# Italy’s leading epidemiologist on why the virus has spread in a ‘surprisingly enduring’ way, and how Germany managed lower deaths

Carlo La Vecchia, professor of medical statistics and epidemiologist at the University of Milan, explains what’s behind the second wave, why Germany has fared better than most other countries, and what to expect over Christmas.

Did Italy ‘waste’ the progress that was made this summer when the number of cases had reached near zero?

I partially agree with this interpretation. On the one hand, if we had continued into the end of September with no cases, we would be telling a very different story today. Nevertheless, I would not attribute all the negligence to people’s behavior during the summer months. We opened up the country on June 3rd and only had one death on August 23rd, so we’ve had almost no evidence of the virus circulating for months. According to the data available in September, the curve flattened and the ‘summer issue’ seemed to be a problem of the past. 

Unfortunately, we saw a rise in cases and the line began to climb as schools opened and activities restarted in October, most especially in the larger cities. On October 15, the numbers ‘exploded.’ I would ascribe part of the problem to social and work activities, increased human interaction during completely normal activities. I would also say that one must consider the weather conditions. As far as we know, droplets persist in humid and cold air, whereas they rapidly fall in hot and dry environments, conditions we have during an Italian summer.  

Perhaps thanks to a second mild-lockdown, the data over the last few days seems to show that the country is once again flattening the curve, but with an increase in virus circulation. These days, we are seeing a 10% positivity rate. We must acknowledge that the virus is still spreading, in a surprisingly enduring way.

In your opinion, what is peculiar about the way the virus seems to be trending in Italy compared with other European countries?

This second wave of the pandemic looks very similar in four different countries: Italy, Spain, France and the U.K. In the spring, Italy faced the problems of the pandemic about 15 days before the other countries, with over 10% case fatality more than the others. At the time, the two-week ‘warning’ gave the other European countries time to prepare their national health services. 

The second wave seems to follow a different pattern. Now, we expect 10 to 15,000 deaths in each nation, but we expect that we won’t hit the numbers of the first wave, with health-care conditions having been considerably improved almost everywhere. If we compare Italy to the U.K., we can see the subtle difference in percentages: Italy’s death of 50,000 deaths among a population of 60 million and the U.K.’s death count of 54,000 in a population of 66 million. The very unique case in the EU is Germany, where they have had 14,000 deaths in a population of 80 million. We can attribute this to a very different, and more efficient, national health service, with small, but well-equipped, practices all over the country, and even in small towns.

From the archives (March 2020): Eerie silence in Rome as the coronavirus lockdown takes effect

Why have there been lower deaths in Germany? Why is Italy now in need of intensive-care units, doctors and nurses?

The reason is extraordinarily simple: Germany is richer than the other countries in the EU. They have the capability to double Italy’s public spending on health care, and budget more for health care yearly. In contrast, Italy’s financial statements indicate a dedication to retirement benefits. Moreover, Italy’s enormous debt consumes most of the resources, leaving very little for governments to fund essential services. After the 2007 economic crisis, continuous cuts have been suffered, in Italy as in the U.K., France and Spain.

What has Italy’s health-care system lacked?

The answer is very simple. Italy didn’t have a pandemic plan before COVID-19. Every year, we would see our intensive-care units rapidly fill during any ordinary flu season. The reaction was always to wait for the wave to pass, and doing nothing to improve hospital capacity. In the past 20 years, there has been no pandemic plan, despite the warnings. This is a political responsibility, and a large economic issue. We need to admit that Italy was not ready at all to face this pandemic, while Germany was very ready. At least now, we’ve doubled our intensive-care-unit beds.

From the archives (March 2020): From power to ‘the plague’: This is what happened when one Italian politician caught coronavirus

What will the Christmas holidays look like in this COVID era?

Everyone should be careful and reduce contacts to parents and children. This is going to be a Christmas of prudence and awe to the virus. Consider this: we estimated that during the summer approximately 1% of the population would be infected, but now that number reached at least 5%. Every contact made is more dangerous than ever. In the next few weeks, we will probably observe a flattening of the different indicators and a general improvement in the situation, but people should still abide by the regulations. The virus is still spreading quickly. Moreover, we won’t have a vaccine ready before Christmas, and we won’t achieve the herd immunity without it. At this time, we need to try to reduce the risk and hope for a rapid confirmation and distribution of the vaccine.

How long will scientists be studying this epidemic, and what can we do to avoid making the same mistakes?

During our teachings at the university, even after a century, we still use the “Spanish Flu” as a classic example of an epidemic. Humans forget that disease can come at any time, without knocking on our front door. And, we haven’t had an experience like this for the last 50 years. Illnesses are cyclical. I hope we have learned the lesson now and that we will adapt our health-care systems, our public spending and our education system. We need to build highly specialized hospitals and to train new professionals, in order to get prepared for events like this.

From the archives (September 2020): Italian president hits back at Boris Johnson over ‘freedom loving’ COVID-19 remarks