The Washington Post - 21.03.2020

SATURDAy, MARCH 21 , 2020. THE WASHINGTON POST ez su A

the coronavirus outbreak

people who continue to exercise

outdoors a nd have called on Conte

to place a ban on jogging.

In an interview, the vice gover-

nor of the Lombardy region, Fab-

rizio Sala, said anonymized data

provided by telecommunications

companies indicated that 60 per-

cent of all movement in the region

had stopped, compared with a

normal period before the virus.

But even so, he said, too many

people were leaving the house.

“People should stay at home

more,” h e said.

Polls indicate that the lock-

do wn has wide support, and many

of the Italians leaving their homes

are doing so for essential work.

Still, tens of thousands have been

cited by police for breaking the

lockdown rules.

In recognition of the limits on

how democracies can contend

with the virus, Italy has not used

some of the more heavy-handed

or invasive tools used successfully

by China — including sustained

monitoring outside apartment

complexes and apps that log loca-

tion and body temperature.

Italy’s biggest mistake, virolo-

helped. Te n of those towns w ere in

the Lombardy province of Lodi,

where the pace of cases has risen

at a rate far below other areas in

the region. In a sealed-off town in

a separate region farther to the

east, Vo, the transmission of the

illness has nearly stopped.

“You always pay a price for be-

ing first,” said Giuliano Martini,

the Vo mayor. “But the others had

time to act based on our experi-

ence, looking at the situation on

the ground. They could’ve pre-

dicted it.”

Now under nationwide lock-

down, all of Italy resembles Vo

from several weeks ago. People

stress about the economic cata-

clysm that is waiting the country,

but those fears compete for more

foundational concerns — about

elderly parents, about the inabili-

ty to see loved ones. In many

neighborhoods across the coun-

try, stir-crazy Italians go to their

balconies at night and sing or

open their windows and play mu-

sic. At other times in the day, one

of the public radio stations has

started playing songs about the

locked-down life. (“We are all

cooks,” o ne lyric said.)

The moments are levity are

fleeting, though, and there is

widespread agreement that the

country is facing its gravest chal-

lenge since at least World War II.

This week, Italy surpassed China

for the largest number of corona-

virus-related deaths. Each of the

past six days, the country has an-

nounced at least 300 dead. In

Bergamo, among the hardest-hit

areas, military t rucks have started

lining up outside a hospital, to

take the dead away to farther-

away c rematoriums.

On Friday, Sky News published

footage from inside the main pub-

lic hospital in Bergamo depicting

a wrenching crisis — patients on

gurneys struggling to breathe, in-

cluding in the hallways, and ex-

hausted-looking doctors and

nurses without proper protective

gear. In a public plea posted on the

hospital’s Facebook page, the di-

rector of the department of medi-

cine, Stefano Fagiuoli, said the

facility w as in “full e mergency.”

“We are in desperate need of

both nurses and physicians, to-

gether with ventilators” and pro-

tective equipment, he said.

He i ssued what amounted to an

open call for nurses and doctors

who wanted to come to Bergamo.

“If you are a health personnel,

you are more than welcome t o join

us in fighting the coronavirus,”

Fagiuoli said.

The situation i s most dire in the

north, but cases are increasing

rapidly in most parts of the coun-

try, and authorities have been re-

sponding to a growing number of

local hot spots. Some of the cases

were transmitted by people who

fled Lombardy and returned to

their southern hometowns before

travel restrictions were put in

place. This week, authorities

closed off a town of some 40,

two hours south of Rome after

seeing a spike in cases. A new

decree prevents people from leav-

ing even for work purposes.

The spike had reportedly been

triggered by a festival three weeks

earlier.

Since then, according to the

text of the restrictions placed on

the town, the increase i n cases had

been “remarkable.”

c [email protected]

MarzIo tonIolo VIa reuters

Life in lockdown: Bianca Toniolo, 2, hides this week in San Fiorano, one of the first towns in northern Italy to face major restrictions.

BY CHICO HARLAN

AND STEFANO PITRELLI

rome — Police driving through
the center of Rome blast loud-
speaker messages telling people
to stay indoors. The few who ven-
ture out are liable to be charged
with crimes if their reasons are
deemed frivolous. Most Italians
have internalized the lockdown
with a wartime-level commit-
ment, s colding and s haming those
who break the rules. Still, even
that hasn’t b een enough.
A month after the first cases
exploded into view in northern
Italy, the coronavirus has killed
more than 4,000 Italians, includ-
ing 627 reported on Friday alone.
It has sickened tens of thousands
more and swiftly rendered the
country unrecognizable — som-
ber, desolate and scared. But for
all the life-disrupting measures
Italy has taken to slow the v irus, it
continues to spread and kill at an
alarming clip.
The feeling is that the battle
against the virus, brutal and con-
suming as it has been, is only
beginning.
As the first Western country to
deal with a major outbreak, Italy
has become a grim symbol of the
virus’s dangers and the difficulty
of contending w ith it. While other
European countries and some
U.S. states have borrowed Italy’s
stay-home strategy, Italy is learn-
ing that the strategy does not
work quickly, even when broadly
adhered to.
On Friday, 10 days since the
beginning of a strict nationwide
lockdown, the number of known
coronavirus cases was continuing
to rise some 15 percent every day.
While that is shy of exponential
growth, it is enough to overwhelm
hospitals a nd morgues. More peo-
ple are getting sick than can be
cared for.
The lockdown, which included
restrictions on travel and the clo-
sure of most stores aside from
supermarkets and pharmacies,
was initially put in place through
April 3. But Prime Minister
Giuseppe Conte made it clear in
an interview with the Corriere
della Sera that the measures
would go o n longer.
Conte said the “restrictions are
working.” But even once the pace
of transmission starts to wane —
hopefully within days, he said —
“we won’t be able to immediately
resume life as it was.”
Some politicians in Italy’s
northern provinces have pressed
for even harsher measures. They
want narrower hours for super-
markets, a wider closure of facto-
ries and a mass-scale military de-
ployment to keep people off the
streets. Several leaders in the
north have turned their ire toward

Over 4,000 deaths in

a month: How Italy

became overwhelmed

Key moments in Italy’s

coronavirus outbreak

Jan. 31: Italy confirms the

coronavirus in two chinese tourists

visiting rome. the g overnment

declares a six-month state of

emergency and becomes the first

european country to suspend

flights from china.

Feb. 21: Italy reports its first cases

of apparent community

transmission and its first

coronavirus death, a 78 -year-old

man from Vo, in the Veneto region.

Feb. 22: Italy announces a

lockdown affecting 50,000 people

in the northern lombardy and

Veneto regions.

March 4: With more than 2,

cases confirmed, Italy closes

schools and universities.

March 8: With nearly 5,900 cases

confirmed, Italy orders a lockdown

for 16 million people in the north,

while also closing museums and

theaters nationally.

March 10: With nearly 7,400 total

cases, the lockdown is extended to

the rest of the country, limiting

travel abroad and across regions.

March 11: With nearly 12,

cases confirmed, the government

halts nearly all commercial activity

aside from supermarkets and

pharmacies.

Thursday: Italy surpassed china

as the country with the most

reported coronavirus deaths.

gists say, was not instituting the

nationwide lockdown more swift-

ly.

It is unclear whether such a

move, made weeks earlier, would

have been as widely accepted

when the horrors of the virus had

not yet come fully into view. Still,

by the time Conte formally made

his decree on March 10, t he virus’s

explosive growth had been set in

motion.

“That move should have come

from the beginning,” said Giorgio

Palù, a professor of microbiology

and virology at the University of

Padova and the former president

of the European and Italian virol-

ogy societies.

Instead, when Italy was learn-

ing about the first burst of locally

transmitted cases, it put only a

small fraction of the country —

50,000 people, in 11 towns — in

strict lockdown. People in those

towns were banned from exiting

or entering, barring emergencies,

and they were tested rigorously.

Experts say the disaster was

probably set in motion weeks ear-

lier, with people transmitting the

virus well before officials realized

there was any problem. The epi-

center of the outbreak was Italy’s

richest region, but also one of the

oldest areas in a nation that has

the world’s second-highest pro-

portion of seniors. Because older

people are more vulnerable to the

coronavirus, Italy has been hit

particularly hard. Among the p eo-

ple who have died, the median age

is 80, according to Italy’s national

health service.

Some initial signals s uggest t he

localized lockdowns may have

FabIo FrustacI/ePa-eFe/sHutterstocK

A closed carousel on Friday at the Mausoleum of Hadrian in Rome.

The nationwide lockdown in Italy is not expected to end soon.

BY DANIELLE PAQUETTE

When the new coronavirus
erupted in China more than
three months ago, each country
faced a monumental task: manu-
facturing or acquiring enough
tests to track the virus as it
spread across its territory and
around the globe.
Decisions made at those early,
pivotal moments determined the
course of the pandemic. China,
after denial-fueled stumbles, im-
proved its response to the virus
by deploying a flurry of rapid-fire
tests. South Korea, hit hard in the
beginning, mounted a comeback
steered by knowledge gained
from an avalanche of roadside
swabs. In recent weeks, Italy has
led the globe in testing, produc-
ing results that show the highest
caseload and death toll in the
world.
And Germany cleared regula-
tory hurdles to allow biotech
firms to make tests available on a
scale that the country’s govern-
ment could not.
But the United States and
Japan stumbled, experts say, by
initially shutting out the private
sector while proceeding slug-
gishly with public sector efforts,
leaving too few tests to track the
extent of the virus’ spread. Now,
some experts say, the window for
testing as a measure to curb

transmission could be closing in

many places where the virus is

widespread.

“Because we didn’t have test-

ing early on, it fatally flawed our

covid response,” said Lawrence

Gostin, director of the World

Health Organization Collaborat-

ing Center on National and Glob-

al Health Law at Georgetown

University.

The World Health Organiza-

tion has said that the gold stan-

dard for fighting an outbreak

starts with testing.

“Test, test, test,” WHO head

Te dros Adhanom Ghebreyesus

has implored: Te st broadly, pick

up cases, isolate patients, trace

their close c ontacts and put those

people into 14 days of quaran-

tine.

“You cannot fight a fire blind-

folded,” he said Monday.

Many countries do not public-

ly report covid-19 testing data,

and the World Health Organiza-

tion does not track testing by

country. According to an Oxford

University-based outfit that ag-

gregates available governmental

data, South Korea, Italy, the Unit-

ed Arab Emirates, Russia, Ger-

many and one province in China

are among those that have done

the most testing.

The United States had tested

about 5 0,000 as of Friday, a ccord-

ing to the CDC.

U.S. lawmakers have pledged

to massively amplify testing in

the coming days, but epidemiolo-

gists say the virus has blazed

through American soil, following

a troubling community-trans-

mission trajectory similar to

I taly’s.

“The very honest truth is we

have missed the opportunity to

really prevent the worst out-

comes,” said Gostin, who is

studying the pandemic in Wash-

ington. “A nd now we are at the

very last tool in our tool shed,

which is: Everybody hunker

down at home.”

Some are asking whether the

time for widespread testing has

passed in places where the virus

is spreading rapidly. On Friday,

the head of Finland’s health secu-

rity agency questioned the

WHO’s advice to test as many

people as possible.

“We can’t fully remove the

disease from the world anymore,”

Mika Salminen of the Finnish

Institute of Health and Welfare

said in an interview with Hels-

ingin Sanomat newspaper. “If

someone claims that, they don’t

understand pandemics.”

Two months ago, as cases

climbed in Wuhan, the WHO

published instructions from Ger-

man scientists with the recipe for

any nation to create tests.

The global health body didn’t

talk to the Centers for Disease

Control and Prevention about

supplying kits to the United

States, WHO spokesperson Ta rik

Jasarevic said. The United States,

like other wealthy countries, nor-

mally develops its own diagnos-

tic tests, then private companies

approved by the Food and Drug

Administration produce the kits.

But manufacturing problems

with the CDC’s initial diagnostic

test led to a six-week delay. In a

statement announcing coronavi-

rus response legislation, Presi-

dent Trump on Wednesday

pledged to ensure that “coronavi-

rus testing is accessible to every

American.”

While malfunctions bungled

the CDC’s testing rollout, the

WHO supplied hundreds of kits

to countries around the globe.

European nations largely got a

head start on testing, opting to

source materials from the WHO

and a mix of companies.

Unlike South Korea and China,

however, they hadn’t battled oth-

er viral outbreaks in recent years.

The Asian countries already had

close relationships with emer-

gency-ready businesses.

South Korea, which logged its

first case around the time the

United States did, helped curb its

steep transmission by testing

10,000 people per day, experts

say.

“They were much more amped

up and ready because of SARS

and MERS,” said Ashish Jha,

director of the Harvard Global

Health Institute. “They were

more aware and attuned to these

issues.”

The number of confirmed cas-

es in South Korea has steadily

declined since peaking in late

February, a trend officials there

attributed to widespread testing

that allowed for quicker quaran-

tines and other actions to con-

tain the virus.

Germany, t oo, has significantly

ramped up testing. The country

has the capacity to carry out

160,000 tests per week, accord-

ing to the Robert Koch Institute,

a government agency. That’s up

from 35,000 tests between

March 2 and March 8. Germany

had more than 19,000 confirmed

cases and at least 67 deaths by

Friday afternoon, according to a

tally by Johns Hopkins Universi-

ty.

France, Italy and Spain fo-

cused their testing efforts on

travelers from coronavirus

hotspots and the severely ill. But

symptoms manifested after pas-

sengers left airports. Younger,

seemingly healthy people

brought the illness to older, more

vulnerable groups.

Belgium, which opted to make

its own kits, has cited shortages

as the reason behind testing

delays.

“It is becoming more a nd more

important to prioritize testing

and no longer do large-scale

testing,” the Belgian government

posted on its coronavirus web-

site.

India made the same call —

though for different reasons.

Te lling everyone to come in for

a swab “creates more fear and

more paranoia,” said Balram

Bhargava, director general of the

Indian Council of Medical Re-

search.

Japanese authorities, mean-

while, put the country’s National

Institute o f Infectious Diseases in

charge of its diagnostics launch.

Critics soon blasted red-tape de-

lays. The country licensed the

private sector to help with the job

a month later.

The coronavirus pandemic has

afflicted more than 250,000 peo-

ple across the globe. At least

11,100 people have died, accord-

ing to official counts Friday.

A raging spread has yet to grip

African nations, which have re-

corded fewer than 750 cases in

more than 30 countries.

Only two labs on the continent

— in Senegal and South Africa —

could test for the illness in early

February. That number has since

expanded to 45 with the support

of the African CDC, the WHO and

regional health bodies, who have

urged nations to brace for the

worst.

Chinese billionaire Jack Ma,

co-founder of the e-commerce

giant Alibaba, has vowed to do-

nate 20,000 testing kits to each of

the continent’s 54 countries in

partnership with the Ethiopian

prime minister.

“A frica can be one step ahead

of the coronavirus,” Ma tweeted

this week.

In Dakar, the Senegalese capi-

tal, researchers have sourced kits

from a German firm until the

nation’s top virologists can devel-

op their own 10-minute kit.

(Manufacturing on that is ex-

pected to start as early as June.)

The West African nation, like

many in the region, has shut

down schools, closed places of

worship and plans to seal off its

airspace Friday. The military is

setting up hospital tents in the

countryside.

Still, anyone who shows up at

the hospital with symptoms can

get swabbed, said Amadou Sall,

director of the WHO-partnered

Pasteur Institute — “right away.”

[email protected]

simon Denyer in tokyo, Joanna

slater in new Delhi, Michael

birnbaum in brussels, rick noack

and luisa beck in berlin, and borso

tall in Dakar contributed to this

report.

How early decisions on testing shaped a global pandemic

Some countries’ sluggish

response prevented them

from tracking spread