Italy could act as a doorway for the coronavirus outbreak, allowing it to spread outside of China and into Europe.

A new virus on the Old Continent

The famous Venice Carnival closed down in the hope of containing the coronavirus outbreak.

The Coronavirus disease 2019 (COVID-19) is an infectious disease caused by a virus belongs to the Coronaviridae family of viruses. This is not a new family of viruses — we’ve known them for quite a while, both in humans and in animals.

The most common form of coronavirus is widely spread among humans, and causes the common cold — it’s not this one that people are worried about. Other viruses of this family are rarer, including SARS, MERS or the recent SARS-CoV-2. These latter viruses can cause strong respiratory diseases that can be lethal. The novel coronavirus is called SARS-CoV-2 — for simplicity, this is the strain people are referring to when they talk about “the coronavirus”.

Its most common symptoms are fever, cough, shortness of breath and breathing issues. The infection can be also asymptomatic, and in other cases leads to pneumonia, organ failure and ultimately death.

This type of virus commonly infects mammals and birds. Yet, scientists are not sure about its origin. Although it is estimated that the first infection took place in November or early December 2019, in Wuhan, China, it is still not completely clear from which animal the first interspecies transmission took place. The most likely source of the virus is bats, as the virus shares high similarity with a coronavirus that is known to infect these flying mammals. However, bats are probably not the species from which the virus infected humans. Chinese scientists initially proposed snakes, a claim that was then dismissed by other scientists. At the moment, the most likely source seems to be pangolins, as they are also infected by a coronavirus which greatly resembles SARS-CoV-2.

Once the virus became able to infect humans, it quickly spread in China’s Hubei region, and from there to all other Chinese regions. On January 22^nd 2020, the number of reported cases was 580, with this number reaching 80,000 at the present day, affecting 37 countries across the globe. As soon appeared clear, the mortality rate of this virus was very high – the WHO estimates it to be around 2%. Chinese authorities acted promptly to restrict the virus, for instance by imposing a quarantine on the city of Wuhan, populated by about 11 million people. Other countries, following the rapid spreading of the virus, decided to cancel direct flights from China and to impose a “voluntary” quarantine for all those traveling from China. The duration of the ideal quarantine period was estimated to be of 14 days, as symptoms can manifest between 2 and 14 days after infection. During this period, people were requested to stay confined at home, without any social contact.

But despite these laudable efforts, the virus has not been contained in China.

The outbreak is apparently spreading in Italy, South Korea and Iran. Italy in particular is struggling with the disease.

Who (or what) is Patient Zero in Italy?

SARS-CoV-2, the virus that causes COVID-19, isolated from a patient in the U.S. Image credits: NIAID-RML.

In just three days, the number of infected cases reared up to more than 230 from an initial 3, with 7 deaths in just a few hours. Italy substantially adopted the same measures as other European countries – including suspending direct flights to and from China and suggesting a “voluntary” quarantine on those coming back, and yet it is currently unable to confine the virus.

The main reason for this worrying outbreak is that authorities failed in identifying the patient Zero – the first infected person that carried the virus, presumably returning from China. Although initially the authorities thought to have identified the initial carrier of the virus – an Italian businessman who returned from China in January and has been in direct contact with some of the cases in the area of Lodi, in Lombardy – he tested negative for the virus and also showed no sign of antibodies against the infection in his blood.

This was a worrying surprise for the Italian authorities, while seemingly unconnected cases were emerging in other northern regions – Veneto, Piedmont, and other towns all over Lombardy. This prompted the authorities to isolate a few towns in which most of the cases were occurring, in particular Codogno, in the province of Lodi. A few hours later, all activities that gathered large groups of people together were suspended in the north, including the Venice carnival. Schools are closed in these regions starting this Monday, 24^th February 2020, along with universities and sports facilities.

These events are currently unfolding while the WHO may be reconsidering their initial suggestions of preventive quarantines of the duration of 15 days. Indeed, it became evident that some outliers can manifest symptoms even a month after entering into contact with the virus, and some may remain completely asymptomatic while still being able to infect others.

Most likely because of this, Italian authorities haven’t been able to properly reconstruct an epidemiological map, in order to track the patient that initiated the contagion.

Observing the events that are unfolding, it is likely that we are witnessing the emergence pandemic in Italy, as well as in Iran and possibly in South Korea. As it has been so far impossible to track how the virus is spreading among the population, it is also likely that Italy has passed the “contagion threshold”, meaning the ability to geographically restrict the virus and annihilate its possibilities for spreading without restrictions.

If this is indeed the case, two possible scenarios are due to unfold in the next few days: the first possible situation is that neighbouring countries, such as France, Switzerland, Austria, and Slovenia, may decide to temporarily shut down Schengen agreements, which allow the free circulation of people in Europe – a move that is opposed by Italy. These countries may introduce strict border controls with Italy, and they could even block the entrance of Italian citizens within their national borders if the situation further deteriorates.

Brenner Pass, depicted here, might start to feature border checks to help contain the coronavirus. Image via Wikipedia.

This would obviously have tremendous consequences for the Italian economy, which is already trembling as the coronavirus has been blocking many businesses in the past few days in the most economically productive regions of Italy. In line with this, the Milan stock market has lost 5% of its value yesterday (24^th of February), and the economic woes associated with the coronavirus are just beginning.

This first scenario may be the most likely one, as Austria has introduced checks on the trains at the Brenner pass, at the border between the two countries. Furthermore, Romania has imposed a mandatory quarantine for Italians traveling to Romania from the affected cities, and Mauritius has prevented people from disembarking from an Alitalia airplane, allowing passengers to either choose to be repatriated or quarantined at the airport.

A second possibility, is less likely, is that neighbouring countries won’t restrict people’s movement from the affected regions or block their borders in the next few days. In this case the virus will likely spread into France, Switzerland, Austria and Slovenia.

Whether Italy will remain isolated – and become a modern lazaretto – or not, there are undeniable chances the virus will spread outside of its borders, as it did from China. In such a case, we will likely have to start dealing with this coronavirus as we do with other viruses that are part of our lives. Simply put, as containment becomes less likely, we need to start shifting our focus towards resilience methods, like with influenza, for instance.

While we wait for a vaccine to be ready, we have to be prepared to face a global scale emergency, as the virus has been shown to have a 2% mortality rate. Antiretroviral treatments are also intensely researched, although it is unlikely that they will make a major dent in the outbreak.

Regardless of whether the Italian borders will be locked down or not, there are still a lot of things we don’t know about this virus. As the Italian patient Zero is still unidentified, there are rising concerns about environmental contamination, and how the virus can persist on fomites, objects that, once contaminated, can transmit the infection to a person that comes into contact with them. What if the Italian patient Zero is an inanimate object?