The Washington Post - 05.03.2020

A14 eZ su THE WASHINGTON POST.THURSDAy, MARCH 5 , 2020

the coronavirus outbreak

BY CHICO HARLAN

rome — Italy is her favorite

place on Earth, cobblestones and

“magic,” she said, so when Kara

Kaefring booked her plane tickets

last July, she set a countdown

clock on her smartwatch and

thought about everything that

waited ahead: Exploring Rome

and Venice with her 13-year-old

son. Finding the best spots for

gelato. To uring the catacombs

and the canals. Rounding a cor-

ner, as she had done on a previous

trip, and seeing the 2nd Century

Pantheon come into view.

“Compared to Italy,” she said,

“everything else pales in compar-

ison.”

But then, as her countdown

clock neared three weeks, and

every day seemed to bring more

bad coronavirus news, Kaefring,

42, of Klamath Falls, Ore., found

herself imagining far different

scenarios. What if she got sick in a

foreign country with a teenager?

What if the trip went fine but she

had to quarantine herself upon

return? And what if she was

actually carrying the coronavi-

rus? She has diabetes. She works

in a hospital. She could not be

“cavalier.”

“I think Italy is canceled,” she

finally told her son after days of

deliberation, which included

Googling a live cam of Venice’s

main piazza and seeing crowds

thin day after day to an eerie

trickle.

Italy has not shut down to

visitors, and the spread of the

virus has b een limited largely to

two northern regions. But as the

country’s coronavirus death toll

passed 100 on Wednesday, the

government announced schools

would close until mid-March.

That follows warnings from the

U.S. State Department that Amer-

icans should reconsider travel to

Italy.

So the virus has imposed sud-

den new limits on how world

travelers can enjoy themselves

and where they can dream of

going.

For now: probably not Italy.

Normally a country full of va-

cationers and honeymooners,

foreign students and Catholic pil-

grims, Italy has become dramati-

cally quieter — and emptier. Even

regions nearly untouched by the

virus, such as Umbria, have seen a

70 percent hotel cancellation

rate. Angelo Carotenuto, founder

of tour operator LivItaly, said he

thought Italy could lose 50 per-

cent of its visitors for the year —

more than 30 million people.

That includes Americans orga-

nizing destination weddings in

Venice, Germans planning their

spring breaks along the Calabri-

an coast and people like Kaefring,

who has an antique map of Rome

framed in her house, and who

says it is only in Italy where her

soul feels quite so good.

“I could cry,” she said when her

countdown clock said 17 days,

10 minutes to a trip that would

not happen. “When you go to

London, there are cool things.

But then you’re confronted with a

skyscraper. When you’re in Italy,

there is not a single thing that

takes you out of that fairy tale.”

What dissuades travelers is not

necessarily the virus itself, but all

the complications that come with

traveling in a time of uncertainty.

Airlines have scrapped some

routes to Italy. A handful of

countries have closed their bor-

ders to people who have recently

been in Italy, and others have

imposed mandatory 14-day quar-

antines.

The United States has pledged

higher screening for people com-

ing back from Italy. The State

Department last week gave the

country’s two largest northern

regions the same advisory as it

issued to Yemen and South Su-

dan.

“A lot of it is the fear of the

unknown,” said Abbie Synan, 37,

of Pittsburgh, a full-time traveler

and writer. “I’ve not really seen

something that has gotten people

so nervous since maybe 9/11.”

Synan was spending time on

the Sardinian coast as the out-

break erupted in Italy, with plans

to make her way slowly to Sicily

for a conference. Instead, she

decided to retreat and take short

flights through Spain and toward

Paris, staying away from any hot

spots, hoping to make it back

home without interruptions be-

fore her sister gave birth.

Many Italians, as well as for-

eigners living abroad, have

stressed on social media that the

most of nation is safe, and have

tried to portray a country that is

calm and managing still to enjoy

its aperitivi. For those who still

make it to the country, they find

an Italy that is more Italian than

ever, stripped of the Disneyland

crowds in Venice and central

Rome. Some in the tourism busi-

ness make the argument that

Italy is potentially safer than

other European countries, be-

cause its testing for the virus has

been so comprehensive, and the

scale of the outbreak is better

understood.

“When something like this

happens, psychosis goes around,”

said Carotenuto, the Rome-based

tour group owner, who said he

has lost $300,000 in seven days,

mainly because his company, like

many other tour operators, guar-

antees refunds. This week, he

held an emergency meeting with

his 14 employees and told them

nine would have to start working

part time. He and his wife were

eliminating their incomes.

“I’ve been comparing it with

my wife,” Carotenuto said. “This

is much worse than the recession.

In my business, it feels like the

world war.”

Carotenuto said he was getting

cancellation messages at all

hours of the day — by phone, by

text, by email — and yet many of

the messages talked not about

fear, but about disappointment.

Some customers said they had

been saving for the trip for

months. Some said they had been

prevented from going to Italy by

their companies. Some said they

were angry at restrictions im-

posed by their governments.

In other cases, people who

were already in Italy ended up

going home early. Nicholas

Kohler, 21, a college junior, was

studying abroad in Florence,

staying with a local woman in her

70s who happened to be a great

cook. He was focusing on art

history, and, in this case, that

meant walking into Palazzo Vec-

chio, or the Uffizi Gallery.

But last week, Syracuse Uni-

versity decided to suspend his

academic program in Florence.

The school said it was making the

decision for the safety of its

students and to reduce the risk

that they would be unable to

leave Italy because of new restric-

tions.

Kohler headed home to Los

Angeles and tried to weigh his

options. He was a University of

Colorado at Boulder student, but

because he had registered with

the Syracuse program for the

semester, the coronavirus up-

heaval left him with two choices.

Either he could take his Syracuse

classes online before returning to

Boulder in the fall. Or, he could

spend the rest of his semester in

Upstate New York.

Either way, he said, “it’s not

Florence.”

[email protected]

stefano Pitrelli contributed to this

report.

Angst puts dream vacations on hold

BY ERIN CUNNINGHAM

AND DALTON BENNETT

istanbul — The coronavirus
outbreak sweeping through Iran
has delivered a jarring blow to the
senior ranks of its government,
infecting about two dozen mem-
bers of parliament and at least
15 other current or former top
figures, according to official re-
ports.
Among those sickened have
been a vice president, a deputy
health minister and an adviser to
the head of the judiciary, and the
virus has struck at t he pinnacle of
power, killing an adviser to Aya-
tollah Ali Khamenei, Iran’s su-
preme leader.
With the outbreak in Iran rep-
resenting one of the largest in the
world, Kianoush Jahanpour, a
spokesman for the Health Minis-
try, s aid Wednesday that the virus
has killed 92 people across the
country with nearly 3,000 people
known to have been infected.
But data obtained from a group
of hospitals in Te hran strongly
suggests that the epidemic has
spread even more than the gov-
ernment has acknowledged.
About a dozen hospitals in the
capital city have reported
80 deaths from the coronavirus
during the six days ending
Wednesday, according to records
from the medical centers. And
these hospitals represent only a
small fraction of the total in Te h-
ran.
The data set — i ncluding demo-
graphic details and status of the
cases — shows a 17 percent surge
in deaths between Tuesday and
Wednesday.
The hospital information was
collected and provided to The
Washington Post b y Britain-based
Iranian activist Nariman Gharib,
who has been critical of the gov-
ernment’s response to the epi-
demic and fears the government
might be keeping details from the
public.
Based on the figures from Te h-
ran, Ashleigh Tuite, an infectious-
disease epidemiologist, estimat-
ed that the current outbreak in
Iran has reached up to 28,
cases. “I suspect these numbers to

keep going up,” said Tuite, who is

based at the University of To ron-

to’s Dalla Lana School of Public

Health, after reviewing the data

for The Post.

Nurses reached by telephone in

Te hran and Mashhad in north-

eastern Iran reported an increas-

ing number of cases not included

in official figures, including infec-

tions diagnosed based on symp-

toms or CT scans.

The five nurses, who spoke on

the condition of anonymity to

discuss their working conditions,

said that some medical staff were

being prevented from wearing

masks to avoid causing panic and

that there were shortages of

masks, gloves and other protec-

tive gear for workers. The nurses

also described a staffing shortage

as medical workers were being

shifted among hospitals to ad-

dress the growing caseload.

Beyond a concerted effort to

play down the severity of the epi-

demic, Iranian authorities have

taken steps that probably acceler-

ated the virus’s spread. In the

crucial first days of Iran’s out-

break, for instance, officials re-

buffed calls for quarantines,

urged Iranians to participate in

national elections and balked at

closing holy shrines to the public.

According to Iranian officials,

the outbreak in their country be-

gan in the holy city of Qom after

an infected Iranian businessman

returned home from China. The

Health Ministry announced the

first two cases on Feb. 19, just two

days before parliamentary elec-

tions.

Despite the emerging out-

break, government officials urged

Iranians to vote in the elections to

boost turnout amid crises that

have challenged the standing and

credibility of Iran’s leadership. In

January, p rominent military com-

mander Qasem Soleimani was

killed i n a U.S. drone strike. Then,

the government faced searing

criticism for covering up the role

of security forces in downing a

civilian airliner near Te hran, just

months after those forces helped

carry out a crackdown on anti-

government demonstrators that

left hundreds of protesters dead.

Iranian officials “didn’t w ant to

discourage people from partici-

pating,” s aid Kamiar Alaei, a visit-

ing professor and expert on com-

municable diseases and global

health policy at the University of

Oxford. “They downplayed the

seriousness of the disease and

misled and misinformed the

health system.”

As a result, medical profession-

als “were not prepared, and a lot

of doctors and nurses were infect-

ed due to unexpected exposure,”

he said. “There was clear misman-

agement and the elevation of po-

litical interests above health con-

cerns, which resulted in the out-

break.”

Iran’s health system was al-

ready battered by broad U.S. eco-

nomic sanctions that have curbed

the country’s ability to finance

humanitarian imports. Interna-

tional banks, fearing U.S. penal-

ties, often decline to carry out

transactions with corresponding

financial institutions in Iran —

even for the sale of items such as

medicine and medical devices.

This week, the World Health

Organization dispatched a team

of experts and a shipment of med-

ical supplies and laboratory kits

to test and diagnose nearly

100,000 people in Iran. Authori-

ties have also moved to contain

the spread of the virus, closing

schools and movie theaters and

calling on people to stay home

and avoid public gatherings.

But these tough public health

measures have come too late to

prevent the disease from spread-

ing to nearly every province and

the number of infections from

spiking.

Experts say the close ties be-

tween Qom, the spiritual center of

Iran’s r uling clerics, and the polit-

ical leadership in Te hran proba-

bly contributed to the outbreak

among senior officials. Clergy-

men and policymakers travel fre-

quently between the two cities,

and some officials — including

those who later tested positive for

the virus — were together at cabi-

net meetings and in the parlia-

ment.

Disease experts also pointed to

greetings, such as handshakes

and multiple kisses on the cheek,

as potentially aiding the spread.

Iran’s leaders may have assumed

that they would not be infected

and simply failed to take precau-

tions, Alaei said.

“I think denial and foolishness,

likely combined with traditional

three-kiss greetings among men,

have probably infected a substan-

tial number of senior politicians

in Iran,” said David Fisman, head

of the epidemiology division at

the University of To ronto.

According to the hospital data,

five current and former officials

— including two lawmakers, two

advisers and a former ambassa-

dor — had been admitted to the

Masih Daneshvari Hospital,

which is part of the National Re-

search Institute of Tuberculosis

and Lung Diseases. Among those,

two officials — Mohammad Mir-

Mohammadi, an adviser to the

supreme leader, and Hadi Khos-

roshahi, a former ambassador to

the Vatican — w ere listed as dead.

On Tuesday, Iranian media re-

ported the death of an adviser to

Ebrahim Raisi, a former presi-

dential candidate and head of

Iran’s judiciary. That report said

the adviser, Ahmad Tuiserkani,

was treated in a hospital adminis-

tered by Iran’s Islamic Revolu-

tionary Guard Corps, a powerful

branch of the armed forces.

[email protected]

[email protected]

Bennett reported from Washington.

Iranian leadership hit hard, and hospitals give bleak assessment of spread

ePA-eFe/sHutterstoCK

Pedestrians pass a closed cinema in Tehran. In the first days of Iran’s coronavirus outbreak, officials rebuffed calls for quarantines, urged

elections participation and balked at closing holy sites. “They... misled and misinformed the health system,” one disease expert said.

BY ANNA FIFIELD

beijing — H ealth authorities
in the prosperous province of
Zhejiang had finally lowered the
alert level from one to two after
six weeks, satisfied their draconi-
an measures to contain the novel
coronavirus had worked.
Once the hardest-hit Chinese
province beyond Hubei, coastal
Zhejiang had placed 30 million
people under lockdown, but there
were no new cases reported in
nine days in the key export and
manufacturing base.
Then Wang, a 31-year-old wait-
ress who had been working in the
northern Italian city of Bergamo,
came home to Qingtian county,
west of the city of Wenzhou.
She had developed a cough,
headache and diarrhea about a
week before the flight, but never-
theless went to Milan and board-
ed a plane for Moscow, settling
into seat 22F. Traveling with five
others from the same restaurant,
she changed planes in Moscow
and took off for Shanghai. This
time, she sat in an aisle seat.
When Wang, whom authorities
have identified only by her family
name, arrived in China, she was
immediately put into quarantine.
On Sunday, s he tested positive for
the novel coronavirus that causes
the disease named covid-19. Sev-
en others who worked in the Ber-
gamo restaurant and flew back
home were diagnosed this week,
the Qingtian government said on
its WeChat social media account.
This is China’s new coronavirus
challenge.
Having largely contained the
virus at home — the number of
new infections reported each day
has fallen to barely 100, almost all
in Hubei province — China now
faces the prospect of imported
infections as the outbreak rages
beyond its borders.
China thought that once it had
contained the outbreak, that
would be the end of it, said Zhang
Wenhong, director of the depart-
ment of infectious diseases at
Shanghai Huashan Hospital, af-
filiated with Fudan University.
But now, more cases are emerging
abroad than in China — and
they’re starting to come back.
“This is a bad sign and very
worrisome,” Zhang told China
News. “It will bring difficulties to
China’s outbreak control.”
More than 6,700 passengers
had arrived in China with corona-
virus infections by the end of
Tuesday, and 75 were confirmed
as infected, General Administra-

tion of Customs said on Wednes-

day.

China’s Communist Party ap-

pears mindful that other govern-

ments might lack the techno-au-

thoritarian tools to shut down the

spread like it did. Authorities are

taking steps to prevent people

who have traveled to new hot

spots — South Korea, Iran, north-

ern Italy and Japan — f rom bring-

ing the disease back.

The southern province of

Guangdong, a manufacturing

and export hub that borders Hong

Kong, and the financial center of

Shanghai have stipulated that all

travelers arriving from severely

affected countries must quaran-

tine themselves for 14 days.

Beijing, which already has a

14-day quarantine rule for all ar-

rivals, explicitly named the four

hot spot countries during a brief-

ing this week. Two of the three

new cases confirmed in Beijing on

Tuesday were imported, one from

Iran and the other from Italy.

Zhejiang is particularly at risk

of cases from Italy because the

Wenzhou area has historical trad-

ing links with the European coun-

try, which has more than 2,

cases and dozens of deaths. There

are about 200,000 Chinese from

Wenzhou and Qingtian living in

Italy, most working in the restau-

rant business, the Zhejiang Daily

reported this week.

During the initial phase of the

outbreak, Chinese citizens living

in Italy donated 10,000 masks,

300 protective suits and 240 pairs

of goggles to Wenzhou residents.

As the epidemic evolves, Wen-

zhou residents are returning the

favor. The Wenzhou Eyewear In-

dustry Association sent boxes of

protective glasses to Italy this

week.

Likewise, the western province

of Ningxia, home to many mem-

bers of the Hui Muslim minority,

appears susceptible to imported

cases from Iran. Last week, two

people returned from Iran to

Ningxia with the virus, while Bei-

jing found two people who had

been in contact with one of the

Ningxia patients were also infect-

ed.

Chinese officials are in an awk-

ward situation. Early in the out-

break, China’s Foreign Ministry

lashed the United States for “over-

reacting” and “sparking panic”

when Washington warned travel-

ers against visiting China and

evacuated its consulate in Wuhan.

Now, Zhejiang authorities are

telling their citizens abroad to

“minimize” t ravel. Traveling is the

easiest way for infections to be

transmitted, so staying home is

the “best form of protection,” the

Qingtian local government said in

a notice to overseas Chinese.

But in Beijing, central authori-

ties have been encouraging peo-

ple abroad to come home, saying

it “attaches great importance to

the health of Chinese citizens” in

countries such as South Korea,

Japan, Italy and Iran.

“If the situation in those coun-

tries worsens, the Chinese gov-

ernment will take further actions

to help bring them back to China,”

China Daily quoted Cui Aimin,

director general of the Foreign

Ministry’s Department of Consul-

ar Affairs, as saying.

Concerned that its citizens will

catch the illness abroad, China

has started evacuating people

from virus-stricken areas.

Two planes arrived in Hang-

zhou from Milan this week, and

China sent two charter planes to

Iran to collect citizens, since direct

commercial flights have been can-

celed. The first arrived Wednesday

in Lanzhou, near Ningxia prov-

ince.

[email protected]

tiffany liang in Hong Kong and Wang

yuan contributed to this report.

China watches as illness circles back

romAn PIlIPey/ePA-eFe/sHutterstoCK

Air travelers arrive in Beijing this week. Officials now are focused

on potential coronavirus cases coming into China from elsewhere.