Italy wrestles with trauma, privacy and containment in coronavirus battle

Naples, ITALY –– “Let us unite!/We are ready to die/Italy has called,” is the chilling cry that unites millions of Italians leaning out from windows and balconies. The lockdown was imposed throughout the peninsula on March 11. 

The national anthem is among the songs collectively belted out by Italians locked inside their homes during the Covid-19 pandemic in an attempt to instil a little optimism among a frightened population. 

Perhaps, it is also to ward off the psychological effects of the war bulletin broadcast every day at the same time, that defines the outlines of a health tragedy. 

Every day at 6PM a press conference by the head of the Civil Protection, Angelo Borrelli, reads outs the daily figures: yesterday there were 601 deaths (the day before 651), which brings the total number of deceased up to 6077. The newly infected are 3780, less than the day before when 3957 were registered, bringing the total to 50,418; the recovered ones are 408, totalling 7432; 3204 people are in intensive care, 195 more than yesterday. 

These figures convey the epic proportions of an outbreak that is bringing Italy's national health system to its knees.

Five days ago, Italy surpassed China's fatalities, becoming the country with the most deaths from the coronavirus. China tops the list of total cases with 81,496, followed by Italy with 63,927 and the US with 26,747.  

While restrictions in Italy are forcing the population to stay home, the contagion has not ceased though it has marginally slowed down for the second day in a row. 

Experts assure it will take longer to see the curve finally flatten. 

The epicentre continues to be in the northern region of Lombardy: the outbreak has moved from Lodi to Bergamo and Brescia. The confirmed cases in the region are 28,761 and the number is growing by over 3,000 every second day. 

In Lombardy alone, 1,183 people are in intensive care and 3,776 have died, making up 68 percent of the deaths in Italy. The images of rows of military trucks waiting to transport bodies out of town have been seen around the world and have perhaps made even the most reluctant Italian stay home. 

The virus spread to southern Italy, even if not in as high numbers, was helped by the “great exodus” of people who returned from the industrial north to the south during the night the first decree was leaked – the one that would have locked down Lombardy.

The trauma of caregiving

At the forefront of the fight against the virus in the red zone is an army of doctors, nurses and health workers who carry out their duty in debilitating conditions. 

“I have never been afraid to work and I don’t think about the risks. But when I finish, I hope to go home without bringing the virus with me because I have a family, three children. The fear persists, even if I do everything according to the procedures,” Antonio, a nurse, confesses to TRT World.

Antonio has been a nurse for 40 years in the hospital of Seriate, Bergamo, which has been turned into one of the three Covid-hospitals in Lombardy. 

“My ward used to be a cardiology intensive care, now we have seven intubated patients and we are learning things that we were not used to performing. It’s hard to keep up the mood when you see these patients alone, clinging to us as they do not have anyone else close now. In our ward patients are in a state of pharmacological coma, but in other wards, it is emotionally excruciating seeing them gasping for air while you cannot do anything for them.”

The medical staff dealing with the emergency are the ones who are paying the highest cost of this crisis. The shortcomings of the national health system's performance in Italy, given the high number of people who need intensive care, are exacerbated by structural deficiencies. 

In the name of austerity, some 40 billion euros ($43 billion) have been cut out from the Italian public health system in the last ten years, making the emergency even harder to handle. 

Italy is also the country with the highest number of infected among the medical staff, 4824, double that of China. 

“There are no devices for everyone in the wards, there are no helmets for all patients and fans are scarce. The staff is protected but if you get dirty and need to change gears, the risk is not having enough. Even masks are running out. We start the shift with our dedicated mask hoping that we don’t get to need a second one,” says Antonio, his voice breaking up, “it is quite an emotional load for us. I have been dreaming of all this for a month now, every night.”

Italy has 12.5 critical care beds per 100,000 compared to the around 29 per 100,000 that Germany has. The country at the forefront of Europe’s battle against the new Coronavirus and the deadliest hotbed, is now planning to build new wards through private donations. 

“The numbers are clear, the public health service was to be strengthened: we have 50,000 doctors less than what would be needed, especially in the wards that are proving the most important: intensive care units. In the West, not only in Italy, we used to believe that pandemics were something of the past, that these kinds of epidemics only occurred in Asia. We were not prepared for this,” says Ernesto Burgio of the European Cancer and Environment Research Institute (ECERI) in Brussels and President of the Scientific Committee of the Italian Society of Environmental Medicine (SIMA). 

“The responsibilities are systemic, I believe that politicians have not been sufficiently supported. We need to trace back to the history of the epidemic in China: they set a starting point, they predicted and faced the peak of infections. They closed the Hubei region and did what ought to be done: monitor and control everyone.”

The Italians, he said, made an error in judgment.

“We did it too late and in a convulsive manner. We initially barred only small red zones: errors that we are paying for now because we were neither prepared nor informed.”  

Burgio hopes that the restrictive measures will work, although late, but, it's too early to say.

"At this point making predictions is very difficult because we don’t know how many asymptomatic and paucisymptomatic (few symptoms) carriers are around.”

One of the unsolved mysteries is the mortality rate. In Italy, it is a little under 10 percent, much higher than that of China, at 3.8, or South Korea, 1.1. This figure is calculated from the number of deaths and the total number of infected, but in Italy, only 125,000 tests have been carried out so far.

Some governors have requested the entire population to be swabbed in order to get the real proportions of the contagion, but doctors agree on the futility of that operation at this stage. 

“Large-scale swabs could have initially been made in the largest possible area around the identified cases and their contacts so that the virus could not spread, " explains Burgio but, "dabbing huge numbers now would only help to find hundreds of thousands of infected people, but it would have enormous costs and would no longer make sense. We must intervene in the places where the virus is most present - the hospital facilities – and reduce the exposure of health workers.”

Civil liberties vs containment

Italy, although late, has chosen the path of social distancing to combat the pandemic, later followed by other southern European countries. Decree after decree, Italians have increasingly seen their freedom shrinking in terms of movement in an attempt to contain the epidemic. 

After the first week of lockdown, the hashtag #iorestoacasa (I stay at home) became a catchphrase and while the there are no signs of it slowing down, boredom and collective hysteria targeted joggers and runners, who are held up as the new plague-spreaders. They have become the new target of collective hate. 

On the other hand, it was only two days ago that many non-essential factories were closed down in the last draconian clampdown by PM Giuseppe Conte. 

Last week, the European Union launched a 164 million euro ($177 million) call for innovative technological solutions to help curb the coronavirus outbreak. And while Italian police forces will now be allowed to use drones in an attempt to crack down on people’s movement, the fear is that these containment measures could be followed by some form of surveillance of infected people, like in China, jeopardising the professed principles that characterise contemporary Western democracies. 

“The use of digital technologies, especially those conveyed by smartphones, are increasingly used to combat the expansion of the new coronavirus,” Dr Denis Roio of Dyne.org, a Europe-based foundation that promotes digital rights and democracy, tells TRT World. 

“In fact, these technologies allow movement control in a precise way, when using GPS, or in a less-precise but still significant way when Bluetooth, Wi-Fi or GPM are used. In terms of social control also metadata are useful, which contain information like with whom an individual has been in contact, how many times, how long for and their physical proximity.” 

Yet this mass of data can also interfere with people’s individual and social rights. Technologies associated with fitness tracker devices such as smartwatches are capable of controlling body temperature, heart rate and storing information. 

“Valuable data for credit institutes and insurance companies, for example, or for employers to check on the physical conditions of workers or for governments facing tensions over shrinking democratic guarantees,” says Roio. 

In considering the many factors that have contributed to curbing the coronavirus outbreak in China and South Korea, including culture and lifestyle, Roio warns, “the use of digital technology for social control to fight the coronavirus and similar epidemics will increase the fragility of a significant sphere of rights of numerous categories of people: we must stay vigilant.”