One of the major concerns about COVID-19 in northern Italy after concern for the physically infirm and elderly is the impact treating patients will have on the healthcare system. The healthcare system in many northern Italian regions is already at a breaking point as within the first twenty days of the outbreak over 10,000 infections were reported with a current total of 41,035 coronavirus cases [19 March, Coronavirus Cases]. An uptick of cases is expected despite the curbs which were enacted on 23 February in the north of the country followed by a harsher regime around the country decreed last week. Most Italians are taking the self-isolation seriously but many are not. Where the rules of self-isolation are respected, the ability to take a walk or go jogging is not clearly laid out by the current ordinance, as one paper announces that walking outside is only permitted for the purpose of food shopping or work while another states that anyone can take a walk if they observe the rules of social distancing. Things are unclear in Italy, and the default is that most people are simply staying inside. Quaint villages now look like ghost towns.
Between the lack of testing measures and the lax observation of the quarantine, Italians are still taking night trains. Hence, there is an opportunity for spreading the infection around the country. There are lessons Italy and other nations need to learn from Hong Kong, Singapore, and Taiwan which have all had remarkable success thus far in combatting the coronavirus after having learned, from the SARS (severe acute respiratory syndrome) epidemic in 2003, how to tackle infectious viral disease. Some of what was learned comes down to early detection of outbreaks, the effective communication to the public in the event of an outbreak, clear strategies for containment, and multinational collaboration in implementing such strategies.
Where Italy is catching up on these public health mandates, the government clearly failed on all four counts when there was not only early detection and numbers which clearly showed the rising cases, but the strategies for containment were horrifically implemented. Schools were shut down and university classes cancelled yet every football field was awash in boys and young men playing contact sports, bi-weekly street markets were in full operation, and public transport was as packed as ever. Nobody gave a thought to the fact that when the first two-week red zone lockdowns occurred, not only would millions of Italians head to other parts of the country to spread the infection, but that there were no checks in place to prevent this from happening. Hence last week the national government put the entire country on the social distancing model. Still much of the country is unclear about the strategies for containment and the refusal of UK Prime Minister Boris Johnson to implement social distancing has angered many.
Singapore’s health ministry has reported at least 243 cases of COVID-19 infection with 53 of these cases discharged. Hong Kong has had fewer than 150 cases with evidence that social distancing also ended the flu season in there. And Taiwan has 75 cases of coronavirus with only one death thus far as a result of this virus. What did SARS teach these countries in terms of fighting virus transmission?
Aside from banning flights early on from Wuhan, China, Taiwan enacted a series of temperature control stations around the country—from airports to buses to building entries. The Taiwanese government also ensured that masks were readily available and people who tested previously negative were retested and tightly monitored given that many patients had mild to no symptoms which meant that detection of the virus was directly and more heavily linked to monitoring over individuals falling ill. Post-SARS, Taiwan established a central command center for epidemics which offered a coordinated response to COVID-19 which included various actions that were to be taken.
Hong Kong, the first country hit with SARS, has also learned from SARS even if many medical professionals were critical of Hong Kong’s slowness to shut the border with mainland China. Yet the lessons from SARS have helped Hong Kong effectively handle this coronavirus from the moment it finally severed all rail service from China in its incremental border closing in early February. Hong Kong imposed a quarantine on visitors from the mainland, encouraged social distancing and closing schools until the middle of April.
Singapore imposed travel restrictions on people coming from mainland China which went far beyond what the WHO (World Heath Organisation) advises. Singapore, like Taiwan, also implemented an exhaustive testing regime which addressed anyone with flu-like or pneumonia symptoms. The tracking of these cases was integral to the success of Singapore’s low COVID-19 infection rate and the government not only allows for all people to be tested for free, but if they are quarantined, everyone—to include the self-employed—is covered financially with employers being barred from taking quarantine time off from holiday leave.
One important detail that cannot be understated is the sharing of information and effective communication to its citizens, something that China was blamed for its inaction during the SARS outbreak when China took several months to report information to the WHO about the epidemic within the country. This time, however. China has reacted to this coronavirus with a bit more celerity as scientists have noted that the government has been more open to sharing information. This despite other reports which claim that Beijing is censoring unfavorable information about the spread of the virus. Still, the consensus is that China has improved on its transparency with the WHO.
With the huge spike in cases over the weekend in Spain and France, Italy is about to be joined by neighboring nations whose healthcare systems are about to be rattled with few measures in place to prevent this virus from spreading. Where last week there was a battle between Italian, French and German health ministries about the importation of face masks to Italy, this problem now seems to be resolved. Yet there are few other remedies that locals in Italy can depend upon unless you count contactless credit cards which along with mobile phones are turning out to be the best prevention against transmitting or contracting COVID-19.
European nations must learn from these governments’ actions in working towards eradicating COVID-19. In the end, viruses don’t care if children are in school or outside playing soccer, they will spread unless strict measures are enforced. Let this be the end to half measures in the future and individuals who think that only their lives matter. Viruses like COVID-19 are bound to return in different and even more lethal mutations and it is up to all humans to work cooperatively to contain them, to eradicate them for our collective good.Print