Europe’s coronavirus fate was sealed long ago

Illustration: Tom Jellett

Scientists around the world have worked overtime to get a handle on COVID-19, yet one great unknown remains. We still don’t know for sure whether this is only a medical crisis, or also a medical system crisis.

The distinction matters for the novel coronavirus, for the same reason it matters for other so-called “natural disasters” that aren’t entirely natural.

It is now widely understood that famines arise from local political failures in the trade and distribution of abundant global food supplies, not from local crop failures. And floods devastate communities not because the local ­rivers are unusually watery but ­because poor zoning and subsidised flood insurance encourage people to build their homes on floodplains.

This is the context for a conspicuous feature of COVID-19: it is not untreatable, but many health systems are struggling to deliver effective treatment.

Nowhere is this more evident than in Italy, where nightmarish reports are emerging from hospitals in the hardest-hit areas.

Doctors in Italy know what to do to treat severe cases, such as using ventilators in intensive care units. But hospitals lack the beds and equipment for the influx of patients and Italy doesn’t have enough doctors even to make the attempt. Ill patients languish in hospital corridors for want of beds, recovering patients are rushed out the door as quickly as possible, and exhausted (and sometimes still sick) doctors and nurses can’t even muster the energy to throw up their hands in despair.

Is this more a result of the ­severity of COVID-19, or of Italy’s long-term failures to invest in its healthcare system? One starts to suspect the latter.

Italy lags other large European countries in the provision of acute-care hospital beds, furnishing 2.62 of them per 1000 residents as of 2016, according to the ­Organisation for Economic Co-operation and Development. In Germany, it’s 6.06; and in France and the Netherlands, it’s 3.15 and three respectively.

In 2016, Italy devoted only around $US913 per capita to ­inpatient acute and rehabilitative care, compared with $1338 in France, $1506 in Germany and $1732 in the US.

British policymakers understand what such analyses portend, because underinvestment in the creaking British healthcare system is even worse. The UK spent the princely sum of $901.70 per capita on acute care in 2016, according to the OECD. British data doesn’t distinguish acute-care beds, but a comparison of available beds overall isn’t any more favourable to the UK (or to Italy).

In 2017, when Germany provided eight beds per 1000 residents and France offered 5.98, Italy managed 3.18 and the UK only 2.54. The OECD estimated Australia had 3.84 beds for every 1000 residents. Of course, the shortage is more pressing in countries with older populations. Italy has the world’s second-oldest demographic profile. According to the World Bank, 23 per cent of Italians are over 65 compared to 15.5 per cent of Australians.

As a result of the shortage of beds, Britain’s authorities have adopted a very specific policy goal in their approach to COVID-19. The aim is not to prevent the virus’s spread through the general population, which is a foregone conclusion. Rather, the name of the game is delay. British authorities are desperate to hold off a mass outbreak until the socialised National Health Service has recovered from its chronic winter crisis.

That’s right, the NHS, which now will have to cope with a new and fast-moving respiratory illness, already falls to pieces every year with the normal ebb and flow of cold-weather ailments.

Each winter crisis becomes a bit more acute, and this year was no exception. As of December, only 80 per cent of emergency room patients were treated within four hours of arrival, down from 84 per cent in the depths of the previous two winters.

What accounts for these divergences in healthcare resources requires more study than a single newspaper column can provide, but a few early hints emerge. One is the observation that the UK and Italy are significantly more dependent on direct government financing of healthcare than are France and Germany.

Government accounted for 79 per cent of total healthcare spending in the UK in 2017, according to Eurostat, and 74 per cent in Italy. Germany and France both rely on compulsory insurance schemes with varying degrees of subsidy and government meddling, but outright government expenditure amounts to only 6 per cent of total health spending in Germany and 5 per cent in France.

About two-thirds of healthcare spending in Australia is by federal and state governments. In this sense, COVID-19 is a test of how much one trusts central health planners to make wise long-term decisions that boost resilience in the face of unusual dangers.

This is food for thought for voters inclined to scepticism over the wisdom or efficacy of their politicians’ responses to the crisis.

Those same politicians already have made decisions that may seal a country’s coronavirus fate, and it won’t have anything to do with quarantines or restrictions on travel or large gatherings. Rather, the important choices may have already come in the guise of technocratic health spending and investment decisions that were made largely out of public view over many years.

How lucky do Europeans feel?

The Wall Street Journal.