As the novel coronavirus scare hits the United States full-force, comparisons to hard-hit Italy have become increasingly common. The relatively small European country has 41,045 confirmed cases of the virus and 3,405 deaths as of Thursday evening.

But is Italy comparable to the United States? Perhaps, but here are five things to keep in mind.

1. The Italian Healthcare System Is Weak

According to Johns Hopkins rankings, Italy was ranked 53rd in the world under “Sufficient & Robust Health System To Treat The Sick & Protect Health Workers.” The U.S. is ranked number one.

The nation’s “overall” health score is 31st in the world, whereas the U.S. is, again, the top ranked nation.

2. Italy Has The Second-Oldest Population In The World

Data from a United Nations report published in 2015 showed that the Italian population was the second-oldest in the world, second only to Japan.

From the collected data thus far on COVID-19, the elderly are most vulnerable to the virus.

“The average age of those who’ve died from the virus in Italy is 79.5,” Bloomberg News reported Wednesday. “As of March 17, 17 people under 50 had died from the disease. All of Italy’s victims under 40 have been males with serious existing medical conditions.”

The Bloomberg report also highlighted a recent study showing that 99% of the Italian fatalities had at least one underlying health condition:

The new study could provide insight into why Italy’s death rate, at about 8% of total infected people, is higher than in other countries. The Rome-based institute has examined medical records of about 18% of the country’s coronavirus fatalities, finding that just three victims, or 0.8% of the total, had no previous pathology. Almost half of the victims suffered from at least three prior illnesses and about a fourth had either one or two previous conditions. More than 75% had high blood pressure, about 35% had diabetes and a third suffered from heart disease.

3. Italy Was Hardest Hit In Lombardy, Where There Are Direct Ties To China

“Almost exactly a year ago in March 2019, against warnings from the EU and the United States, Italy became the first and only G7 country to sign onto OBOR (One Belt One Road),” The Federalist outlined this week. “As part of the deal, Italy opened an array of sectors to Chinese investment, from infrastructure to transportation, including letting Chinese state-owned companies hold a stake in four major Italian ports. The deal gave communist China a foothold in the heart of Europe.”

Italy started to curtail China travel at the end of January, but there are other ways of entering the county.

According to Smart Travel, “26 countries are a party to the Schengen Agreement, which means you do not need a passport to travel between these countries: Austria, Belgium, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Slovak Republic, Slovenia, Spain, Sweden, and Switzerland.”

It wasn’t until March that neighboring nations started taking border security seriously, with Switzerland, for example, partially closing their border with Italy last week.

President Donald Trump restricted China entry into the U.S. on January 31.

4. Italians Are Smokers

“Smoking is another factor clearly associated with poor survival” in coronavirus cases, CNN reported last week. “Smoking rates are about the same between the two countries: 24% for Italians and 27% for South Koreans.”

“But gender differences among smokers are widely different: In Italy, 28% of men versus 20% of women smoke, while in Korea, it is about 50% of men and less than 5% (!) of women. In other words, South Korea has an outbreak among youngish, non-smoking women, whereas Italy’s disease is occurring among the old and the very old, many of whom are smokers. (We do not know the male-female breakdown of Italy’s cases),” the CNN report added.

In the United States, an estimated 14% of the population smokes, according to data from the Centers for Disease Control and Prevention (CDC).

5. Italians Are Affectionate With Rich Social Lives

Though it may seem trivial, Italians’ affectionate nature could be a contributing factor to the nation’s intense outbreak.

“Italian culture is very warm, and Italians have a very rich social life,” noted American-British-Israeli biophysicist Nobel Prize winner Michael Levitt, who accurately predicted the coronavirus (COVID-19) slowdown in China. “For these reasons, it is important to keep people apart and prevent sick people from coming into contact with healthy people.”