As Italy shuts down all school, why is struggling compared to China?

Italy is struggling to cope with the increasingly demanding outbreak of COVID-19, the respiratory illness caused by the coronavirus.

Meanwhile, China – where the disease originated – is reporting a long-awaited slowdown in the number of new cases.

Why has Italy struggled so much with the epidemic?

Italy is the hardest hit country in Europe, and has the second-deadliest outbreak outside of China, where the disease originated.

On Wednesday Italy ordered all schools and universities to shut down until mid-March. It has imposed quarantines, suspended football games, shut down events and monuments.

But so far it has not been able to curb the spread of the disease.

It has reported 80 deaths from 2,502 confirmed cases. Most patients who died were either old or had other condition.

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Sky News science correspondent Thomas Moore said: “One explanation is that Italy has the second-oldest population in the world after Japan, and it’s the elderly, particularly those with underlying health conditions, who are at highest risk of serious illness from the coronavirus.

“The alternative explanation favoured by scientists at Imperial College London is that lots of people with mild symptoms, or possibly none at all, are going undetected.”

The outbreak struck at the heart of Italy’s wealthy north. Lombardy, the region around Italy’s financial capital, Milan, is one of the richest and most productive in Europe.

Along with neighbouring Veneto, the other main area hit by the coronavirus outbreak, it generates around a third of Italy’s economic output.

This means the healthcare system was better equipped to cope (for now at least). On the other hand, it also means the economic toll on the country will be heavier.

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So what is the true scale of the epidemic?

Italy has a fatality rate of around 3.16%.

Sky’s Thomas Moore said there is suspicion that the number of deaths reported in Italy do not reflect the true scale of the epidemic.

He said researchers from Imperial College London have found that the real number of cases could be between 50,000 and 100,000 cases of COVID-19 in Italy but many with symptoms so mild they don’t realise they have the virus.

Is Italy testing more people than other countries?

Data from Italy’s ministry of health shows that, as of 2 March, there had been 23,345 tests done – or 386 per million people. As a comparison, the UK has seen 13,525 tests – 199 per million.

Comparisons with Austria (235 tests per million) and Switzerland (214 per million) could show that perhaps the scale of the outbreak is simply being revealed in Italy before many other countries.

What has Italy done to try to control the disease’s spread?

Flights from China were banned from an early stage in the outbreak – but only direct ones, not those with a stopover.

Questions have also been asked about whether an early case was mishandled by a hospital in Codogno, a small town in the north that is the epicentre of Italy’s outbreak and has since been quarantined.

On 21 February, Lombardy announced that the 38-year-old from the town, named only as Mattia, had tested positive for the virus.

But when he first went to hospital on 18 February, no alarm was raised about his symptoms because he had not been to China. By the time the nature of his illness was realised, he had infected five health workers and at least one other patient, as well as his pregnant wife and a friend.

Massimo Galli, head of the infectious diseases department at Milan’s Sacco hospital, said he thought the epidemic had probably started well before Mattia had fallen ill, however.

Is the number of cases in China really slowing?

Yes. The country reported 119 new confirmed cases on 3 March, the lowest number since late January. China still has, by far, the highest number of cases, with more than 80,000 of the 93,000 reported worldwide. Some 2,980 of China’s confirmed cases have resulted in death, a rate of 3.71%.

WHO outbreak expert Maria Van Kerkhove said: “We scrutinised this data and we believe this decline is real.”

As the number of new cases seems to be falling, attention is turning to stopping new cases from being brought into China from overseas. Beijing and Shanghai have said travellers arriving from South Korea, Japan, Iran and Italy – the countries with the worst outbreaks – will have to be in quarantine for 14 days.

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Why does China seem to be stemming the spread of the virus?

A report following a joint WHO-China mission pinpointed three main ways China had started to turn the tide: the speed at which experts isolated the causative virus, established diagnostic tools and determined transmission parameters – such as the route of spread and incubation period.

Dr Bruce Aylward, a Canadian WHO epidemiologist who led the mission, said China had used “probably the most ambitious and, I would say, agile and aggressive disease containment effort in history”.

He said China’s approach had been “turbo-charged with modern science and modern technology in a way that was unimaginable even a few years ago”.

Two specialist hospitals were built in Wuhan in just over a week, many routine hospital provisions were transferred to online platforms, and a 5G platform was rolled out allowing real-time contact and support for investigators in the field – even in remote areas.

But the technology also included surveillance through phone apps such as WeChat to trace contacts of confirmed cases as well as making sure travel restrictions were obeyed. Events were cancelled, leisure facilities were closed and business in the world’s second-largest economy stopped.

The mission’s report said the Chinese people had reacted to the outbreak “with courage and conviction”, accepting and adhering to “the starkest of containment measures”.

Mr Aylward added: “What they’ve done has only been possible because of tremendous collective commitment and will of the Chinese people from the most bottom-level community leaders we met and talked to, to the governors at the top.”

He said China’s approach had “definitely reverted and probably prevented at least tens of thousands – but probably hundreds of thousands – of cases of COVID-19 in China”.

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Why can’t Italy – or any other country – react the same way?

As the WHO report says, reacting in the same way as China would require extremely proactive surveillance to immediately detect cases, very rapid diagnoses and immediate case isolation, rigorous tracking and quarantine of close contact and “an exceptionally high degree of population understanding and acceptance of these measures”.

Such widespread lockdowns and intrusive surveillance by an authoritarian government would cause problems in any country where citizens valued their rights and their privacy.

Sky’s Thomas Moore added: “Hardly a day goes by without the World Health Organisation praising the efforts of China in containing the coronavirus.

“Hubei province was sealed off, with factories closed and travel banned, in an effort to stop the virus spreading.

“And if you look at the official figures the strategy seems to have worked, with new cases declining since they peaked at 3,887 on 5 February. Now there are just over 100 being reported each day.

“Italy also tried to quarantine the areas affected by COVID-19, but the virus had already spread before the authorities sealed off 11 towns in the north.”

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