The coronavirus continues to spread rapidly in Italy. In just the last 24 hours the country announced an additional 2,300 cases and 196 more deaths.

The surge of cases in Italy has many people wondering why the nation is being hit so hard. ABC News published a story today in which two medical doctors suggest several possible explanations:

To start, part of the answer may lie in the age distribution of Italy’s population. Italy has an older population with a greater percentage of adults over the age of 65 than the U.S. The Centers for Disease Control cautions that older adults may be at risk for more serious COVID-19 illness…

Another risk factor may relate to smoking. COVID-19 is a respiratory disease that can lead to pneumonia, respiratory failure and, in the worst cases, death. Smoking is known to impair lung function and the immune system, contributing to more severe respiratory illnesses. A recent study suggests that more than 21% of Italians are smokers, compared to less than 14% in the U.S…

An additional risk factor could be related to local customs. The CDC has urged the use of social distancing as a precaution against the spread of COVID-19 — but prior to this outbreak, the common custom in Italy was to greet friends and loved ones with a kiss on both cheeks.

As of Tuesday, the entire nation of Italy is on lock down with people ordered to stay at home unless they have to go out for necessities like food or health care. But the NY Times reports that officials in the north of Italy, where the infection has hit the hardest, are asking for even tougher measures.

On the first day of Europe’s first nationwide restriction on movement and public gatherings to stem the rampant spread of the coronavirus, Italians steered clear of their streets, shops, churches and soccer fields.

They obeyed the government’s “I Stay Home” decree, announced on Monday night by Prime Minister Giuseppe Conte with a plea for common sacrifice to safeguard the country’s elderly population and to save the health system from collapse.

But even as Italians stayed inside, officials in the country’s north, the front line of the outbreak, pleaded for still stronger measures that would essentially shut down all commercial activity and public transportation in an effort to suffocate the contagion…

Italy needs to show how to stop it, Mr. [former prime minister Matteo] Renzi said, or if not, “The red zone will be Europe.”

Luca Zaia, the governor of Veneto, which includes Venice and other cities affected by the outbreak, agreed with his political allies in Lombardy in urging stricter measures. He said that to stop the virus and save the public health system, more draconian measures, including a “total closure,” were preferable to “drawing out the agony.”

Christina Higgins, an American living in Italy, wrote a long post on Facebook yesterday describing what it feels like to be at the center of this and pleading with people around the world to make changes now to prevent other countries from experiencing similar outcomes:

I am writing to you from Bergamo, Italy, at the heart of the coronavirus crisis. The news media in the US has not captured the severity of what is happening here. I am writing this post because each of you, today, not the government, not the school district, not the mayor, each individual citizen has the chance, today to take actions that will deter the Italian situation from becoming your own country’s reality. The only way to stop this virus is to limit contagion. And the only way to limit contagion is for millions of people to change their behavior today.

If you are in Europe or the US you are weeks away from where we are today in Italy.

I can hear you now. “It’s just a flu. It only affects old people with preconditions”…

When Prime Minister Conte announced last night that the entire country, 60 million people, would go on lock down, the line that struck me most was “there is no more time.” Because to be clear, this national lock down, is a hail mary. What he means is that if the numbers of contagion do not start to go down, the system, Italy, will collapse.

Why? Today the ICUs in Lombardy are at capacity – more than capacity. They have begun to put ICU units in the hallways. If the numbers do not go down, the growth rate of contagion tells us that there will be thousands of people who in a matter of a week? two weeks? who will need care. What will happen when there are 100, or a 1000 people who need the hospital and only a few ICU places left?

On Monday a doctor wrote in the paper that they have begun to have to decide who lives and who dies when the patients show up in the emergency room, like what is done in war. This will only get worse…

You have a chance to make a difference and stop the spread in your country. Push for the entire office to work at home today, cancel birthday parties, and other gatherings, stay home as much as you can…

And for those who say it is not possible to close the schools, and do all these other things, locking down Italy was beyond anyone’s imagination a week ago.

Soon you will not have a choice, so do what you can now.

So is this likely to happen here? There is some evidence to suggest the spread of this virus follows a fairly consistent pattern in most countries:

There’s still time to change the shape of the curve but to do that we’ll probably need to make some dramatic changes now to avoid winding up where Italy is now.

https://twitter.com/SMerler/status/1237492257458204673

The left in this country has been beating Trump up on an hourly basis over his response to the coronavirus. They are demanding more government action. So what happens the moment Trump orders the entire nation on lockdown the way Italy’s Prime Minister has? Can a president even issue such an order? How would it be enforced? Even if it can’t be enforced, should Trump do it anyway?

Incredibly, we may have arrived at a moment where the best thing Trump can do for the nation is to become the authoritarian figure many on the left already imagine him to be.

Update: Italy’s Prime Minister announced today that most businesses will close nationwide.

Prime Minister Giuseppe Conte of Italy on Wednesday ordered almost all businesses nationwide to close as infections and deaths from the new coronavirus continued to soar, two days after he announced stringent travel restrictions.

Pharmacies, grocery stores, banks and public transit will be allowed to operate, but any other commercial enterprise that is not vital — restaurants, bars, most stores, cafes, beauty salons — must close to limit the contagion, Mr. Conte said in an evening address to the nation.

Italy had already imposed controls unlike anything seen in a modern democracy, banning public gatherings and telling a nation of 60 million people to halt travel except for work or emergencies.