It has been more than a week since UK Prime Minister Boris Johnson ordered Brits to stay home as much as possible to curb the spreading coronavirus. The order came when numbers of new cases started to reach 1,000 per day. However, when Italy introduced similar measures at the same moment of the outbreak, it didn't save the country from reaching a peak of almost 100,000 cases in less than a month. If the UK faces the same fate, can its healthcare system cope with a similar influx of infected patients as Italy did?
Here is a brief comparison of the two states' responses to coronavirus and their level of preparedness for the pandemic:
From First Reported Cases to National Response Plans
- The first recorded COVID-19 infection was confirmed in the UK on 31 January, but the government's plan for dealing with the outbreak was presented over a month later - on 3 March. It includes three phases - contain, delay and mitigate.
- At the time, Prime Minister Johnson said that the government understands the public concern and assured that the country is "extremely well prepared" for an increase in the number of infections, which he said was "highly likely".
- However, the ban on all public gatherings and the closure of public places was adopted by the government only two weeks later, on 20 March when 3,983 COVID-19 cases were reported.
- The Brits were ordered to stay home three days later, when the number of cases reached 6,654. They were allowed to shop only for necessities such as food and medicine, to seek medical help, exercise outdoors once per day or visit work if it was absolutely necessary.
- Police were allowed to enforce the new restrictions through the use of "fines and dispersing gatherings".
- Italy suspended all non-crucial business activities and asked citizens to stay home in so-called red-zones established in local hotbeds of infection on 23 February, when only 76 people were known to have contracted the virus. The order came less than a month after the first two cases of COVID-19 were registered on 30 January.
- As Italy introduced its first measures, Prime Minister Giuseppe Conte called on people to stay calm and "to stop panicking", while Foreign Affairs Minister Luigi Di Maio announced measures to combat "fake news" about the state of the outbreak in Italy.
- The government then extended the measures to all provinces "at risk" on 8 March, when infections had reached 5,883, as the February measures apparently failed to contain the pandemic.
- Along with the new measure, the government changed the tone of its public messages. Prime Minister Giuseppe Conte stated on 8 March that it was "Italy’s darkest hour" and vowed to combat the pandemic with "massive shock therapy".
- Later, the government extended its efforts to curb the pandemic as catering services in Italy (including bars, pubs, and restaurants delivering food) were ordered to close and all people were strongly advised to stay home on 11 March, at which point over 10,000 cases were reported.
- All Italian citizens were ordered to stay home to prevent the further spread of infection on 22 March, when the number of cases reached 59,138.
While Italy introduced the first strict measures in the affected areas faster that the UK, when the number of cases was low, steps to introduce a complete lockdown came when a significant portion of Italy's population, over 10,000 people, were affected. In turn, the UK resorted to stricter self-isolation and lockdown measures at earlier stages of the outbreak than Italy did, meaning it can avoid the fate of Europe's worst-affected state.
How and When People Get Tested:
- In the UK "samples" of the population have been tested since the end of February to understand the spread of the infection in various neighbourhoods - a little less than a month since the first two cases were registered. The government has not clarified which principle had been used to pick people for testing except that it included people admitted to hospitals "with severe respiratory infections".
- But the rate of testing was relatively low, with only 50,000 people getting tested throughout March and around 135,000 tested overall in the country of 67 million.
- Last week, the UK officially ran around 10,000 daily tests with the aim of reaching 25,000 tests per day a month from now. However, some British media found out that on certain days, the tests were performed on as few as 5,000 people.
- The pace of mass testing in the country was harshly criticised by the former head of the World Health Organisation, Anthony Costello, who argued that British laboratories stood still as the coronavirus pandemic was spreading across the country.
- Outside testing samples of the population, the UK healthcare system prioritises "highest-priority cases" and those with acute coronavirus-like symptoms, when it comes to running swabs. Most people with symptoms similar to COVID-19 infection have to either pay a private clinic to get tested (which is not cheap), or to simply self-isolate until the symptoms are gone.
- Pretty much like in the UK, Italian general practitioners decide whether to run swabs on a person with coronavirus-like symptoms.
- There is, however, no unified criteria for GPs on whom to test, with all Italian provinces setting their own rules on running tests.
Both countries have failed to run substantial mass-testing programmes at the early stages of outbreaks, which could indicate what parts of the country should be subject to lockdowns. The UK made efforts in this direction, but a deficit of available COVID-19 tests limited its effectiveness.
When Does a Person With COVID-19 Symptoms Go to Hospital?
- The UK NHS chooses to admit a person with coronavirus-like symptoms to the hospital only if they "feel" they "cannot cope with symptoms at home" or if their condition "gets worse".
- Otherwise, a person with such symptoms is simply advised to stay home until they pass.
- In Italy, a person with COVID-19 symptoms is obliged to notify authorities, who will try to send a GP their way to evaluate this person's condition and decide whether or not to take them to a hospital.
- There are no unified criteria in Italy as to who must be admitted to a hospital as they vary from province to province.
- People with pre-existing pathologies are, however, more likely to be hospitalised, according to the data provided by the Italian Health Ministry. Around 50% of patients with coronavirus symptoms with three and more pathologies were hospitalised, while only 2.1% without one were admitted to the hospital. The rate of hospitalisation reached around 23% for people with one or two pre-existing pathologies.
Both countries chose to instruct potential coronavirus carriers to remain at home, hospitalising selectively those with risks to their health, apparently due to a limited number of beds and specialists in hospitals.
So There is Not Enough Space and Personnel in These Hospitals?
- There are a total of 33,000 hospital beds at the disposal of the UK's NHS, according to service's head, Sir Simon Stevens.
- In addition to that, the NHS had 4,000 intensive care beds available at the start of March and around 8,000 ventilators. Some ventilators for children and theatre ventilators are being re-purposed to be used with coronavirus patients too.
- Apart from that, the NHS struck a deal with private hospitals for an additional 8,000 beds and almost 1,200 ventilators and is re-purposing ExCeL Centre in London for a field hospital with a capacity of 4,000 beds. The hospital will be operational in a matter of weeks, while two more capable of accomodating a total of 6,000 beds will become available in mid-April.
- This means that the UK NHS is left with only 0.67 beds per 1,000 people at the moment, with the ratio rising to 0.82 beds per 1,000 people when the three field hospitals are ready in the middle of April.
- The UK NHS also faces personnel shortages as the number of patients is growing and some of the doctors and nurses are catching COVID-19 too due to the lack of protective equipment.
- Some 20,000 former medical staff have already been summoned to help with 18,700 student nurses and 5,500 final year medics joining them. An additional 20,000 medical staff will be provided by private hospitals next week.
- According to the data compiled by the Organisation for Economic Cooperation and Development, Italy has roughly 3.2 beds in its hospitals per 1,000 people.
- This was not enough, according to the accounts of doctors from heavily-hit Lombardy province and other parts of the country. They said the hospitals lacked both beds and personnel to attend all of the worst-affected patients.
The numbers suggest that if the UK is hit as badly by the pandemic as Italy, its hospital bed shortages will be even more severe, although the NHS will apparently have enough personnel to care for those who are admitted to a hospital.
How Both Nations Treat COVID-19 Patients
Neither country has adopted any specific treatment for the COVID-19 infection; they've chosen to provide supportive care and treat symptoms instead. The UK NHS said it expects the "vast majority of cases" to be managed at home and advised those with coronavirus-like symptoms to "drink plenty, rest, sleep and take paracetamol to lower body temperature".
While this approach is broadly utilised in other countries fighting COVID-19, some have already developed specific treatment plans for the coronavirus in order to speed up the recovery of their citizens, and hence lift quarantines and restore normal economic activity.