What happened in Italy?

Italy experienced a complete “lockdown” to control the rapid virus spread and significant morbidity and mortality associated with the contagion. We don’t know why Italy had such a severe reaction, but there are multiple likely explanations:

  • Spread likely began before the first patient was formally identified (several severe pneumonia cases are suspected to have been undiagnosed for an appreciable period of time)
  • Italy has the oldest population in the oldest continent, and we know the elderly are more likely to experience severe disease (mortality rate has been reported up to 4% in Italy, higher than other parts of the world. Understanding this is an overestimate because of lack of early testing, it does suggest that the average age at death of 81 was partly the reason
  • Air quality is different (often worse in northern Italy) – worse air quality makes nearly every respiratory illness worse/more severe
  • There are more smokers than the USA (almost double) – a known risk factor for nearly every respiratory illness, as well
  • Italian greeting customs (kiss on cheeks) are more favorable for transmission
  • Possibly underfunded public health system (vs France, Germany)-controversial but worth acknowledging reported shortage of nurses and ICU beds

Is this the same in the USA? Obviously there are differences, but we need to be vigilant to appropriately place our efforts so we can avoid the extreme situation Italy is now stuck in.


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