Why has Italy recorded the second most coronavirus cases in the world?

George Martin
·4-min read

Coronavirus has been sweeping through Italy over the past few weeks and has already killed hundreds of people.

The southern European nation now has the largest number of coronavirus cases outside China, where the outbreak started late last year.

Monday saw another 1,807 people infected, bringing the total to 9,172, and cases of the virus have been confirmed in all 20 Italian regions.

ROME, March 9, 2020 -- A man with a face mask visits the Fontana di Trevi in Rome, Italy, on March 9, 2020. Measures to stem the spread of the novel coronavirus will be extended to the entire country in the next hours, Prime Minister Giuseppe Conte announced late on Monday. (Photo by Alberto Lingria/Xinhua via Getty) (Xinhua/ via Getty Images)
A man with a face mask visits the Fontana di Trevi in Rome (Getty)

The Italian government extended its emergency coronavirus measures on Monday, which include travel restrictions and a ban on public gatherings, to the entire country.

With the total number of confirmed coronavirus cases creeping towards 10,000, why has Italy been so badly affected?

Coronavirus may have gone undiagnosed for months

Experts believe one possible reason for the high infection rate is that coronavirus may have been spreading through the country long before it was officially detected.

In fact, health officials say the infection may have gone undetected in the country since late January.

The first person to test positive in the north of Italy who had not been to China was confirmed to have coronavirus on 21 February.

VENICE, ITALY - MARCH 10: A coffin is brought out of the hospital in the presence of the funeral home employee, to be loaded onto the funeral boat towards the cemetery on March 10, 2020 in Venice, Italy. According to the funeral home, the deceased was a 60-year-old woman who died of breast cancer. Due to the Coronavirus, funerals have been canceled all over the country like other religious ceremonies and weddings, as a result the bodies of the deceased are brought directly from the funeral chamber of the hospitals to the cemeteries for burial, where only close relatives can attend. The Italian Government has taken the unprecedented measure of a nationwide lock-down, in an effort to fight the world's second-most deadly coronavirus outbreak outside of China.The movements in and out are allowed only for work reasons, health reasons proven by a medical certificate. (Photo by Marco Di Lauro/Getty Images)
A funeral being conducted by undertakers in face masks in Venice (Getty)

Read more: Italy travel advice: How will tourists be affected by coronavirus lockdown?

By that stage the 38-year-old man had already infected his wife and several doctors, nurses and patients at the hospital where he had attended with flu-like symptoms three days earlier.

Experts now think the virus may have been present and spreading in northern Italy since at least the second half of January.

TORINO PORTA NUOVA RAILWAY STATION, TURIN, ITALY - 2020/03/09: Police officer checks a passenger leaving from Turin Porta Nuova train station. The Italian government imposed a virtual lockdown on the north of the country as part of measures to stop the spread of the coronavirus COVID-19 outbreak in Italy. (Photo by Nicolò Campo/LightRocket via Getty Images)
A police officer checks a passenger leaving from Turin Porta Nuova train station (Getty)

Ageing population

On Monday, the death toll from coronavirus in Italy rose to 463, and the country’s fatality rate currently stands at 5% – higher than the 3-4% estimates elsewhere.

One reason for Italy’s high death toll may be the ageing populations of the worst affected areas.

The country has the world’s oldest population after Japan and most of those who have died are elderly with previous health issues.

Read more: Thousands of Britons ‘stranded’ in locked-down Italy as BA axes flights

Professor Marina Della Giusta, from the University of Reading, said: “The little we know so far of this virus is that it has much higher mortality rates for older people, at least that’s what the Chinese data suggests so far.

“Italy is the oldest country in Europe probably so that won’t be surprising. The demographic affected is way bigger than it would be in lots of other places.”

Journalists keep their distance as the League leader Matteo Salvini, center, is flanked by Brothers of Italy Giorgia Meloni, right, and former European Parliament President Antonio Tajani give a statement to journalists after meeting with Italian Premier Giuseppe Conte, outside Chigi palace in Rome, Tuesday, March 10, 2020. Italy entered its first day under a nationwide lockdown after a government decree extended restrictions on movement from the hard-hit north to the rest of the country to prevent the spreading of coronavirus.  (AP Photo/Andrew Medichini)
Matteo Salvini, centre, makes a statement on Monday (AP)

Sociable culture to blame?

According to Professor Della Giusta, the rapid spread may also be attributed to the sociable nature of Italian culture.

Italians generally enjoy the great outdoors and meeting up with one another, she said, and interactions often include far more touching than in other parts of the world.

“The interpersonal physical space in Italy is a lot shorter than it is in the UK,” Professor Della Giusta added.

“Their habit is to kiss each other when you say hello.

“There is higher physical contact anyway around the Mediterranean between people and people are outdoors more at this time of year than they are in other parts of Europe, where it’s still a bit colder.”

A policeman selects a car coming from Italy at the autobahn near Gries am Brenner on Tuesday, March 10, 2020. Austria authorities started on random checks of arriving vehicles at the border crossings with Italy in reaction to the outbreak of the new coronavirus in Europe, particularly in Italy. As part of the move, officials measure the temperatures of some passengers in cars, trucks and buses. For most people, the new coronavirus causes only mild or moderate symptoms, such as fever and cough. For some, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia. (AP Photo/Kerstin Joensson )
An Austrian police officers stops a car coming from Italy on the autobahn near Gries am Brenner (AP)

Ignoring emergency policy

Experts believe government and international health advice on self-isolation may not have been observed when the first cases were declared in Italy last month.

Professor Della Giusta believes that movement between regions did not stop when the schools were first closed in northern regions a few weeks ago and many people did not take self-isolation measures.

“When schools got shut in Lombardy a lot of people just took their kids and went off on holiday to their holiday homes in the mountains and at the seaside in the other regions.

“They thought they were making their kids safe by taking them away, but this kind of behaviour is really very damaging.”