Rome’s streets are empty, the supermarket shelves loaded with food. My fellow denizens, for once free of the tourist hordes, are enjoying their lives in a state of limbo, waiting for coronavirus to come crashing down around their heads before they start stocking their larders and hunkering down.
At least that’s what things were like yesterday. I can’t say about today, because I just arrived in San Francisco to begin a two-week book tour cum working vacation scheduled months before that damned virus jumped the species barrier deep into China.
We were biting our nails until the last moment – would the Americans impose a 15-day quarantine on all travellers from Italy? – and felt some relief at getting away, like Boccaccio’s fictional pals who fled to the hills outside Florence to escape the Black Death.
But the first New York Times headline I see on landing is “California Declared a State of Emergency”, and it’s entirely possible that all the events we’ve come for will be cancelled in the spreading panic.
When Covid-19, coronavirus disease, struck northern Italy in February like a bolt from the blue, the authorities got their act together surprisingly fast.
They isolated the worst-affected areas, set up national and regional telephone hotlines, called in medical trainees and retirees to man them, planned dedicated wards in infectious disease hospitals, instructed practicing physicians in telephone triage.
Medical staff outside a special emergency facility set up outside a hospital in Piacenza, Emilia-Romagna. Photo: AFP
They broadcast two concepts to the general public: people leaving an epidemic area should self-isolate for two weeks even if they have no symptoms, and if you have cough, body pain, or fever you should pick up the phone rather than heading for doctors’ offices or emergency rooms where they might infect the sick and vulnerable
Anyone with suspected coronavirus is tested in isolation in the emergency room, if they’re sick enough to be there, or in their own homes by a hazmat team sent by the Health Department to take the swab.
Testing is free, preliminary results are available and public within hours, anyone who needs to stay home gets paid sick leave, and under the Italian National Health Service nobody pays a penny for doctors, Emergency Rooms, or intensive care.
Human beings being imperfect, implementation has had some hiccups. A Rome policeman developed a cough on February 28th after hosting a houseguest from Lombardy, the northern region where coronavirus disease is most rampant. Instead of calling his doctor or the hotline he went to an emergency room, where the ER staff left him to stew in the regular waiting room, where he infected at least 15 fellow patients in addition to his wife and children. It's not clear who was dumber, the doctors or the cop.
Italy’s response capacity is also hamstrung by its chronic and ever-worsening underfunding. If even wealthy Scandinavia will have trouble rounding up enough ventilators and intensive care unit beds if a true pandemic develops, imagine where Italy will be with half the resources.
And how about on the other side of the Atlantic? How will the United States succeed in handling an epidemic that seems increasingly likely to hit big, either soon or in the fall?
My guess is badly. As a haven of rugged individualism and for-profit medicine, the US is far less equipped than Europe to mount an adequate response.
To start with, a third of Americans have no paid sick time at all, and few have as much as two weeks. Which means that many people mildly ill from coronavirus will keep going to work, putting everybody around them at risk.
And as we all know, US is one of the few countries where access to medical care depends on access to money. Between deductibles and co-pays even insured Americans often find it hard to afford doctors’ visits, medications, and hospital care. Which means that many who should be tested for coronavirus are likely to skip it in order to avoid starting a chain reaction of medical expenses – some are even being charged for the test itself.
Not to speak of the 27 million citizens who have no insurance at all, or the millions of undocumented immigrants who steer clear of hospitals for fear of hovering ICE agents, all primed to swell the pool of infected people who may soon be mingling with the crowds on American streets, subways, stores, classrooms, and baseball stadiums.
Even stocking up on medications in case of preventive quarantine can be impossible in the American context – insurance companies don’t allow it.
In Italy about 30,000 people have been tested for the novel coronavirus, versus only a few hundred people in the vastly larger US. The lag is largely because every test needed advance approval from the Centers for Disease Control; broader testing is set to start now.
Italy is notorious for disorganization, and has neglected epidemic preparedness. But this time it’s bested the US, which has been unable thus far to enact some obvious measures for containing the coronavirus.
The Italian authorities tell a Neapolitan businessman who was obliged to spend a day in Milan for a meeting that he should stay home for two weeks when he gets back. When I landed at San Francisco Airport today the border police chatted me up about my life in Rome, and wanted to know whether I was carrying any cigarettes, but didn’t even ask when I had last been in northern Italy. Scary.
Then there’s the politics of an election year. Our real experts on the science and the handling of epidemics, such as Dr. Anthony Fauci, are being sidelined and even muzzled, while the coronavirus task force is run by Vice-President Mike Pence, who as governor of Indiana suggested the best response to the state’s HIV epidemic was prayer.
Obviously the situation in both my countries is evolving not just day by day but hour by hour, and much of what I’m writing today may be out of date tomorrow. But having scribbled these musings, mostly on the plane, I thought I'd offer them to you anyway.
Susan Levenstein is an American doctor who has been practicing in Italy for the past 40 years. She is the author of the book Dottoressa: An American Doctor in Rome.