Interview. The delay with which the Lodi outbreak was detected was due to a combination of errors and bad luck. ‘There is an underlying problem: in Italian hospitals, infection control is something taken lightly.’

Pisa disease specialist: ‘We lack a culture of infection control’

The inevitable political controversy around the Italian outbreak is becoming more and more surreal. On the one hand, the government is recalling on every occasion that it was the first (and only) government in Europe to shut down flights to and from China.

On the other hand, the right wing is stressing that more could have been done to protect Italy. However, the dynamics of the Lodi and Veneto outbreaks, which were discovered with considerable delay, demonstrate that if there was a fault, it was regarding “preparedness,” i.e. the ability of the first-line workers of the health system to respond.

However, it’s very unlikely that we’ll see a public tender to increase the resources available to one of the least expensive (read: underfunded) health systems in Europe. Caught between the aging population and the historical shortage of staff, the Italian system still remains among the best in the world, thanks to the daily heroic acts of doctors and nurses, who are exposed more than in other countries to the risks involved in their profession. The infectious disease specialist Dr. Pierluigi Lopalco, Professor of Hygiene and Preventive Medicine at the University of Pisa, is one of those who have been signaling the growing deficiencies and inequities in our healthcare system well ahead of the current crisis. 

The delay with which the Lodi outbreak was detected was due to a combination of errors and bad luck, explains Dr. Lopalco. “The doctors in the emergency rooms were informed that any suspicion of coronavirus had to have a connection with China, and at first, ‘Patient 1’ in Codogno denied any such ties. Only after a second visit to the emergency room, with symptoms that were already serious, did a possible link emerge with a ‘Patient zero’ who had returned from China. This turned out to have been false information later on, but that error started the investigations that uncovered the Codogno outbreak.”

Wasn’t there also a deficiency with regard to preparation?

There is an underlying problem: in Italian hospitals, infection control is something taken lightly. We are among the first countries in Europe in terms of hospital infections, and the first for a number of particular pathogenic germs. We lack a culture of infection control. When such a virus arrives in hospitals where control is poor, that’s when you have a problem.

Many doctors were among the first who were infected. This suggests that the preparedness of our healthcare system is not at a very high level. Is that true?

The problem is not about the level of preparedness: there’s an absence of preparedness. Among epidemiologists, we immediately began to talk about a potentially pandemic virus. We may have been written off as doomsayers, but we warned about the need to prepare for a pandemic. Not because the pandemic was certain to occur. But preparedness means preparing for the worst possible scenario. The hospitals are starting to take action now. Our top-of-the-line facilities, like the Sacco and Spallanzani, don’t have this problem. But provincial hospitals do.

Today, Italy is the country with the most cases of coronavirus in the world after China and South Korea. One of the neighboring countries, Germany, has also had an outbreak with local transmission, but it was quickly contained. Are they better protected than we are?

Some countries, such as the US, are now testing all the patients who tested negative for seasonal flu. European countries aren’t doing this. However, it seems strange to me that there are so many cases in northeastern Italy and not in Germany. These are similar areas in terms of demography, industrial activity and contacts with China. It is likely that a situation similar to ours will occur there as well, and soon.

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