It isn’t the first time: Italy and its history with epidemics

There is a lot to say  about epidemics, because epidemics are as old as Man himself.

While what we’ve been experiencing since last month is, without a doubt, unprecedented for our generation and the one of our parents, epidemics and pandemics are not new to Humankind. In Italy, throughout history, they have affected our lives so much that some of our most beautiful — and well known — literature made of them bona fide narrative characters; that’s exactly what happened in Boccaccio’s Decameron, where the 1348’s European plague epidemic was pretext for a group of wealthy Florentines to self isolate in the countryside, and spend their time telling to one another the very stories that formed the  backbone of the work. Some of you may be  also familiar with Alessandro Manzoni’s Promessi Sposi (the Betrothed), a love story set on a backdrop of pestilence and death in the very cities and valleys, those of Lombardia, where Covid-19 has claimed the most victims — reason for which many an Italian chose the novel as their quarantine reading. 

But the history of epidemics in the  Belpaese dates further back in time and goes all the way to the glorious centuries of the Roman Empire. Galen, doctor and writer whose medical knowledge influenced the scientific world for over 13th centuries, left us accounts   of what is known as the Antonine Plague, a pandemic that hit Rome and the whole Empire  between 165 and 180 AD. While the actual nature of the pandemic has never been fully ascertained — some historians says it was smallpox, others measles —  we know it was spread by soldiers returning from the Roman-Parthian campaigns. Another Roman historian Cassius Dio, recounted how the  illness arrived to kill 2000 people a day in Rome and,  ultimately, a quarter of all the infected. According to his words, the pandemic continued on and off for the good part of 30 years, decimating the  Roman army. It is estimated it may have caused between 5 and 30 million victims. 

Scoppio della peste a Pavia, Italia (45/186). Copyrighted work available under Creative Commons Attribution- Click image for details

A few centuries later, the — by then Eastern — Roman Empire was the epicenter of a deadly pandemic again. It was the year 541 AD and Rome no longer was the caput mundi, replaced by Costantinople. From there, plague spread its deadly, black tentacles across the Mediterranean, following the commercial routes that connected all the major ports of the basin. This wasn’t a contained epidemic, if it’s true that  outbreaks took place regularly for two centuries, causing an estimated dead count ranging between 20 and 100 million. From a socio-cultural point of view, the Justinian plague had similar effects to  those of its way more famous 14th  century’s cousin, the Black Death. Modern research also shows  that it was, indeed the same bacterium, Yersinia Pestis, to cause both epidemics. 

… The Black Death, yes.  Most of us,  when thinking  about epidemics, think about that one, the most deadly and terrifying example of what a fast and easily spreading infection can do to a  continent. In those years there was no cure, no vaccine,  no treatment and   knowledge about how infectious diseases could spread was little, which resulted in the  literal decimation of Europe’s population: 25 million dead in 7 years, one third of the continent’s inhabitants. However the Black Death, which had reached Sicily and Genoa in 1347, following — once again — trade routes across the Mediterranean, was to teach the world something incredibly important: isolation and containment could stop the spreading of infections effectively. The timely rules and restrictions imposed, for instance, by the Visconti family in Milan, which limited immensely the circulation of goods and people in their territories, saved the Signoria from widespread contagion and losses. Plague returned to the shores of Europe with a certain regularity for  centuries, including the epidemic mentioned by Manzoni in The Betrothed, which took place in 1630-31 causing  1.5 million victims in Italy alone. 

A print of San Babila Square in Milan, during the 1630 plague, described also by Manzoni. Copyrighted work available under Creative Commons Attribution — Click image for details copyrights

The first pandemic  to hit the world,  and Italy, in the 20th century was, of course, the infamous Spanish Flu, the mother of all modern pandemics. Considered the most lethal and  frightening of them all, Spanish flu likely spread through soldiers during  the First World War and modern research underlines the possibility its incredibly high mortality — it killed between 50 and 100 million people in two years around the world, and 600.000 in Italy, over a population of 36 million —  was not only due to the specific virulence of the H1N1 flu strain, but also to other detrimental factors, largely tied to the consequences of four  years  of war, including malnutrition and unprepared hospitals. Whichever the  reason behind the  lethality of the Spanish Flu, the disease reduced life expectancy of a whopping 12 years among the people of Italy and the  world. 

Historic Personal Protective Equipment during the plague. Copyrighted work available under Creative Commons Attribution — Click image for copyrights details

After the end of the Second World War, Italy was hit by both global pandemics and localized epidemics in specific parts of the country. In 1957, the A H2N2 virus caused yet another flu pandemic, named Asian Flu, which ended only in 1960, after a vaccine was found. In Italy, l’Asiatica infected about 57% of the population at that time and caused 30.000 deaths. Asian Flu returned, modified, in December 1969 and, while it was almost fully defeated by Christmas, it still managed to infect around 13 million Italians and  killing about 5.000. 

Then, in 1973, Italy was hit by a sudden cholera epidemic, which involved the regions of Campania, Apulia and Sardinia and lasted from the 20th of August to the 12th of October of that  year. The disease, which probably was transmitted to man through the consumption of infected raw seafood, caused 278 cases and 24 victims. Fears and anxiety spread more than the disease itself among population, with the Cotugno hospital in Naples (still today one of the best infectious diseases’ hospitals in the country) admitting almost 1000 people in 10 days for tests. However, the epidemic was, in fact,  handled quite well: shortly after the disease began spreading, over 1 million Neapolitans were vaccinated against it in a week. A great effort of the local healthcare system, supported by the help of  Americans in Italy: the special syringes used, which made inoculation much quicker, were provided by the United States Sixth Fleet which, yesterday just like today,  has its headquarters in Naples.