Worried about coronavirus? Italy has a long history of fighting disease outbreaks

Italy has been struck hard by the coronavirus, with the number of cases rising at an exponential rate. Should we be so surprised, however? Some have suggested that the nation’s geography and history have had an important role to play in the number of epidemics that have struck it over the centuries.

Worried about coronavirus? Italy has a long history of fighting disease outbreaks
The "Plague Doctor" masks found in every Venice turist shop have now taken on a slightly more sinister tone. Photo: AFP

Global hub, global problems

Italy’s role as the cradle and ‘home base’ for the Roman Empire made it uniquely suitable for the arrival of disease.

With a constant flow of people including troops, political figures, merchants and slaves moving in and out of central Italy, epidemics had little trouble spreading along main roads and trade routes. The cramped, tightly-packed streets of cities across the Italian Peninsula were also ideal breeding grounds.

Two major outbreaks of disease would ravage the Roman Empire over its existence. The first came in 165CE, when a plague, possibly a strain of smallpox, travelled with legions returning from wars against the Parthians. Those sick quickly passed the contagion on to others, and it soon spread from the east, right throughout the Mediterranean. Some suggest it killed up to 15% of the population of the Empire at its peak.

Photo: AFP

Indeed, the arrival of what has become known as the ‘Antonine Plague’ is considered to be a contributing factor in the halt of Roman expansion – there simply weren’t enough troops to press forwards.

A second outbreak of disease in 542CE effectively sounded the final death-knell for the Roman Empire. The ‘Justinian Plague’ – this time thought to be the Bubonic Plague – killed upwards of 30 million, again issuing from the east.

READ ALSO: Why the average ancient Roman worker was dead by 30

Such a virulent outbreak meant that the troops gamely attempting to defend the Western Roman Empire’s borders from Goths, Vandals and other tribal groups eventually buckled, and it was only a matter of time before the Empire crumbled as a political entity, as migrating groups swept through.

Tall Tales and Morbid Masks

Italy is far more well-known as a possible European ‘Ground Zero’ for the ‘Black Death’ of 1348. Many of us hear in history class of ships from the Black Sea port of Caffa, docking at Genoa and carrying the plague with them.

The Bubonic Plague, using infected fleas as a primary vector, would ravage Italy and the rest of Europe for the next three years. Estimates of the number of fatalities reach up to 475 million, across the planet – a significant percentage of the population.

Like nowhere else, the ‘Black Death’ left its mark on Italy.

Chroniclers, such as Angolo di Tura of Siena described the devastation: ‘Father abandoned child, wife husband, one brother another,' he wrote, 'for this plague seemed to strike through the breath and sight. And so they died. And no one could be found to bury the dead for money or friendship’. Indeed, the city’s cathedral remains functionally unfinished, the manpower lacking to complete the original design.


Perhaps the most famous legacy of the ‘Black Death’ in Italy is the ‘Decameron’ of Giovanni Boccacio.

Consisting of a number of amusing and instructive stories, the framing text of the piece concerns ten wealthy individuals who escape plague-struck Florence to wait things out at a villa. There, they take turns telling each other tales to pass the time. It is now one of the stalwarts of the Italian literary canon.

No less iconic were the 'plague doctor' masks that began to appear as part of the Venice carnival. These long-beaked, often full-face covering masks were identical to the masks worn by doctors who had treated the outbreaks of plague from the 14th to 17th centuries.

In these times, it was thought that 'miasma', or foul-smelling, poisonous vapours, were responsible for spreading disease, so garlands of aromatic plants were kept in the 'beak' to protect the wearer.

Venice was particularly susceptible to disease, being both a heavily-trafficked trading port and built atop a lagoon – indeed the city has had constant problems with outbreaks of disease for centuries. With Venice being particularly hard-hit by the coronavirus, the masks that one can find in almost every tourist shop have taken on a slightly more sinister tone.

Photo: AFP

Drain the Swamp

While outbreaks of the bubonic plague would ravage Italy until the invention of penicillin, by far the more devastating diseases faced by Italians were malaria and cholera.

Malaria found a natural home in many Italian cities built on or near swampy ground, such as Rome. Mosquitoes in stagnant swamps infected those they sucked blood from, with an estimated 15 – 20,000 succumbing each year, often children.

It wasn’t until the late 19th century that serious, large-scale draining of low-lying saturated ground was carried out, and the 20th century before government efforts to combat the disease led to a significant reduction in deaths.

READ ALSO: 8 things you probably didn't know about the Romans

Cholera was more of a problem. A water-borne contagion, it was transmitted through faecal matter, either in cesspits, water pumps, or through laundering clothes.

A series of outbreaks swept through during the course of the 19th century, hitting cities such as Naples very heavily. Despite the best efforts of public health officials, hundreds of thousands died over the course of these epidemics, and it wasn’t until 1973 that the Italian peninsula saw its final outbreak of the disease.

In flew Enza?

Italy was one of the nations impacted most heavily by the last great pandemic in human history – the ‘Spanish Flu’ of 1918.

This was probably due to a number of factors, chiefly Italy’s role in the war. Troops returning to and from the fronts in the north, down the length of the country, again was a natural vector for transmission.

The relatively slow pace of modernisation, particularly in more rural, impoverished communities, made it easier for the virus to spread. It’s estimated that around 390,000 Italians may have succumbed to the pandemic.

Time to worry?

Italy has been visited by both localised epidemics and global pandemics almost constantly over the last two millennia – there’s nothing to suggest that this won’t continue. However, this does not mean that we should necessarily be too worried about the coronavirus.


Improved medical science, rapid government interventions and advances in tracking movements mean that we may never again see anything on the scale of the Spanish Flu, let alone the Black Death. For now, practice basic hygiene, avoid travel to quarantined areas, and there is no need for concern.

Michael Stuchbery is a historian and author. Follow him on Twitter

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Covid-19: Are Italian live events at risk of being postponed?

As the infection rate rises sharply across the country, Italian virologists are calling for concerts and festivals to be rescheduled.

Covid-19: Are Italian live events at risk of being postponed?

Italy has seen a large increase in the number of Covid-19 cases in recent days, so much so that a number of virologists across the country are now urging the government to postpone major live events in a bid to curb infections. 

According to a new report by Italy’s independent health watchdog, the Gimbe Foundation, 595,349 new cases were recorded in the week from June 29th to July 5th; a worrying 55 percent increase on the previous week. 

In the same time span, the country also registered a 32.8 percent rise in the number of hospitalised patients, which went from 6,035 to 8,003.  

The latest Covid wave, which is being driven by the highly contagious Omicron 5 variant, is a “real cause for concern”, especially in terms of a “potential patient overload”, said Nino Cartabellotta, president of the Gimbe Foundation. 

As Italian cities prepare to host a packed calendar of concerts and festivals this summer, health experts are questioning whether such events should actually take place given the high risk of transmission associated with mass gatherings.

READ ALSO: What tourists in Italy need to know if they get Covid-19

“Rescheduling these types of events would be the best thing to do right now,” said Massimo Ciccozzi, Director of Epidemiology at Campus Bio-Medico University of Rome. 

The summer wave is expected to peak in mid-July but, Ciccozzi warns, the upcoming live events might “delay [the peak] until the end of July or even beyond” and extend the infection curve.

Antonello Maruotti, Professor of Statistics at LUMSA University of Rome, recently shared Ciccozzi’s concerns, saying that live events as big as Maneskin’s scheduled Rome concert are “definitely not a good idea”. 

The Italian rock band are slated to perform at the Circus Maximus on Saturday, July 9th but the expected turnout – over 70,000 fans are set to attend the event – has raised objections from an array of Italian doctors, with some warning that the concert might cause as many as 20,000 new cases.

If it were to materialise, the prospected scenario would significantly aggravate Lazio’s present medical predicament as there are currently over 186,000 Covid cases in the region (nearly 800 patients are receiving treatment in local hospitals). 

Italian rock band Maneskin performing in Turin

Italian rock band Maneskin are expected to perform at the Circus Maximus in Rome on Saturday, July 9th. Photo by Marco BERTORELLO / AFP

But, despite pleas to postpone the event, it is likely that Maneskin’s concert will take place as scheduled.

Alessandro Onorato, Rome’s Tourism Councillor, said that rescheduling is “out of question” and that “all recommendations from the local medical authorities will be adopted” with the help of the event’s organisers and staff on the ground.

At the time of writing, there is also no indication that the Italian government will consider postponing other major live events scheduled to take place in the coming weeks, though the situation is evolving rapidly and a U-turn on previous dispositions can’t be ruled out.

READ ALSO: At a glance: What are the Covid-19 rules in Italy now?

On this note, it is worth mentioning that Italy has now scrapped all of its former Covid measures except the requirement to wear FFP2 face masks on public transport (though not on planes) and in healthcare settings.

The use of face coverings is, however, still recommended in all crowded areas, including outdoors – exactly the point that leading Italian doctors are stressing in the hope that live events will not lead to large-scale infection.

Antonio Magi, President of Rome’s OMCEO (College of Doctors, Surgeons and Dentists), said: “Our advice is to wear FFP2 masks […] in high-risk situations.”

“I hope that young people will heed our recommendations and think about the health risks that their parents or grandparents might be exposed to after the event [they attend].”