Squabbling leaders, publicity-seeking scientists, and late containment efforts show that authoritarian regimes aren’t the only ones mismanaging public health crises
Italy currently has the world's second-largest reported coronavirus infection rate after China, and it is the first country in the West dealing with a sizable outbreak, with 10,149 confirmed cases and 631 deaths; so far, 724 people have recovered after being treated. The head of the center-left Democratic Party, Nicola Zingaretti, has tested positive for COVID-19, as has the governor of the Piedmont region.
On Saturday, in a dramatic step, the government put the entire region of Lombardy and 14 other provinces in the country's north on lockdown, effectively quarantining about 16 million people until at least April 3 in a region that is the country's economic powerhouse—a move akin to locking down the entire New York or London metropolitan areas. Schools and universities will be closed until early April, and all public events are canceled, while coffee shops, and other stores will be opened only on weekdays and until 6 p.m. Schools will remain closed in the rest of Italy until March 15, although the date will likely be extended.
The latest decree imposes the most stringent restrictions any country outside of China has taken in response to the epidemic, but it is also infused with ambiguous signals and hard-to-interpret provisions. For instance, it forbids people from crossing the red-zone borders but also from traveling within it, with the exception of those travelers motivated by "proven professional needs, exceptional cases, and health issues." How to evaluate what constitutes a professional mandatory need is unclear. This and other vague aspects of the decree spurred an intense debate between the state and some local governors, who are in charge of enforcing it.
The government also mishandled its communication strategy. An early draft was leaked to the press while the cabinet was still discussing it, and the unconfirmed reports of the lockdown worsened an already panicky mood. Many people scrambled to leave the "red zone," either by train or car, before the government officially announced the decree.
This strange combination of severity and amateurism is quite typical of a nation historically burdened by volatile governments, shifting parliamentary coalitions, inscrutable power struggles, and a self-harming tendency to sacrifice its international credibility on the altars of domestic squabbles. The current cabinet—the 66th in Italy's 74 years as a republic—perfectly embodies these traits, a fact that does not bode well for the country's coronavirus response.
The primary goal of Italy's draconian new policy is to ensure that the country's already stretched health system can handle the flow of patients needing intensive care. Acute care units in Lombardy, the region with the most cases, are currently at capacity—and in some instances, doctors are forced to choose which patients to give priority to, following guidelines around life expectancy that are both brutal and inevitable in a state of emergency.
World Health Organization (WHO) data shows that Italy has 275 acute-care hospital beds per 100,000 residents, while the average in the European Union is 394. The Italian government has a plan to increase intensive-care beds by 50 percent, but that requires time. The government has also allocated 7.5 billion euros (about $8.6 billion) to support families and businesses heavily impacted by the epidemic, which will have a crushing effect on the slowest-growing economy in the EU.
"We should come down hard on the irresponsible people, the virus is not a joke," said Health Minister Roberto Speranza, in reference to the many instances in which the previous measures to enforce social distancing to curb the contagion were widely disregarded. Reports of people crowding bars, skiing in packed resorts in the Alps, or squeezing into the beaches in several coastal towns made clear that mild measures wouldn't work.
The effort to stop COVID-19 will be complicated by the country's political dysfunction. Prime Minister Giuseppe Conte leads a peculiar center-left alliance between the Democratic Party and the populist Five Star Movement, two parties that formerly loathed each other. Just six months ago, he was at the helm of an equally strange all-populist combination that included the far-right League as its driving force. Rome is a political laboratory that makes scholars' most daring theories on populism look outdated.
In the last few weeks, Italy became a case study in crisis mismanagement, as a medical emergency of great magnitude met a chronically unstable political environment. The results of the mix are hardly encouraging but could provide some valuable lessons. The coronavirus is an extremely serious threat, but a climate in which politicians weaponize every bit of information for political gain could worsen its effects.
The government's first misstep was to underestimate the threat when, in January, many called for severe measures to quarantine every single passenger arriving from China. Making difficult decisions in moments of uncertainty is hard, but the actual reason why those appeals weren't considered was politics.
The hard-line position was mostly pushed by the League's Matteo Salvini, the archenemy of the cabinet, and by some League governors in the country's northern regions. Salvini was widely attacked for using the medical emergency as a fig leaf to push his trademark anti-immigration and xenophobic rhetoric—but for once he actually had a point, albeit for the wrong reasons.
When the virologist and media personality Roberto Burioni suggested those draconian measures were actually necessary to contain the spread, he himself was accused of being a "fascist" and a League supporter. Walter Ricciardi, a member of the WHO European Advisory Committee, later said that it was a "great mistake" not to quarantine people traveling from China in the first place.
In a misguided attempt to compensate for the initial underestimation, on Jan. 30 the Italian government canceled direct flights to and from China. It was a mistake that made it impossible to track down the flow of people from the areas hit hardest by the epidemic while allowing thousands of passengers to reach Italy, unchecked, through connecting flights in other European airports and elsewhere.
In a press conference announcing the decision, Conte bragged about Italy being the first EU country to take a step that, he said, was in line with the WHO assessment on the COVID-19 as a global threat. It was a well-intentioned yet ill-advised decision. Later on, when the outbreak was raging in Italy, Conte deemed the decisions of several countries to suspend flights to Italy "unacceptable."
While the virus was quickly spreading, Conte's government did not miss the opportunity to shift responsibility to the governors of Lombardy, Veneto, and Piedmont. On Feb. 25, the prime minister even pointed to a hospital mess-up in the town of Codogno, where the person then identified as the country's "patient zero" was hospitalized, which "certainly contributed to the virus's spread." The alarming piece of news quickly spread around the world, feeding the perception that Italy was unprepared to handle the emergency. The story turned out to be false, but the prime minister's actual goal was simply to discredit his adversaries. Afterward, Conte awkwardly scrambled to take his comments back.
Those mistakes combined with a communication strategy that mixed uncertainty, improvisation, and continuous leaks to the press—in a memorable Freudian slip, Conte said at one point that the cabinet needs to send "equivocal messages" to the population, sparking some furious reactions even beyond right-leaning circles.
In a scathing op-ed in the newspaper Il Messaggero, the sociologist Luca Ricolfi wrote, "If we want to limit the number of victims we will have to sacrifice some of our freedoms, at least for few weeks." The alternative, he explained, "is to go ahead with the rancid soup that this government is giving us. But we must know, then, that the cost of it will not be measured in terms of consensus, or lost GDP points, but in terms of human lives that we will choose not to save."
Salvini, of course, jumped at the opportunity to politicize the emergency, and for weeks he called Conte and his allies every name in the book. "This government cannot manage normalcy, let alone an emergency," he told the Spanish newspaper El Pais. He even tried to use the crisis to promote the idea of forming a government of "national unity," suggesting former European Central Bank president Mario Draghi as a potential prime minister—a rather acrobatic twist for a leader who made his name thundering against Eurocrats and bankers.
Salvini's allies most involved in dealing with the outbreak contributed to creating a disjointed narrative that mixed alarmist cries and a Trumpian no-big-deal tone. Just a few days after describing coronavirus as "a little more than the normal flu," Attilio Fontana, the League governor of Lombardy, dramatically announced on his Facebook page that he was voluntarily self-isolating after one of his aides tested positive for the coronavirus.
Meanwhile, the governor of Veneto, Luca Zaia, took a candidly racist stance by saying on live TV that "we've all seen Chinese people eating live mice." Lately, the League and the other far-right populist party, Brothers of Italy, have been obsessing over reports that the Italian outbreak had originated in Germany, which fits with their nationalist narrative and provides someone to blame.
Another bizarre and damaging aspect of Italy's initial handling of the emergency was the public role played by virologists. Media-savvy—and sometimes publicity-hungry—medical experts have flooded the debate on television and social media, offering sometimes contradictory information about the danger of the virus and the proper measures required to contain its spread. At times, they bitterly fought on Twitter, fueling the perception that the scientific community was as divided as politicians on the issue and undermining the notion that there is a true and proven method of containing the outbreak.
The debate over competing hypotheses is the cornerstone of the scientific method, but instead of taking place in medical congresses and peer-reviewed journals, the argument unfolded publicly, in real time, interacting in bizarre ways with a quickly moving news cycle and generating a good deal of confusion. For several weeks, Italians have been more divided about their preferred virologists than they are about soccer teams.
And people picked their experts according to what they wanted to hear. "The war among scientists on the virus," recited the main headline on La Stampa's front page on Feb. 28. One instance that generated wild reactions involved a virologist at Luigi Sacco Hospital in Milan, Maria Rita Gismondo, who described the infection as "only slightly more serious than flu." She was heavily rebuked by a number of her peers, but for days her words bounced around the internet, giving a sense of legitimacy to those who were shrugging off the threat.
A data analysis conducted by the Economist shows that epidemics like COVID-19 are typically deadlier in authoritarian regimes. Democracies, with free flow of information and open debate, usually prove to be more resilient in dealing with complex crises. "During an outbreak, for example, constructive feedback about how government policies are working can help guide a more dynamic response," the magazine wrote.
Italy—now that it has put in place a somewhat coherent, science-based plan to curb the contagion—may in the end confirm that assessment as accurate. But if its dysfunctional political system, amateurish ruling class, and short-sighted leaders continue to squabble while Italians die, Rome's response could end up making the authoritarians in Beijing—despite their initial cover-ups—look more competent in moments of crisis.
Mattia Ferraresi is a writer for the Italian newspaper Il Foglio.