The good

Italians star at disorganization, disobedience, and discord. They sneak past no-entry signs, light up under no-smoking signs, barrel along at 80 in 35 mph zones, fasten their seat belts under their butts. Plus, they had the worst COVID-19 epidemic in Europe.

So how come they’re doing so well now? Europe battles a second wave, with the U.K., France, and Spain all reinstating restrictions, while Italians amaze both Americans and themselves by remaining with Germany, among the winners. Here’s why:

• Italy’s lockdown was one of the strictest and lengthiest around, achieving an astonishing level of compliance from a population who for 12 weeks had to carry a pass every time they went out, certifying they were shopping for food or medications or walking for exercise, all within 200 yards of home. People survived on community spirit, deliveries from corner stores, and constantly available surgical masks, disinfectants, and toilet paper—no T. P. Arias here.
• Italian institutions shone. Doctor visits, hospitalizations, and COVID-19 swabs are free, medications cost a couple of bucks max, workers have 3-6 months paid sick leave, and the central government has generally been successful at dictating policy. A Facebook friend commented: “Despite political differences, Italian leaders actually care about their citizens.” Imagine! Italy a civilized, unified country, the United States not.
• Italy hasn’t seen America’s anti-mask, open-it-up madness.
• Italy has reopened intelligently, almost all regions leaving shuttered the bars and discotheques feeding the second wave in Spain and the ongoing disaster in the United States.
• Italy is over its testing shortage. It has so few new cases and so many trained trackers that they can do real contact tracing: finding, testing, and quarantining everyone exposed to a case.
• Cultural health mania facilitates the paranoid new normal—Italians peel their apples, for fear of pesticide residues.
• Mainly, Italians remain COVID-prudent.

Stores easily enforce mask requirements, many adding obligatory hand disinfection.

During patient visits in my office, everybody’s masked and the windows open. Whatever touches a patient gets disinfected, from chair to stethoscope. The waiting room is ventilated, near-empty—no accompanying family—and emptied of items that risk repeated handling.

We’ve attended two concerts: outdoors, assigned/distanced seats, masks when standing, names, and phone numbers recorded. At the marvelous Raphael exhibition, we were ushered from one room to the next every five minutes at the sound of a bell, in masked groups of six.

The bad

Italy may be ducking a second wave, but it’s had a ripple, with new diagnoses creeping up from 200 a day to 1,600, evenly divided among symptomatic cases, contact tracing, and mass screening.

What went wrong?

Tuscany and Sardinia, where young vacationers are the backbone of the summer economy, defied national discotheque shutdowns; other club hoppers went abroad. Thousands carried coronavirus home, driving the average age of new cases down to 30. Everybody entering from Spain, Greece, Croatia, Malta, or much of France now must get a COVID-19 swab at airport rapid-test centers or drive-bys.

Many cases affected resident foreigners. Italy responded by canceling flights from Bangladesh, ordering returning Romanians to quarantine, and performing mass testing in both communities.

American colleges opened complete with frat houses, karaoke bars, and bacchanals: 3,000 new COVID-19 cases a day. Israel allowed over-the-top weddings and undistanced schools: a second wave worse than the first, new lockdown. Spain still leaves indoor bars and restaurants open with minimal distancing: it tops the US in daily cases per capita.

Italy has avoided those traps, but people are getting sloppier. Yes, there’s plenty of masks even outside, one customer at a time in small shops and uncrowded supermarkets, but inside large stores, I see little distancing; people clearly think a mask takes its place. Outside the big city, I hear folks have returned to hugs-and-kisses greetings.

Screening of incoming travelers has gone by the boards. When my husband and I arrived from the US in June, officials demanded our address and telephone numbers, and health authorities phoned daily during quarantine to check up. Lately, they just wave you through.

Public transport theoretically runs more frequently and plasters “Do Not Sit Here” signs on half the seats. But the first (and last) time I took a tram, I waited 20 minutes, the car was packed, the windows were sealed shut, and all the Do Not Sit Here places were occupied. At least passengers were masked.

The pandemic has strained an already frayed Italian economy, with the young worst-hit—they’re concentrated in decimated industries such as tourism, and often hired on temporary contracts. Unemployment compensation covers 70 percent of salary, and €600 more has been wired once or twice into bank accounts of certified taxpayers with permanent jobs. But the millions working under the table get nothing.

I ask every patient how they’ve been bearing up. Several burst into tears; I’ve heard of 4 suicides.

One Italian friend old enough to remember World War II agreed this was the first time since that people have had to tolerate such disruption of their lives. But, he added, “The pandemic is worse. During the war, we still had our dreams.” Now people—worldwide—have lost their sense of the future and their dreams.

The ugly

Neotrumpian anti-immigrant frenzy being whipped up by the country’s right-wing in the persons of frankly fascist Giorgia Meloni and merely racist Matteo Salvini.

Minimizers such as publicity-hound physician Alberto Zangrillo, who continued to deny the resurgence threat even when his patient Silvio Berlusconi was hospitalized with COVID-19 double pneumonia.

Loose talk of herd immunity—is there less disease because everybody’s immune? No! In Milan, the epidemic’s epicenter, bus drivers who had worked at its peak and were at extremely high risk were tested for antibodies. Only 7.7 percent were positive.

No Italian nonsense comes anywhere near American levels. A “giant” COVID-denier demo fizzled at 1,500 people. And even at Salvini’s blame-the-immigrants open-it-up events, you see plenty of masks, though not all cover the nose.

Susan Levenstein is an internal medicine physician and author of Dottoressa: An American Doctor in Rome.

Image credit: Shutterstock.com