How Italy Snatched Health From the Jaws of Death

Those who used to scoff at its mismanagement should take note of Rome’s strategy for defeating COVID-19.

By , a columnist for Foreign Policy and a fellow at the American Enterprise Institute.
A man walks past a large billboard showing a woman wearing Italy’s national flag as a face mask and the headline “All together, without fear,” in Naples, Italy, on March 22.
A man walks past a large billboard showing a woman wearing Italy’s national flag as a face mask and the headline “All together, without fear,” in Naples, Italy, on March 22. Carlo Hermann/AFP/Getty Images

In January this year, COVID-19 struck Italy, the first European stop on the virus’s deadly journey around the world. “Italy’s Health Care System Groans Under Coronavirus,” the New York Times wrote in March, while Germany’s Bild described macabre processions of military trucks delivering the COVID-19 dead to cemeteries. The global shock over Italy’s tragic fate betrayed a sense of superiority: The disorganized Italians were mishandling the crisis, sure, but the rest of us would know what to do.

Half a year later, the Italians have not only managed to get their infection rate down to the level of Europe’s star performers like Germany and Finland, but have achieved low fatality rates comparable to the Germans and Finns too.

Transportation is just one sector in which Italy is overperforming. Recently, Rome’s Fiumicino Airport was awarded the world’s first five-star COVID-19 airport cleanliness rating by Skytrax. A trial in which passengers flying out of Fiumicino are tested at the airport, with results available before they board their flights, is also set to be expanded if it proves successful. A number of other Italian airports, ports, and train stations already offer COVID-19 tests to arriving passengers, which a British member of Parliament pointed out to remonstrate U.K. Prime Minister Boris Johnson over the fact that travelers can get tested at Italian airports while “in the U.K. there’s total chaos in the testing system.”

It isn’t just airports and train stations that the Italians are managing well. This week, Italy held a virus-safe referendum on the size of the country’s parliament with nearly two-thirds voter participation in some areas.

If anything, Italy’s performance during the pandemic should make the world rethink its condescension toward the country, which is often seen as both shambolic and overly bureaucratized at the same time. To be sure, much of that criticism has a basis in fact. As the Italian academic Roberto Orsi pointed out in a 2013 article, political mismanagement has left the country with debt far surpassing its GDP. And a 2010 article by a U.S. geological team calculated that, partially thanks to shoddy construction, an earthquake of the same magnitude would kill 3,000 people in Iran, 150 in Italy, and three in California. But after earthquakes and now during COVID-19, Italy has responded with surprising agility. Indeed, the rest of the world could learn a thing or two from its response.

The novel coronavirus is thought to have arrived in Italy in late January, after an infected traveler arrived from China. By Jan. 31, the country had two confirmed cases of COVID-19. Four and a half weeks later, with more than 3,000 confirmed cases, the government closed schools and universities. A few days later, Prime Minister Giuseppe Conte announced a lockdown covering large parts of the country’s north. But it didn’t help. “When the lockdown of the north was announced, thousands of people went to the south,” said Mark Lowe, a British businessman who has lived in Italy for a quarter-century. “We would have needed a simultaneous lockdown of the whole country.”

And so, by March 22, the country had nearly 60,000 COVID-19 cases. The government ordered factories shut. Italian life was confined to hospitals, supermarkets, pharmacies, and homes. But the misery continued. On March 26, 712 Italians died of COVID-19; the following day the virus claimed another 919.

The world watched the suffering country with a not inconsiderable amount of prejudice. “We always wanted to be a bit like you. So relaxed, so beautiful, so passionate. We wanted to cook pasta like you, drink Campari soda like you, make amore like you,” Bild opined. The Sun and countless other international media outlets reported about a COVID-19 lockdown Romeo and Juliet-like love story (hint: it involved balconies) in the lovers’ hometown of Verona.

Meanwhile, the country’s allies failed to respond to its urgent pleas for medical supplies. Instead, Russia and China swept in with dubious help—think sometimes-unusable Chinese personal protective equipment for purchase and Russian military teams basing themselves near NATO installations—and plenty of PR fanfare. In an early April poll by the Italian pollster SWG, 52 percent of Italians called China a friendly country, up from 10 percent in 2019. Meanwhile, 32 percent called Russia friendly, a 17-percentage-point increase, while 45 percent identified Germany as hostile.

Italy seemed stuck in a destructive descent, albeit one with the occasional balcony romance. But half a year later, it has had a mere 34 COVID-19 infections per 100,000 residents in 14 days, a far lower figure than seen by Spain (311) and France (193) for the same period; indeed, it was much closer to star performer Germany’s rate of 26 per 100,000 residents.

And that’s not all. Unlike virtually every other country, the supposedly disorganized Italy has managed to organize dignified tribute to those whose lives COVID-19 has claimed. In June, Bergamo—a city devastated by the coronavirus—put on a spectacular performance of Requiem by the 19th-century opera composer Gaetano Donizetti, a son of the city. This month in Milan, the Duomo followed with a performance of Giuseppe Verdi’s famous Requiem. Both concerts were attended by President Sergio Mattarella and a host of other officials. Of course, other countries have remembered their victims and health care workers—mostly in the form of statues (as in Latvia’s capital, Riga) or online church services (as in Manchester, England). Italy’s stunning musical memorials are in a league of their own.

There was, of course, something to mourn: To date, 35,738 Italians have lost their lives to the coronavirus. But the fact that the country has managed to battle the virus into submission more effectively than many a supposedly better organized nation is remarkable. With its low infection rate, Italy also looks likely to hold off a devastating second wave.

How did the Italians snatch health from the jaws of death in just a few short months? Lowe says both the government and the population adapted with surprising speed. “This was an emergency, and since Italy was the first European country to be hit there wasn’t a model that Italy could use,” he pointed out. “The government implemented draconian measures, but it implemented them very well.” Of course, many of those came too late and were too lenient at first. “On top of that, since Italy’s health service is decentralized, too many regional officials and too many virologists made different decisions. But we have to remember that this was uncharted territory, and the government did act courageously,” he said. That included its decision last month to mandate wearing of face masks in all open spaces where social distancing isn’t possible. In the first few days, quite a few face mask refuseniks were fined.

Although not omnipotent, Italy’s central government has more power across the country than, say, the U.S. federal government. But perhaps even more important than any government courage was the resilience of ordinary Italians. It is true that Italian governance can be haphazard, retired Gen. Vincenzo Camporini, a former chief of the defense staff of Italy, told me. “But as a result, we developed a network of informal initiatives that eventually was more successful than what was done in countries that are better organized,” he said. Those informal initiatives included people shopping for elderly neighbors. On their own initiative, local Carabinieri police stations did the same, with many even bringing pensions to elderly residents, who typically collect them at the post office. Indeed, in many regions Italians used to calamities such as earthquakes were well placed to take on yet another crisis.

Italy’s culture of less-than-rigid organization may turn out to be an advantage not just during this pandemic but in future crises as well. “Since in our culture regulation is treated more as advice than as mandatory rules, once people grasped the severity of the problem adherence to the rules became natural for them,” Camporini said. Giampaolo Roidi, a senior editor at Italy’s AGI news agency, agreed, telling me that “from a health perspective the Italians showed that they immediately understood the seriousness of the situation.”

When people feel that they are following rules of their own volition, there is less temptation to disobey out of contempt for the authorities. In some ways, that idea unites Italy’s and Sweden’s responses to the pandemic. Sweden, like Italy, has relied on recommendations rather than rules. Rather than imposing a lockdown, the authorities have asked the public to behave responsibly. The strategy seems to have worked: Sweden had an early spike in fatalities, but its infection rate is now declining.

Craig Fugate, the administrator of the U.S. Federal Emergency Management Agency for the duration of Barack Obama’s presidency, makes a similar point. “Embrace the chaos,” he argued at a recent RUSI event, explaining that governments need to treat the public as a resource rather than a burden during crises. And there will be more crises, whether caused by Mother Nature or by hostile states. Much like teenagers, the public is more likely to play a productive role if it feels empowered rather than forced.

Italians, in the face of deep devastation, empowered themselves to rise above. The question now is whether the public will act as stoically in trying to get the country’s shattered economy back on track—a herculean task even with the European Union’s 540 billion euro ($630 billion) aid package for the member states worst hit by COVID-19.

Of course, “embrace the chaos” would hardly be the label chosen by the Italian government for its coronavirus recovery strategy. But doing so has been a source of resilience so far.

Call it grassroots crisis management. That’s obviously not the entire answer to crises, but Italy’s performance shows that it is part of a complete response.

Elisabeth Braw is a columnist for Foreign Policy  and a fellow at the American Enterprise Institute, where she focuses on defense against emerging national security challenges, such as hybrid and gray-zone threats. She is also a member of the U.K. National Preparedness Commission. Twitter: @elisabethbraw