Why the U.S. Could Be Worse Off Than Italy With the Coronavirus

Italy is implementing radical new measures against COVID-19, and that could soon be the new normal for other countries fighting the virus.

But experts say that a number of unique factors in the U.S. — a sluggish approach to testing, and a lack of public healthcare and paid sick days for some workers — are likely to make its battle to contain the outbreak even more difficult than in Europe.

“The situation is even worse for the U.S.,” Francois Balloux, a professor of computational systems biology at University College London, told VICE News. “The U.S. is a special case.”

Italy, battling the deadliest coronavirus outbreak outside China, announced Sunday it was putting an emergency quarantine on 16 million people — a quarter of the population — living in the economically powerful north, including the entire Lombardy region, as well as Milan, Venice, and 14 other provinces.

Under the strict new rules, residents are banned from traveling outside or within the quarantined areas, with exceptions only made for “proven professional needs, exceptional cases and health issues,” according to Prime Minister Giuseppe Conte. Previously, about 50,000 people in badly affected towns in the region had been under lockdown.

In addition, the government announced it was rolling out strict social distancing rules, previously imposed in the north, to the rest of the country, closing museums, movie theaters, and nightclubs.

“It's our darkest hour, but we will make it,” Conte told La Repubblica newspaper Monday.

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The emergency measures, announced as Italy reported a surge in fatalities from 233 to 366 Sunday, are the most dramatic announced so far by a democratic country in trying to contain the outbreak. Other affected countries are watching their rollout closely, weighing when it's time to curb personal liberties, and incur a massive economic hit, to try to halt COVID-19’s spread.

Balloux, director of the University College of London's Genetics Institute, said it was likely that other governments could impose their own regional lockdowns or social distancing rules in coming weeks, as the scale of their crisis caught up with Rome’s.

But he believed the U.S. was facing an even bigger challenge than Europe in limiting the spread of the virus, due to several factors.

Despite the U.S. government’s pledges to ramp up testing capacity, it appeared that far fewer tests were being carried out in the U.S. than in other affected countries in Europe.

“There’s very little testing; it’s lagged quite badly behind,” he said. “There’s a lot of unknowns.”

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Exact figures are difficult to establish since the Centers for Disease Control and Prevention said last week that it would no longer provide an official tally of tests conducted or under investigation, because states and private institutions had been authorized to conduct their own tests.

But an analysis by The Atlantic published Friday could only confirm 1,895 tests carried out in the U.S., where the number of confirmed COVID-19 cases passed 550 Monday. By contrast, in the U.K., where 319 cases have been confirmed, health authorities have conducted more than 20,000 tests.

William Schaffner, professor of preventive medicine and infectious diseases at the Vanderbilt University School of Medicine, told Al Jazeera that problems with the U.S. testing system meant the country lagged “behind much of the rest of the world” when it came to testing.

"We don't know yet in the United States whether the coronavirus is widely distributed or whether it is just present in certain small spots,” he said.

Balloux said the lack of a public healthcare system, and of guaranteed paid sick leave for all workers, would also hamper efforts to respond to the outbreak in the U.S. “It will make it much more difficult to convince people to self-isolate, and impose the required social distancing methods,” said Balloux.

U.S. federal law does not require employers to grant paid sick leave, and In some industries, like food service, only about a quarter of workers get paid sick days, forcing many of them to continue working when they’re ill. According to the U.S. Centers for Disease Control and Prevention, one in five food service workers have reported working in the past year while sick with vomiting or diarrhea.

"These conditions create a near-guarantee that workers will defy public health warnings and trudge into their workplaces, regardless of symptoms,” Karen Scott, a PhD student at the Institute for Work and Employment Research at MIT, wrote last month.

"In this way, a manageable health crisis can spiral out of control."

Already, officials in other countries have indicated they are looking to take a similarly aggressive approach to Italy. Austrian Chancellor Sebastian Kurz said it was inevitable that more European countries would adopt more drastic measures, while French government spokeswoman Sibeth Ndiaye said last week that officials would probably have to raise the country's epidemic alert to the maximum level, potentially leading to travel bans and restrictions on public activities.

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In the U.S., Washington Gov. Jay Inslee told Face the Nation Sunday that officials were considering whether to impose mandatory measures around social distancing or bans on public gatherings to stop the outbreak, one of the biggest in the country.

Balloux said he believed the Italian lockdown had come too late to prevent the spread of the virus to other regions, and had doubts as to whether it would be as effective as the government hoped. “I think the time for containment of the outbreak is gone,” he said. “That doesn’t mean it cannot be slowed down, or limited but containment is probably not an option any more.”

The belated Italian response has had its share of problems. A leaked report of the government’s plans for the mass quarantine sent thousands fleeing the region late Saturday ahead of the lockdown, potentially spreading the virus with them. Reports have emerged from the excluded zone that there are few visible controls on people entering or leaving, while residents have spoken of confusion about what they can and can’t do.

The lockdown has also triggered violent protests in Italian prisons, with inmates rioting over restrictions on face-time meetings with relatives during the outbreak.

“The cost to the people of northern Italy is immense,” said Balloux. “The decision was taken too late, but I don’t think anyone should be blamed for that, because these are measures you would only take when you are really desperate.”

Cover: A completely empty San Marco Square is seen on March 9, 2020 in Venice, Italy. Prime Minister Giuseppe Conte announced a "national emergency" due to the coronavirus outbreak and imposed quarantines on the Lombardy and Veneto regions, which contain roughly a quarter of the country's population. (Photo by Marco Di Lauro/Getty Images)