could have happened in other parts of the world as well."