Don't want to enter the discussion as it's really complex and with multiple possibilities, but.. I can tell you both, living in Italy, that you've a few misconceptions about what happened there, and other data's that are probably wrong (cause it's what the media says about the country, I imagine) Mostly:
- Reaction was really not that bad in Italy (consider that I'm usually highly critical of politics and decision.makers here), a lot of measures and the complete block of the Milan zone were taken quite rapidly, when people was still not understanding the problem. I'm actually more worried about the lack, of slow reaction of other european countries, and USA too in part, that had the "luck" to not being hit first (being the precursors it's always harder, you've less data and knowledge) and still were not that fast to get ready. The numbers now says that Italy is a big problem and a big focus, but that's just because was hit first. Unfortunately, I expect worst numbers in other countries that are already ahead of Italy curve (comparing the time-difference)
- The medical system in Italy it's one of the few things that still works well, and more than that, it's still open and free for everyone. I was actually more worried about you USA friends that have a different system in which is necessary to pay for some things, when the virus was still not a problem in your territory. Hospital system is overwhelmed in zones where the virus hit the most, but that’s quite normal when a ton of people get sick in a very short time. It’s perfectly normal in the other zones. There’s really no indication that the smoking factor is a direct issue, but even if it’s, the difference between & of smokers in USA and Italy it’s not that big, and there’re a lot of nations that have a lot more smokers than Italy, and that could be in trouble soon.