Q & A with Jed Smith, American Expat Living in Italy

You’re experiencing this pandemic as an expat living in a hotspot area of Italy, where restrictions are much tighter than most of the U.S. What advice do you have for Americans feeling frustrated with the restriction of freedom, the disruption to “normal” life, and the impact on our livelihoods / economic future?

First, I’d like to add a bit of perspective and comparison. Both Italy and the U.S. were slow to swing into action in responding to COVID-19, losing, in my opinion, time and a crucial ability to blunt the devastation that we’re now seeing. I saw what I consider to be a basic human condition that I call “this will never happen to me.” Believe me, I saw and heard plenty of that in later February and early March when this virus started showing up within Italy’s borders. The news media gave us the illusion, by the protection of our computer and TV screens, that we wouldn’t be touched. Even when we were out and about (early March, in a more relaxed initial lockdown phase) in Treviso , our city of just over 80k, many people would go out of their way to shake hands, embrace, and kiss. It was as though people wanted to make the statement that this virus wouldn’t touch customs so fundamental to Italian culture. We also heard people say, “It’s just a bad flu.”

Sound familiar?

The above is to illustrate the defiance that can take center stage when a person is facing something that has the potential to upend their life and freedoms. From my vantage point, Italy’s government really dragged its feet in swinging into action. And when it did, they quickly realized while new cases and deaths from COVID-19 were rocketing off the launchpad, too many people were not complying with guidelines and that stricter lockdown measures and penalties were required. Looking at Italy’s infection/new cases curve, a person can see that the more severe restrictions were implemented March 21 at a pretty steep and high point in the curve. It took a solid two weeks before the curve began to reliably descent. Fortunately we didn’t get stuck on a plateau, and our curves continue to approach more manageable levels.

It’s taken “sticking with the pain” to get to this point. Yes, Italians are itching to return to life and former freedoms, but our prime minister Conte has promised that a bigger relaxing of restrictions isn’t guaranteed if the curves start edging upwards again. If all goes well, that next date will be May 18.

I had hoped, much to my disappointment, that the U.S. would have learned from Italy’s fiasco in getting restrictions into place and acting more expeditiously. While Italy missed the boat in the beginning, I believe they’ve wisely understood the importance of the long game and not opening up too soon, only to witness another fiasco. Italy already is suffering hugely. Another surge could very well hobble Italy beyond repair in the foreseeable future.

Lastly, I feel compelled to point out that Italy entered significant lockdown well before the States, yet the U.S. is already opening up dramatically more than Italy. Our easing of restrictions are weeks away from being anything on that level.

What do you think would happen if governments said “OK, we’re removing all restrictions, but here’s how we suggest you conduct life based on global scientific data.” How would people behave without government “rules”?

Hm. That’s a toughie. If I were witnessing widespread responsible behavior, here and abroad, that would give me confidence that people have educated themselves with the clearly available facts and data, and have adopted an attitude of “we’re all in this together,” I could venture an opinion. But as long as there is a dangerous percentage (even small) of “every man and woman for themselves” I’m convinced this isn’t an option.

I believe it’s helpful to look at Sweden’s approach, which is to not impose restrictions and instead appeal to its residents’ good will and good sense to behave responsibly. The Swedish government makes suggestions but has implemented very few guidelines. Many people are lauding Sweden’s results, saying that the country isn’t faring so badly with this approach. But the fatality rate in Sweden is alarmingly high (compared to neighboring countries) and the new cases are still up there. I try to follow and make sense of the country’s curves, but all I can deduce is that it is “spiky” and isn’t really dropping off in an encouraging way. Swedes are hoping their approach will lead them more quickly to herd immunity and are confident in their hospitals ability to house and care critical patients until that happens.

Many people believe this is the way to go so as to not remain “on the ropes” with COVID-19. BUT the culture of Sweden is dramatically different from Italian and U.S. cultures. The Swedes tend to be better rule followers and they already have a reputation for not being the most touchy-feely people. My point is that probably there, in Sweden, exists better self-regulation than in other countries. And the jury is still out on their approach.

In the U.S., many aspects of the pandemic are being politicized in divisive ways — the finger-pointing-blame-game is strong. Do you see this happening in Italy and other parts of Europe?

We’re certainly seeing our share of politicians being opportunistic and politicizing this crisis. Matteo Salvini, leader of the Lega Nord (Northern League), a decidedly right-wing, populist and anti-EU party, just recently camped out in the Italian parliament with members of his party as protest against the restrictions still in place. Most see this for what it is, a media stunt to draw attention to himself. Before the crisis (and still) Salvini has been one of the most popular political leaders in the country. But, COVID-19 eclipsed many of his shenanigans (my opinion) and he’s been dropping in the polls. Salvini’s message? To unlock Italy NOW and get people back to work. He’s positioning himself as the champion of the working man, while Conte is staying firm and sticking with a plan that has greater potential to lead us out of the woods for the long haul.

Here in Treviso, people are pretty much sticking together and supporting the current plan. But, we see people becoming defiant and confrontational. Thankfully, not a lot.

What has surprised you most about how the Italian people have handled this pandemic? As an American expat observing across the miles, what do you think Americans can learn from how Italians / other European countries are coping?

While we’ve seen our share of upset Italian residents protesting the freedoms that have been taken from them, for the most part we’ve seen solidarity. Italy is a country that has had more than its share of tragedy and devastation. It has survived World Wars (it’s very different when a war is being fought on your home turf) and many of Italy’s citizens remember only too well. And, in contrast to the U.S., Italy has been mired in economic difficulties for well over a decade.

So, what I’m proposing is that Italians, while hurting, aren’t having reactions as severe as we’ve seen across the Atlantic.

What is a big question mark for Italy and its residents is: How the EU will fare? In the beginning of this crisis, Italy was smarting from the lack of immediate support (emotional and financial) from other EU countries who weren’t initially hit so hard. COVID-19 could be the impetus for the EU to unite or to fracture into countries protecting their own interests and borders. In my opinion, the latter would be a sad outcome.

This is not the worlds’ first pandemic, hopefully not the worst and likely not the last. In just our lifetime, the world has seen HIV/AIDS, Hong Kong Flu, Swine Flu, and more. But the extent of this worldwide shutdown — it’s a first. As a global citizen, what are your observations on how this has come about given today’s world?

I believe, first and foremost, that too many citizens of the world have taken shelter in the belief that science and medicine can (and should) vanquish every malady that comes along. Unfortunately, as COVID-19 is showing us, nature takes its own course and can’t just be wrestled to the ground. As you point out, this isn’t the world’s first pandemic and it won’t be the last. Viruses and bacteria will continue to evolve and fight for their place on earth. I believe we have to accept that and, of course, become smarter at our preparations and responses. Otherwise, we’re just running for the safety and mindsets of our former lives.

I also think we’re seeing the effects of people living in greater concentrations, and how places of such population density can be like dry kindling for something like COVID-19.

I’ll be curious as to what trends we see in the wake of the peak of this crisis. Already people are re-examining their values and priorities. NYC is already seeing a surge in people seeking out homes in nearby, less population dense areas. Will there be a movement to more open spaces and more fundamental values?

Until recently, Italy and the U.S. were on par in terms of COVID-19 cases per 1m population (the U.S. recently surpassed Italy), but Italy is more than double the death rate. Any hypothesis on why? Also, Italy has tested a much higher percentage of the population. Are tests more available there?

Italy did ramp up testing to a certain extent but in the beginning tests were sparse and only given to people with clear and pronounced symptoms attributable to COVID-19. That lack of testing is what drove me indoors and induced more protective behaviors before the government took more decisive action.

I wasn’t terribly confident in Italy’s statistics/reporting in the earlier days of this crisis. There were reported lags and accuracy in reporting, which wasn’t a surprise since the hardest hit region, Lombardy, was drowning in an onslaught of cases and deaths.

The town of Po, near Padova, was one of the very first towns put under strict quarantine. They found a way to test most of their residents and brought their infection curve to almost zero in a very short period of time.

We’re still awaiting word of how available and widespread COVID-19 testing will be. I take comfort that the government seems to understand this, and that the infectious disease specialists that we’ve seen interviewed keep hammering this point home. For me personally, this will be an important factor with how far I will venture out.

I wouldn’t be surprised that, if most of Italian residents were to be tested, the infection rate has been far higher than we’ve understood. It would also explain why Italy’s fatality rate is so high.

Having experienced healthcare systems in both the U.S. and Italy, what is your take on how Italy’s system is equipped to deal with this healthcare crisis?

It frustrates me to hear some Americans imply that Italy’s healthcare systems is somehow inferior to theirs. The World Health Organization ranked Italy as 2nd best in the world. Some of medicine’s greatest minds reside here. Italy also has one of the highest life expectancies in the world.

Italy functions primarily on social medical care. A permanent resident or citizen retains right of access to medical care whether they have a job or not (and whether they have personal savings). Going through the system can be slow for non-urgent matters, but an option always exists to go private. By going private, this doesn’t mean outrageous expense like it does in the U.S. For example, if you want to see a specialist and the system deems your situation as non-urgent, you can pay a couple hundred euro (or less) to see a specialist (often the same one) sooner.

For medical care under a “tessera sanitaria” most doctor visits and procedures cost nothing or very little. Prescriptions have a co-pay based on a person’s income level. Critical life-saving drugs usually are free or cost very little.

People in Italy take comfort in knowing that their healthcare is a fundamental right and that they will always have access to care without fear of going bankrupt.

Private healthcare coverage policies are available, often with some type of exclusion for pre-existing conditions. Some people choose to be self-insured because the direct out-pocket-expense for doctor visits and procedures are a fraction of what they are in the States.

Pull out your crystal ball… When the world enters into the “recovery” phase of this crisis, what do you see changing indefinitely? What new innovations will take hold and shape a better future?

This is a hard one since I have to ask myself what is wishful thinking and what is realistic thinking. But here goes, anyway. I think more people will wake up to the fundamental importance of self-responsibility in maintaining health and not being wholly reliant on the miracles of modern medicine. As you said earlier, this won’t be the last pandemic, and many people will do more for themselves to help them weather the next pathogen more successfully. Sadly, however, many people will abdicate personal responsibly and remain completely dependent on doctors and medicines.

I hope this means that we’ll adopt wise practices even in flu season (when and if COVID-19 is knocked back to manageable, treatable levels—and with an effective vaccine). I’m already asking myself what I can learn to prevent illness and make my way into my golden years as a robust individual.

I believe global travel will not return to previous levels for a long, long time, if ever. The travel experience and logistics will be altered materially. Maybe they’ll eventually be relaxed, but I believe some practices will stay with us. It’s kind of like remembering how there was a time when there were no passenger TSA checks. Now they’re with us forever.

I believe that smart, responsible governments will join with other governments and consider health as a global responsibility requiring collaboration. I believe that countries will realize that healthcare and crisis readiness is essential and not a line item that can be cut to save money.

I believe that the processes for development of therapeutic treatments and vaccines will be abbreviated. Right now, many people don’t see how that can change. But, there was a time when no one believed a sub-four-minute mile could be run.