OF THE 24 confirmed cases of Covid-19 in the Republic of Ireland, 12 are directly linked with travel to Northern Italy, which has recorded the second-highest Coronavirus toll globally.

As China reports a decrease in confirmed cases, Italy, by comparison, has seen a spike since late February.

“We are facing an emergency, a national emergency,” said Prime Minister Giuseppe Conte on Sunday, as Italians woke up to a series of drastic measures, aimed at preventing Covid-19 spreading to other parts of Europe.

Last night, Conte announced that the whole country was being put on lockdown until 3 April.

On 22 February, there were 54 confirmed cases of Covid-19 in Italy. By 2 March, that number had surged to 1,694.

As of yesterday, there were 9,172 confirmed cases of this coronavirus in Italy. Over 450 people have now died as a result of infection.

Ireland’s Department of Foreign Affairs, meanwhile, has updated its advice, advising Irish citizens not travel to Lombardy or other affected regions.

As European countries implement measures to prevent further cases of Covid-19, how did this virus spread so rapidly in Northern Italy and can lessons be learned from how Italy first reacted to its spread?

‘We Shake Hands’

The first person to fall ill in Northern Italy met someone who’d returned from China on 21 January without presenting with any symptoms of Covid-19, Italian health authorities said on 21 February.

According to Italy’s Corriere della Sera newspaper, the 38-year-old man with Covid-19 symptoms had to wait 36 hours at a hospital in Lombardy before he was tested for the virus, during which time he had contact with hospital staff and visiting friends and family.

It was reported in late February this may have contributed to the rapid spread of the virus in Italy.

Codogno Hospital – where the man was treated – then closed its emergency room. New hospital beds were brought in as quarantine kicked in.

Milan pharmacies at this time were reportedly selling out of protective face masks weeks beforehand.

The following day, it was reported that Covid-19 had claimed two lives in Italy and that Local Authorities in Lombardy and Veneto ordered schools, businesses and restaurants to close. The Mayor of Milan shut down public offices.

One month before the virus outbreak, Italy’s Health Ministry created a Taskforce, suspending all flights to and from China and declaring a State of Emergency.

Yet Covid-19 could have arrived in Italy before this travel ban was even issued.

Sacco Hospital, which is in Milan, studied three different genetic sequences found in Lombardy, confirming Covid-19 weeks before doctors confirmed Italy’s first case.

“It is plausible that when Covid-19 landed in the country, it was still in incubation, and the infection developed into somebody with light or no symptoms at all,” Massimo Galli, Head of Infectious Disease at Sacco Hospital, told Corriere della Sera.

An uncommon number of pneumonia cases presented At Codogno Hospital in late December. These patients could have carried Coronavirus. Doctors, however, treated them for typical winter diseases.

“Unfortunately, a decisive contribution to [Covid-19's spread]” was given by Sacco Hospital itself by medical staff working there, Al Jazeera reported last Friday.

Italian authorities, meanwhile, urged calm but acknowledged that clusters of Covid-19 cases in Northern Italy were alarming.

Source: PA Graphics

Covid-19 spreads through specific contact with an infected person if their coughs, sneezes, droplets of saliva or other body fluids are passed on to another person through their eyes, mouth or nose.

Scientists believe that a person needs to be within a metre of an infected person to risk catching it – as that’s the zone where bodily fluids can be projected through a cough or sneeze. The virus cannot penetrate the skin.

Italy has recorded six times as many cases as France (1,126) – the 2nd-highest number of confirmed cases in Europe.

Despite the nature of Covid-19 and how it spreads, criticism has been levelled at how prepared Italy has been to deal with it, and its response so far.

Friendly greetings, a health service under strain and political instability have each been put forward as probable factors for this spread.

On 1 March, Special Commissioner for Covid-19, Angelo Borrelli, suggested that Italians’ demonstrative nature could be contributing to the virus’ spread.

“We have a collective social life that is very florid, very expansive. We have lots of contact, we shake hands, we kiss each other, we hug each other,” said Borelli.

“Maybe it’s better in this period not to shake hands, and do not have too much contact, and try to be a bit less expansive, which is different from how I am,” he said.

‘Retired Doctors’

The outbreak, meanwhile, has overloaded Italy’s public health system.

On 2 March, it was confirmed that 10% of Lombardy’s doctors and nurses are out of commission after testing positive for Covid-19 and are in quarantine. Hospitals in Lodi and Cremona are overwhelmed.

“Effectively some of the hospitals in Lombardy are under a stress that is much heavier than what this area can support and has trained for years, to face this type of emergency,” Dr Massimo Galli, head of infectious disease at Milan’s Sacco Hospital, said on 2 March.

“This epidemic is on a scale that is larger than anyone could have thought, imagined or prevented,” he said.

An empty St. Mark's Square in Venice, Italy. Source: Anteo Marinoni/LaPresseLaPresse

Lombardy’s Regional Government asked Central Government to reactivate retired doctors and nurses to help cope.

Meanwhile, nursing students graduated early so they could be immediately put to work.

‘Pope In A Cage’

As Europe grapples with disrupted supply chains, Italy’s economy looks set to grind to a halt.

Northern Italy contributes massive amounts of revenue to the country’s economy, largely through tourism, compared with poorer Southern regions.

As the whole country goes into lockdown today, the country’s hotel, restaurants and tourist hotspots are set to lose billions of euro as airlines cut flights.

As news of Northern Italy’s lockdown leaked on Sunday, chaos erupted.

In a reversal of North-South tensions in Italy, Puglia’s Governor urged Northerners to stay away and not bring Covid-19 infections down South.

“Get off at the first railway station. Don’t take planes,” Michele Emiliano said in a dramatic appeal. “Turn around in your cars. Get off the pullman buses at the next stop.”

Italy’s new measures – which will be in place until 3 April – will affect weddings, museums, cinemas and shopping malls.

Areas under lockdown include Milan, Italy’s financial hub in Lombardy, and Venice, the main city in the neighbouring Veneto region.

Restaurants and cafés in affected regions are advised to keep customers three feet apart.

Pope Francis, meanwhile, held his Sunday blessing by video instead of in person, even though he was not directly affected by the lock-down. He described feeling like he was “in a cage”.

Director-General of The World Health Organisation (WHO) Dr Tedros Adhanom Ghebreyesus commended Italy for the “genuine sacrifices” it had made to contain Covid-19′s spread.

‘Free Movement’

Over the past two weeks, health authorities throughout Europe and The United States have implemented individual response policies aimed at containing Covid-19 Coronavirus.

There are now more than 105,000 confirmed cases of this coronavirus worldwide and 3,584 deaths, according to the European Centre for Disease Prevention and Control (ECDC).

Coupled with a rapidly spreading virus undetected in the environment for weeks beforehand and an unprepared health system, it’s clear how Italy quickly became overwhelmed.

Ireland’s health officials, by comparison, have had time to learn from its spread there into neighbouring European countries and to put in place measures to reduce this spread. Travel is key.

Ireland, UK, The Netherlands, France, Spain, Germany Croatia, Israel and Nigeria have all had confirmed cases where a person returned from Italy.

On Sunday, The Department of Foreign Affairs updated its advice for Irish people travelling to affected regions.

Alongside Lombardy, the provinces of Modena, Parma, Piacenza, Reggio Emilia, Rimini, Pesaro and Urbino, Alessandria, Asti, Novara, Verbano Cusio Ossola, Vercelli, Padova, Treviso and Venice have all been placed in self-isolation.

“If you are in Italy, you should monitor developments regularly and follow the advice of Local Authorities,” a Department of Foreign Affairs spokesperson said.

As Local Authorities come under enormous pressure to prevent Covid-19′s spread, Italy – the locus of Europe’s Coronavirus crisis – is being closely watched.

Writing in The Atlantic on Sunday, Rachel Donadio noted that Italy is a rule-bound country “where rules are often ignored…a place that often falls short on long-term planning but rises to the occasion in emergencies and has a knack for improvisation that its Northern neighbours lack.

“It’s a free society in which information is often unreliable and politicised,” said Donadio.

“Today, it is an experiment in which free movement of people and goods meets free movement of a deadly virus.

“Countries across Europe and the world are watching how Italy handles an epidemic that knows no borders, has been putting tremendous strain on public-health structures, and is pushing the country’s already fragile economy to the brink.”