I think it’s pretty obvious that yes, they also did have systemic failures.

We also know more about how the virus spreads and treating people who are severely ill with it than we did 3-4 months ago. Part of why Germany’s death rates were a lot lower than its neighbors is likely due to having far more ICU beds per capita before the crisis, but also, hitting our infection rate peak a bit later. Those two things combined meant that our doctors had more time to figure out what does and doesn’t work, and never came close to the horrible decisions doctors in Italy had to make - Germany was even able to take in several hundred patients from Italy and France.

Also of interest: Germany has almost as many ECMO-equipped hospitals as the US does, despite having 1/4 the population and a tiny fraction of the land area.

Italy you can maybe excuse that they were caught by surprise, but yes, the other countries in Europe handled it badly initially. The surprising thing about the US is that somehow it's handling it worse.

From what I can tell, Italy being caught by surprise was a largely self-inflicted problem - they seem to have not tested any patients who were hospitalized with potential symptoms unless they'd travelled to China or had contact with someone who had. Other countries like the US had testing policies that, on paper, excluded those patients but in reality they did get tested anyway often enough that community spread was detected relatively early on. Italy only spotted theirs when someone happened to be hospitalized who'd had contact with a person that'd travelled to China but hadn't caught it from them.

This is very different from the narrative the American and British press have been pushing, probably for political reasons - in that narrative Italy was just unlucky, and it was the other countries that didn't learn from them and stop themselves following in Italy's footsteps that failed. That doesn't seem to match reality. As best I can tell, Italy screwed up so badly that they doomed not only themselves, but any hope of containing Covid-19 in Europe and America. Everywhere else seems to have done a reasonably good job of stopping it coming from China, and it was the unexpected, undetected cases from Italy when they claimed to be completely clean that caused the outbreaks.

But the rest of Europe stood around, slack-jawed, while things spiraled out of control in Italy. I live in a different European country, and the lead-up to the COVID crisis was like watching a someone being chased down by a snail -- the only reason the snail caught them was because they didn't bother to move out of the way. For example, people were regularly traipsing off to the Italy for vacation up until the point when things started to spin out of control and they shut the country down.

“Per capita it is still less than France”

Give it a couple days.