COVID-19: why is it worse in Italy?

Q. “Do we know why Italy was the most affected by COVID-19 when we might have thought that other countries with more ties to China could have been affected long before?” The Italians claimed they were testing more than the others, but do we have any answers? ” asks Mathilde Paul-Hus, from Quebec.
R Essentially, answer the researchers in epidemiology of the Laval University Mélanie Drolet and Marc Brisson, “the countries are more or less affected according to the prevention measures which they succeed in implementing quickly”. Initially, the ideal for a country is to identify and isolate the cases which come from outside, but it is not easy to do with a virus like COVID-19, of which a majority of cases present little or no symptoms.

“In Italy,” says Ms. Drolet and Mr. Brisson, “local transmission began before the first cases were identified and isolated [possibly due to transmission from people who were mildly or not symptomatic]. Once older people with more severe symptoms started to get sick, these cases were identified, but the damage was already done: the virus was already circulating in the population. ”

It is true that Italy was the first western country to be affected by the coronavirus. There is no real reason for this, but it does two things. First, the Italian case seems worse in part because the disease has just had more time to spread. But it’s not just that: it’s really worse than elsewhere. So two, it is also possible that the early outbreak in Italy partly explains why this country was not able to impose social isolation measures in time to decrease the number of people affected – its government, or its population, or both, would have been more or less taken by surprise. At least this is a hypothesis that has been raised by various experts around the world.

Either way, the result was the same. The cases exploded, the complications too, and the Italian health system was literally overwhelmed, to the point of having to leave many patients without care, for lack of means. With the dramatic consequence that the mortality rate is much higher there than elsewhere: as of Sunday, more than 59,000 Italians had been officially diagnosed, of which nearly 5,500 have died. That makes a rate of more than 9% while elsewhere in the world, it hovers around 1% (except in the Chinese province of Hubei, the first place hit by COVID-19, which was possibly taken by surprise. also and where mortality is around 4%).

It must be said in this regard that the Italian population is a little more vulnerable than the others: it is the oldest in Europe and the second oldest in the world, after Japan. No less than 23.3% of Italians are aged 65 and over (compared to 17% in Canada and 19% in Quebec) – however, COVID-19 kills 15 to 20% of those over 70 even in countries that are still able to care for them.

In addition, researchers in the scholarly journal Demographic Science recently noted , intergenerational contact is more intense in Italy than elsewhere in the West: adults live there more often with their elderly parents than elsewhere, and even when the generations do not cohabit. , many Italians choose to settle close to their parents, with whom they have very frequent contacts. This could speed up transmission to the most vulnerable, and therefore increase hospitalizations and deaths.

But it was not inevitable either. To come back to the first point raised by Mr. Brisson and Ms. Drolet, there are countries which, by acting quickly and energetically, have managed to contain the spread. In Hong Kong, Singapore and Taiwan, the (painful) experience of the SARS epidemics in 2002 and various strains of avian influenza in the past made them set up a very effective containment system, which involves severe quarantines, careful tracing of recent contacts of infected people, etc. In Hong Kong, for example, a total of only 273 cases had been reported as of the end of last week since the start of the epidemic, despite the proximity of China and frequent contact between the two. places.

COVID-19 raises a lot of questions among our readers. We invite you to send them to our journalist Jean-François Cliche ( ) and he will respond to one a day in the coming weeks.

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