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Many face the harsh reality that Italy is experiencing a terrible second wave as the cold arrives. The country has reached nearly 50,000 dead. As Italy experiences the COVID-19 pandemic, politicians debate how to allow families to spend the holidays together; how to enable a traditional dinner while managing the spread of the virus.
Carlo La Vecchia, professor of medical statistics and epidemiologist at the University of Milan, explains what is behind the second wave, why Germany fared better than most other countries and what to expect at Christmas .
Has Italy “spoiled” the progress made this summer when the number of cases was close to zero?
I partially agree with this interpretation. On the one hand, if we had continued until the end of September without a case, we would be telling a very different story today. Still, I wouldn’t attribute all the neglect to people’s behavior during the summer months. We opened the country on June 3 and only had one death on August 23, so we have had virtually no evidence of the virus circulating for months. According to data available in September, the curve has flattened and the “summer number” appears to be a problem of the past.
Unfortunately, we have seen an increase in cases and the line has started to climb with the opening of schools and the resumption of activities in October, especially in the big cities. On October 15, the numbers “exploded”. I would attribute part of the problem to social and work activities, increased human interaction during completely normal activities. I would also say that you have to take into account the weather conditions. To our knowledge, the droplets persist in humid, cold air, as they fall rapidly in hot and dry environments, conditions we experience during an Italian summer.
Perhaps thanks to a second mild lockdown, data over the past few days appears to show the country is flattening the curve again, but with increased viral circulation. These days we are seeing a positivity rate of 10%. We have to recognize that the virus is still spreading, in a surprisingly sustainable way.
What do you think is special about the way the virus seems to be evolving in Italy compared to other European countries?
This second wave of the pandemic is very similar in four different countries: Italy, Spain, France and the United Kingdom In the spring, Italy faced the problems of the pandemic about 15 days before the other countries , with more than 10% more mortality than the others. At the time, the two-week “warning” gave other European countries time to prepare their national health services.
The second wave seems to follow a different pattern. Now we are predicting 10 to 15,000 deaths in each country, but we do not expect to hit the numbers for the first wave, as health conditions have improved dramatically almost everywhere. If we compare Italy to the UK, we can see the subtle difference in percentages: Italy’s death toll of 50,000 out of a population of 60 million, and UK death toll of 54,000 over a population of 66 million. The very unique case in the EU is Germany, where they had 14,000 deaths out of a population of 80 million. We can attribute this to a very different and more efficient national health service, with small but well-equipped practices all over the country, and even in small towns.
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Why have there been fewer deaths in Germany? Why does Italy now need intensive care units, doctors and nurses?
The reason is extraordinarily simple: Germany is richer than other EU countries. They have the ability to double Italy’s public spending on healthcare and budget more for healthcare each year. In contrast, Italy’s financial statements show an allocation to pension benefits. In addition, Italy’s huge debt consumes most of the resources, leaving very little for governments to fund essential services. After the economic crisis of 2007, continuous cuts were suffered, in Italy as well as in the United Kingdom, in France and in Spain.
What is missing from the Italian healthcare system?
The answer is very simple. Italy did not have a pandemic plan before COVID-19. Each year we would see our intensive care units fill up quickly during any regular flu season. The reaction has always been to wait for the wave to pass and do nothing to improve the capacity of the hospital. For the past 20 years, there has been no pandemic plan, despite warnings. It is a political responsibility and a big economic problem. We have to admit that Italy was not at all ready to face this pandemic, while Germany was very ready. At least now we’ve doubled our beds in the intensive care units.
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What will the Christmas holidays look like in this COVID era?
Everyone should be careful and reduce contact with parents and children. It will be a Christmas of caution and respect for the virus. Consider this: We estimated that during the summer about 1% of the population would be infected, but now that number is at least 5%. Every touch is more dangerous than ever. In the coming weeks, we will probably see a flattening of the various indicators and a general improvement in the situation, but people should still comply with the regulations. The virus is still spreading quickly. In addition, we will not have a vaccine ready before Christmas and we will not achieve collective immunity without it. At this time, we must try to reduce the risk and hope for rapid confirmation and distribution of the vaccine.
How long will scientists study this epidemic and what can we do to avoid making the same mistakes?
In our university teaching, even after a century, we still use the “Spanish flu” as a classic example of an epidemic. Humans forget that disease can occur at any time without knocking on our door. And we haven’t had such an experience in the past 50 years. Diseases are cyclical. I hope that we have learned the lesson now and that we will adapt our health systems, our public spending and our education system. We need to build highly specialized hospitals and train new professionals to prepare for events like this.
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