2 regions of Italy took different approaches to fighting the coronavirus. Their results show that widespread testing and early social distancing really work.

Cecilia Fabiano/LaPresse via AP

Workers disinfect the buildings that host the Region Lazio in Rome, on March 8, 2020.

• Italy has become a new epicenter of the coronavirus outbreak, with over 41,000 cases and 3,400 deaths.
• Two northern regions, Lombardy and Veneto, reported the country's first cases on February 21.
• However, their responses differed: Veneto issued multiple rounds of testing for residents, even those without symptoms, and isolated patients that tested positive. Lombardy lagged in testing those who were asymptomatic.
• Nearly a month later, Lombardy has reported far more cases than Veneto - indicating that aggressive testing and isolation can be an effective response.
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When two regions in northern Italy realized the new coronavirus had been spreading undetected through their communities in February, their governments had to decide how much to limit residents' mobility and how to use limited resources to treat sick people.

The regions - Lombardy and Veneto - are provinces in northern Italy that hold Milan and Venice, respectively. The two took different tacks: Veneto imposed travel restrictions early and started testing all residents that had come into contact with the coronavirus patients, even if they weren't showing symptoms. Lombardy, however, only tested residents that showed symptoms and had difficulty enforcing a lockdown in the region.

Nearly a month later, data reveals that these approaches resulted in different outcomes: Veneto has seen a slower rate of increase in new cases and deaths than Lombardy.

The data suggests that more aggressive testing and restrictive travel rules can slow the pandemic, which is what the World Health Organization has been calling for.

"Our key message is: test, test, test," Tedros Adhanom Ghebreyesus, the WHO's director-general, said at a press briefing on Monday.

Italy is the new epicenter of the coronavirus pandemic

As the number of new coronavirus patients reported in China have slowed, they have grown quickly in Italy. Italy is now the epicenter of the pandemic - over 41,000 Italians have tested positive, and 3,400 have died.

Two cases were detected in Veneto and 14 in Lombardo on February 21. It's not yet known how the virus first entered the northern regions.

In response, the regions began implementing lockdowns on February 23. The restrictions applied to 10 towns in Lombardy and one in Veneto, affecting approximately 50,000 people. Trucks were able to still get in and out with essential supplies, but police roadblocks kept residents inside the lockdown zones.

Still, cases grew exponentially. Within a week, nearly 900 people had tested positive for the disease and 21 had died in Italy.

A few weeks later, on March 8, the Italian prime minister announced that all 60 million residents would be put under lockdown.

Daniele Mascolo/Reuters

Police officers talk with people at Milan's main train station, following a government decree that shut down large areas in the north of the country, to stem coronavirus contagion, on March 9, 2020.

Veneto's response

Italy's first coronavirus death came in the town of Vo Euganeo, in Veneto, on February 21. In response, the town tested approximately 3,300 residents in late February, according to The Financial Times. The city also did multiple rounds of testing, which allowed for the discovery of more cases.

The virus' incubation period is about five days on average, though in outlier patients, the period can last longer than two weeks.

The tests in Veneto found that people without symptoms accounted for more than half of all the positive cases, Reuters reported.

Associated Press

Empty St. Mark's Square after the quarantine order in Venice, Italy, on March 9, 2020.

Veneto quickly imposed a strict quarantine on all people who tested positive, even those that were asymptomatic. Towns also went into lockdown: Stores and schools closed, while sports games and church services were postponed or canceled.

Almost a month later, the rate of coronavirus case growth in Veneto has slowed. The region reported 2,704 total cases on Tuesday.

However, cases are rising elsewhere in the country. Both Lombardy and another nearby northern region, Emilia Romagna, have reported far more cases than Veneto.

The coronavirus in the Lombardy region

Lombardy has been most affected by the coronavirus - more than 16,200 cases and 1,200 deaths had been reported there as of Tuesday. That's a steep rise from the original 14 reported on February 21, and a vast difference from Veneto's count. (The fact that Lombardy initially reported more cases than Veneto, however, suggests its outbreak could have been larger and farther along to begin with.)

When Lombardy went into lockdown on February 23, the New York Times reported, non-essential stores were closed, residents were told to stay in place, and police were brought in to enforce the shut down. But checkpoints between locked-down towns and free towns nearby were porous, and residents continued to shop and dine out.

Maurizio Pedrinazzi, a 60-year-old street cleaner in the town of Secugnago in the Lombardy region, told the Times that despite the quarantine, people in locked-down towns often stopped into the nearby village bars for drinks.

"They know the country roads, the shortcuts," Pedrinazzi told the Times. "They all come here."

According to Wired, Lombardy governor Attilio Fontana told the regional parliament that the coronavirus was "just a little more than normal flu" on February 25. The following day, the region relaxed the restrictions on bars and restaurants.

But on March 1, the region put its lockdown back into place as more residents fell sick. One of Fontana's aides was infected, and Fontana went into isolation.

By March, when Italy's full nation-wide lockdown was issued, experts believe that it may have been too late - the virus had already been widely spread by carriers who may have been asymptomatic.

Associated Press

Italian Foreign Minister Luigi di Maio holds up a map of Italy showing the municipalities in regions of Lombardy and Veneto during a press conference at the foreign press association, in Rome, February 27, 2020.

Lombardy's hospitals became overloaded: Over the past three weeks, 1,135 people have required intensive care in the region, but it only has 800 intensive care beds, according to Reuters.

Italy also has one of the world's oldest populations, with 60% of residents over age 40 and 23% over 65. Coronavirus death rates are highest among older patients.

Lower rates of new cases in Veneto compared to Lombardy

Veneto's success in decreasing the rate of growth of the coronavirus outbreak there within a month suggests that aggressive testing and increased social distancing measures work. These findings could inform policy-making and decisions in other countries, including the UK and the US.

Alfredo Falcone/LaPresse via AP

The Colosseum, which closed following the Italian government's ban on public gatherings, is reflected in a puddle where a face mask was left, in Rome, on March 8, 2020.

Leaders in both places have faced criticism for not making testing widely available early enough. Without testing large swaths of the population who could be asymptomatic carriers, the health and well-being of vulnerable populations, such as the elderly and those with preexisting conditions, are more at risk.

In the US, according to the COVID Tracking Project, a test-tracking resource from two journalists at The Atlantic and the founder of a medical-data startup, about 100,000 tests have been run - a giant increase from Monday, when only about 40,000 had been conducted.

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