ROME -- With confirmed coronavirus cases in the U.S. surpassing 5 million Sunday, by far the most of any country, the struggle of the most powerful nation in the world to contain the scourge has been met with astonishment and alarm in Europe.
Perhaps nowhere outside the U.S. is America's virus response viewed with more consternation than in Italy, which was ground zero of Europe's epidemic. Italians were unprepared when the outbreak exploded in February, and the country still has one of the world's highest official death tolls, at more than 35,000.
But after a strict nationwide, 10-week lockdown, vigilant tracing of new clusters and general acceptance of mask mandates and social distancing, Italy has become a model of virus containment.
"Don't they care about their health?" a mask-clad Patrizia Antonini asked about people in the United States as she walked with friends along the banks of Lake Bracciano, north of Rome. "They need to take our precautions. ... They need a real lockdown."
Much of the incredulity in Europe stems from the fact that America had the benefit of time, European experience and medical know-how to treat the virus, which Europe itself didn't have when the first covid-19 patients started filling intensive care units.
Months into a sustained outbreak, the U.S. has reached the 5 million-case mark, according to the running count kept by Johns Hopkins University. Some health officials believe the actual number is perhaps 10 times higher, or closer to 50 million, given testing limitations and the fact that as many as 40% of all those who are infected have no symptoms.
As the Midwest grapples with new spikes and states across the South and the West fight to contain surges, the 5 million mark came just 17 days after the U.S. total exceeded 4 million, according to The Washington Post's tracking.
The infections milestone was another sign that virus cases have continued to multiply as the United States collectively fails to contain the spread. Disparate parts of the country have responded to the pandemic differently, with some regions maintaining strict social distancing rules and other areas trying to carry out a slightly modified version of business as usual.
GATES' CRITICISM
Microsoft Corp. founder and billionaire philanthropist Bill Gates said Sunday that it's "mind-blowing" that the U.S. government hasn't improved covid-19 testing that he described as slow and lacking fair access.
"You're paying billions of dollars in this very inequitable way to get the most worthless test results of any country in the world," Gates said on CNN's "Fareed Zakaria GPS" on Sunday. "No other country has this testing insanity."
"A variety of early missteps by the U.S. and then the political atmosphere meant that we didn't get our testing going," he said.
Gates cited long lines at commercial labs and delays in obtaining test results, meaning that "you pay as much for the late result as the timely result." Meanwhile, "very wealthy people have access to these quick-turnaround tests," he said.
"It's mind-blowing that you can't get the government to improve the testing because they just want to say how great it is," Gates said.
"It's unacceptable for the country to have testing come back a week or even two weeks later," agreed Tom Inglesby, director of the Johns Hopkins Center for Health Security, speaking on NBC's "Meet the Press" on Sunday. "It's not useful at that point."
Public officials have regularly cited delays in testing results in the U.S. as an impediment to quick contact tracking and isolation of people infected with the virus.
President Donald Trump has defended the U.S. record on testing as "the best ever, the best in the world," telling Fox News last week that half of the country's testing is "short-term."
CONTRASTING RESPONSES
"We Italians always saw America as a model," said Massimo Franco, a columnist with the newspaper Corriere della Sera. "But with this virus, we've discovered a country that is very fragile, with bad infrastructure and a public health system that is nonexistent."
With the U.S. having a world-high death toll of almost 163,000, a politicized resistance to masks and a rising caseload, European nations have barred American tourists -- as well as visitors from other countries with growing cases -- from freely traveling to the bloc.
France and Germany are now imposing tests on arrival for travelers from "at-risk" countries, the U.S. included.
"I am very well aware that this impinges on individual freedoms, but I believe that this is a justifiable intervention," German Health Minister Jens Spahn said last week.
Mistakes were made in Europe, too, such as delayed lockdowns, insufficient protections for nursing home residents, and critical shortages of tests and protective equipment for medical personnel.
Hard-hit Spain, France, Britain and Germany have seen infection rebounds, with new cases topping 1,000 a day. Italy's cases went above 500 on Friday. Some scientists say Britain's beloved pubs might have to close again if schools are to reopen in September.
Europe as a whole has seen more than 207,000 confirmed virus deaths, by Johns Hopkins' count.
In the U.S., new cases are running at about 54,000 a day -- a high number even when taking into account the country's large population. And while that's down from a peak of well above 70,000 last month, cases are rising in nearly 20 states, and deaths are climbing in most.
In contrast, Europe at least for now appears to have the virus somewhat under control.
"Had the medical professionals been allowed to operate in the States, you would have belatedly gotten to a point of getting to grips with this back in March," said Scott Lucas, professor of international studies at the University of Birmingham, England. "But of course, the medical and public health professionals were not allowed to proceed unchecked," he said, referring to Trump's frequent undercutting of his own experts.
When the virus first appeared in the United States, Trump and his supporters dismissed it as a scourge that would quickly disappear once warmer weather arrived.
Trump's criticism of Dr. Anthony Fauci has regularly made headlines in Europe, where the U.S. infectious-disease expert is a respected figure. Italy's leading covid-19 hospital offered Fauci a job if Trump fired him.
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Trump has defended the U.S. response, blaming China, where the virus was first detected, for America's problems and saying the U.S. numbers are so high because there is so much testing. Trump supporters and Americans who have refused to wear masks, despite medical advice, have backed that line.
"There's no reason to fear any sickness that's out there," said Julia Ferjo, a mother of three in Alpine, Texas, who said she "vehemently" opposes wearing a mask. Ferjo, 35, teaches fitness classes in a large gym with open doors. She doesn't allow participants to wear masks.
"When you're breathing that hard, I would pass out," she said. "I do not want people just dropping like flies."
And health officials watched with alarm as thousands of bikers gathered Friday in the small South Dakota city of Sturgis for an annual 10-day motorcycle rally. The state has no mask mandate, and many bikers expressed defiance of measures meant to prevent the virus's spread.
Dr. David Ho, director of the Aaron Diamond AIDS Research Center at Columbia University Irving Medical Center in New York City, who is leading a team seeking treatments for covid-19, decried such behavior, as well as the country's handling of the virus.
"There's no national strategy, no national leadership, and there's no urging for the public to act in unison and carry out the measures together," he said. "That's what it takes, and we have completely abandoned that as a nation."
When he gets on Zoom calls with counterparts from around the globe, "everyone cannot believe what they're seeing in the U.S., and they cannot believe the words coming out of the leadership," he said.
Information for this article was contributed by Nicole Winfield, Lisa Marie Pane and staff members of The Associated Press; by Yueqi Yang of Bloomberg News; and by Derek Hawkins, Marisa Iati and Jacqueline Dupree of The Washington Post.
