Lessons learned
As Europe faces a resurgence of Covid-19, one country gives cause for hope
When the reports about Covid-19 in Italy and other European countries first came out, something about the outbreaks struck me immediately. Covid-19, I realised, was hitting these countries in the late winter and early spring, just at the time that the annual flu season was declining. Although Covid-19 is different from influenza in many ways, they are both respiratory virus spread by droplets. These types of viruses spread best when people spend time indoors together, which makes winter the prime time for them to spread. The change of seasons would be to Europe’s advantage in managing the virus.
But while Europe, and then the USA, were facing the pandemic in spring, New Zealand was not. We were facing this highly transmissible virus as the weather turned colder and wetter, in a country where hundreds of thousands of people live in cold, damp, substandard housing.
Worse, New Zealand was far from ready to deal with this kind of situation. In 2019, New Zealand’s ranking for pandemic preparedness was 35, putting us slightly below Italy and just above Greece. Well ahead of us were the countries we’d expect to have everything under control: the United States, Britain, Australia, Sweden, Canada, Germany, South Korea and France, as well as quite a few we might not have expected – Thailand, Brazil, Mexico, Indonesia, Malaysia, Chile.
I had every reason to believe that things were going to be bad here.
Now, though, I’m feeling that New Zealand is like the student at university who skipped half their lectures, hung out at the pub and joined every club, then swanned into the exam at the end of the year and somehow came out with an A. In reality, a better analogy might be the student who mucked about all year and then, at the last minute, finally knuckled down and crammed a year’s worth of learning into a few days. While, clearly, the international rankings for pandemic preparedness meant nothing in the face of Covid-19, there’s no doubt that New Zealand wasn’t well prepared. Our highly fragmented contact tracing system, for example, was not well-placed to deal with clusters spread across multiple district health boards. And in the early days of the outbreak, we were able to test only a few hundred people per day.
Although the resurgence of community transmission in New Zealand was a nasty shock, we had learned a few things by then. Even with no active cases, we kept testing, and, when we needed it, our testing rate per capita surged ahead of countries like the USA and Germany. The student who left everything to the last minute the first time didn’t repeat their mistake.
But, as the northern hemisphere enters autumn, there are ominous signs that not every country has learned from their past mistakes.
In March, when New Zealand first went into lockdown, Europe was the centre of the pandemic. When the disease hit its first peak, in mid-April, more than half of the nearly 7000 deaths per day were in Europe. Nearly two thirds of those deaths were in just four countries – Britain, France, Italy and Spain.
Getting the outbreaks in those countries under control took months.
Italy first began by putting individual towns into lockdown on the 22nd of February, followed by most of northern Italy on March the 8th, then the whole country on March the 10th. It didn’t begin easing restrictions until mid-May, but many restrictions remained through June and in some cases July.
Spain went into lockdown on the 14th of March, tightening it further two weeks later. France went into lockdown just two days later, on the 16th of March. Both countries began easing a few of the restrictions in May, but most restrictions were lifted in June.
And Britain, which resisted using lockdowns initially and talked about herd immunity, finally imposed a lockdown on the 23rd of March, the same time as New Zealand went into Alert Level Three. Like the other European countries, Britain first began to ease restrictions in mid-May. Over June and July, restrictions were eased to something resembling New Zealand’s Alert Level Two, but they were never fully lifted.
All four countries paid dearly in terms of the numbers of deaths, economic harm, stress on their health systems and medical staff, and in overall human suffering. While there’s no measurable number for human suffering, we can measure the economic damage, and the numbers are clear. The four European countries with the largest drops in GDP were Spain, Britain, France and Italy.
There were many lessons to be learned from what happened in those four countries, but an obvious one is that lockdowns are tough on everyone, especially if they are long. And, in general, a late lockdown is a long lockdown, because the more the disease has been allowed to spread, the longer it takes to get it under control.
Those who are still following Covid-19 statistics will know that the really large outbreaks are mainly in large, populous countries with right-wing populist leaders – the USA, India and Brazil. Most of the worst death rates per capita are in South America – Peru, Bolivia, Brazil, Chile and Ecuador – although Spain is also in the top ten. But something has been happening in Europe in the last few weeks, and it’s not good news.
France, Spain and Britain, as well as some other European countries are all seeing serious increases in case numbers. France has been reporting record numbers of new cases per day. This is yet to be reflected in record numbers of deaths, so perhaps the increase is partly due to case definition and more testing, but, then again, perhaps it’s just that there’s always a lag between infection numbers and deaths.
Spain has become the first European country (apart from Russia) to record more than half a million Covid-19 cases – an unenviable record for a country with a population just under 47 million. And Britain has re-imposed a number of the restrictions which were previously lifted, as its case numbers are also increasing fast.
But, as the graph shows, there’s some good news in there too. Germany and Greece, both A+ students when the virus first emerged, are still doing well. Greece, in particular, deserves more recognition for the way it managed Covid-19.
But there’s something else in the data, and it’s very encouraging indeed. Italy, which suffered so much early in the pandemic, isn’t having the same increase in case numbers as Spain, France and Britain. Something different is happening.
In the early days of the pandemic, when Italy’s outbreak was dominating media coverage, there were a number of reasons given as to why the disease was so devastating there. As well as the aging population, other suggested factors were the high population density of Italy and the way that Italians are always in close proximity – hugging, kissing and generally giving much less personal space than you’d see in countries like New Zealand.
Why, then, has Italy not had the resurgence of Covid-19 that France, Spain and Britain have? While some have suggested that Italy is just behind the others because it was slower to come out of lockdown, there’s clearly more to it than that.
Quite simply, it appears that Italy learned from its terrible experience with Covid-19 earlier this year. Compliance is still rather variable, but enforcement is taken seriously. When considered necessary, Italy has kept some restrictions in place. And although Italy is testing far fewer people than Britain, it is targeting that testing, by making much more effective use of contact tracing.
If New Zealand was the student who crammed at the last minute and somehow managed an A, Italy didn’t even come close to a pass mark the first time around. But it’s good news indeed to see that they have turned the situation around.
For the next few months, I’ll be writing The Turnstone once a fortnight instead of once a week, while I do a course.
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